Optimising preoperative diagnosis in phyllodes tumour of the breast

Abstract

The role of the pathologist in the preoperative diagnosis of phyllodes tumours of the breast is critical to appropriate surgical planning. However, reliable differentiation of phyllodes tumour from cellular fibroadenoma remains difficult. Preoperative diagnostic accuracy allows correct surgical treatment, avoiding the pitfalls of reoperation because of inadequate excision, or surgical overtreatment. Specific clinical indices may arouse diagnostic suspicion but are unreliable for confirmation, as with current imaging modes. Fine needle aspiration cytology has a high false negative rate. Few studies have evaluated the role of core needle biopsy, but it may prove a useful adjunct. Both diagnostic and prognostic information may in future be gained from application of immunohistochemical and other techniques assessing the expression of proliferative markers including p53, Ki-67, and others.

486 From the 1 Department of Pathology, Faculty of Medicine, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia, 2 Department of Surgery, Faculty of Medicine, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia, 3 Department of Anatomy, Faculty of Medicine, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia Received: Jan. 18, 2011; Accept: Mar. 8, 2012 Correspondence to: Dr. Siti Aishah Md Ali, Department of Pathology, Faculty of Medicine, University

“…[36] p53 expression in PT has been found to be associated with histological features of malignancy, and the positivity increases in those tumors which progress from benign to malignant phenotypes. [6] …”

“…[2][3][4] The PTs are rare neoplasms and accounting for less than 1% of all primary breast tumors. [5][6][7] PTs show predominantly of FA criteria, with a leaf-like projection cells and more cellular connective tissue stroma component.…”

“…[16,17] Ki-67 is linked to cell cycle specially expresses during late G1, S, M and G2 phase of the cell cycle, is undetected in cells of the G0 phase. [6,18] It is observed as a marker of cell proliferation and the best indicator in determining the growth fraction of cells. [6] Expression of the proliferation marker Ki-67 has been reported to vary among histological categories of PT as well as between PTs and FAs and was also reported in several studies to show a correlation between MIB-1 positivity and the histological grade.…”

“…[6,18] It is observed as a marker of cell proliferation and the best indicator in determining the growth fraction of cells. [6] Expression of the proliferation marker Ki-67 has been reported to vary among histological categories of PT as well as between PTs and FAs and was also reported in several studies to show a correlation between MIB-1 positivity and the histological grade. [7,19,20] Besides, p53 immunohistochemical expression, commonly used as an identification for tumor-suppressor gene mutation, has been also correlated with tumor grade.…”

“…stromal distribution. [1,[6][7][8] Apoptosis is one of the factors that play a key role in the development and growth regulation of normal and neoplastic mammary tissues. [9,10] Bcl2 is an oncoprotein that plays a role in apoptosis; by blocking programmed cell death, discourages the promotion of cellular proliferation and induces tumor development.…”