Gaint phyllodes tumour with axillary &amp; interpectoral lymph node metastasis; A rare presentation

Shafi, Alam Ara; Alharthi, Bandar N; Riaz, Muhammad Masood; AlBagir, Asim

doi:10.1016/j.ijscr.2019.12.026

Cited by 12 publications

(15 citation statements)

References 18 publications

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“…While routine axillary node dissection is not recommended in phyllodes tumour as nodal involvement is rare [31], many authors support nodal clearance in cases of palpable axillary nodes [32,33], even though only 1.1%-3.8% of clinically evident nodes have been reported to be pathologically positive [31]. Palpable nodes in three patients with phyllodes tumour in our series necessitated clearance.…”

Section: Discussionmentioning

confidence: 60%

Impact of axillary node-positivity and surgical resection margins on survival of women treated for breast cancer in Ibadan, Nigeria

Ayandipo¹,

Ogun²,

Adepoju³

et al. 2020

ecancer

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Introduction: Oncologic surgical extirpation, the mainstay of loco-regional disease control in breast cancer, is aimed at achieving negative margins and lymph node clearance. Even though axillary lymph nodal metastasis is a critical index of prognostication, establishing the impact of lymph node ratio (LNR) and adequate surgical margins on diseasespecific survivorship would be key to achieving longer survival. This study examines the prognostic role of pN (lymph nodes positive for malignancy), LNR and resection margin on breast cancer survival in a tertiary hospital in Ibadan, Nigeria. Methods: We conducted a longitudinal cohort study of 225 patients with breast carcinoma, documented clinico-pathologic parameters and 5-year follow up outcomes-distant metastasis and survival. Chi-square test and logistic regression analysis were used to evaluate the interaction of resection margin and proportion of metastatic lymph nodes with patients' survival. The receiver operating characteristic curve was plotted to determine the proportion of metastatic lymph nodes which predicted survival. The survival analysis was done using Kaplan-Meier method. Results: Sixty (26.7%) patients of the patients had positive resection margins, with the most common immuno-histochemical type being Lumina A. 110 (49%) patients had more than 10 axillary lymph nodes harvested. The mean age was 48.6 + 11.8 years. Tumour size (p = 0.018), histological type (p = 0.015), grade (p = 0.006), resection margin (p = 0.023), number of harvested nodes (p < 0.01), number of metastatic nodes (p < 0.001) and loco-regional recurrence (p < 0.01) are associated with survival. The overall 5-year survival was 65.3%. Conclusion: Unfavourable survival outcomes following breast cancer treatment is multifactorial, including the challenges faced in the multimodal treatment protocol received by our patients.

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Section: Discussionmentioning

confidence: 60%

Impact of axillary node-positivity and surgical resection margins on survival of women treated for breast cancer in Ibadan, Nigeria

Ayandipo¹,

Ogun²,

Adepoju³

et al. 2020

ecancer

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“…Other large prospective studies have reported 5-year disease-free survival rates of 96% for benign PTs and 66% for malignant PTs [15]. Most sarcomas metastasize hematogenously, and the incidence of axillary lymph node involvement in malignant PTs ranges from 1.1 to 3.8% [16].…”

Section: Discussionmentioning

confidence: 98%

Malignant phyllodes tumor of the breast with rapid progression: a case report

et al. 2020

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Background Malignant phyllodes tumors (PTs) of the breast occur infrequently and are difficult to treat with adjuvant therapy. Here, we present a case of a female patient with a huge malignant PT with rapid progression in a short period. Case presentation A 44-year-old woman presented to our hospital with a rapid growth mass in her right breast, measuring 20 cm. She was initially diagnosed as having a borderline phyllodes tumor by core needle biopsy and underwent total mastectomy and artificial dermis was grafted, 20 days later, latissimus dorsi muscle flap and free skin grafting were performed. Two courses of doxorubicin–ifosfamide therapy were administered because of recurrence, but the patient died 4 months after the mastectomy. Conclusions A standard therapeutic strategy for malignant PTs is needed in urgently to reduce the risk of tumor recurrence.

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“…Lymph node irradiation is not a standard approach, as metastasis from malignant phyllodes tumors are mainly hematogenous. Nevertheless, these may occur, as reported in the literature [14][15][16]. Given the clinical local and metastatic aggressiveness of the tumor and also the lack of complications expected from axillary/supraclavicular irradiation with our accelerated radiotherapy regimen [6], we decided to include these areas in the radiotherapy planning.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Successful Treatment of a Locally Recurrent and Metastatic Malignant Phyllodes Tumor with Accelerated Radiotherapy and Nab-Paclitaxel, Cisplatin, and Liposomal Doxorubicin Chemotherapy

et al. 2021

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Phyllodes tumors are rare breast lesions of fibroepithelial origin. Malignant transformation with metastases is linked with poor prognosis. We present a case of a 62-year-old woman with a recurrent malignant phyllodes tumor of the breast and lung metastases. The patient was originally presented with a borderline phyllodes tumor (7.4 cm) of the left breast, treated with wide local excision. A year later, the patient returned with palpable left breast masses. On PET-CT, increased uptake of <sup>18</sup>F-FDG by large breast tumors was evident. A right lung lesion of metastatic origin was also present. A simple left breast mastectomy was performed. Histopathological report described 2 malignant phyllodes tumors (7 cm and 6.5 cm). One month later, during the CT simulation for radiotherapy planning, encysted fluid in the chest wall and 2 additional pulmonary lesions of the right lung were identified, confirming progressive lung metastatic disease. Both the chest wall and the regional lymph node area were irradiated with hypofractionated and accelerated radiotherapy. Biweekly chemotherapy with albumin-bound paclitaxel, cisplatin, and liposomal doxorubicin was also prescribed at the start of radiotherapy for 12 cycles. At the end of chemotherapy, complete regression of lung metastases was achieved, and there was no evidence of local recurrence. Within 2 years of follow-up, the patient is free of disease and treatment-related toxicities. Accelerated hypofractionated radiotherapy is effective in the locoregional control of malignant phyllodes tumors. The combination of cisplatin with nab-paclitaxel and liposomal doxorubicin chemotherapy has acceptable toxicity and is highly effective in eradicating metastatic lesions.

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Gaint phyllodes tumour with axillary & interpectoral lymph node metastasis; A rare presentation

Cited by 12 publications

References 18 publications

Impact of axillary node-positivity and surgical resection margins on survival of women treated for breast cancer in Ibadan, Nigeria

Impact of axillary node-positivity and surgical resection margins on survival of women treated for breast cancer in Ibadan, Nigeria

Malignant phyllodes tumor of the breast with rapid progression: a case report

Successful Treatment of a Locally Recurrent and Metastatic Malignant Phyllodes Tumor with Accelerated Radiotherapy and Nab-Paclitaxel, Cisplatin, and Liposomal Doxorubicin Chemotherapy

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