Phyllodes Tumor of the Breast during Pregnancy and Lactation; A Systematic Review

Abstract

<jats:p> <jats:bold>Background:</jats:bold> Phyllodes tumor (PT) is a rare tumor of the breast, which may occur during pregnancy or lactation. Several studies have reviewed and discussed PT occurring in pregnancy, gathering up to 14 patients. We performed a thorough systematic review of the literature in an attempt to find all reported cases, and identify their common characteristics. <jats:bold>Methods:</jats:bold> We searched Google scholar, PubMed, Ovid Medline, Scopus and ClinicalTrials.gov with several relevant combinations of keywords, looking for texts or abstracts without any date or language limitations, but using only English keywords. The existing literature only consisted of case reports and series; therefore any paper including one or several cases of PT presenting during pregnancy or breastfeeding was recognized as eligible. Articles with vague description of the tumor which made the diagnosis uncertain, and those lacking data about the tumor and management data were excluded. We contacted authors for more details in cases with incomplete information. <jats:bold>Results:</jats:bold> After excluding those with very deficient data, we included 37 studies, counting 43 cases. The mean age of the patients was 31 years (21-43 years). Some features were different from usual PT: bilaterality (16.2%), large size (14.2 ± 8.6 cm), rapid enlargement (79.5%), and rate of malignancy (60.5%). <jats:bold>Conclusion:</jats:bold> Our findings show high rates of bilaterality, large size, rapid growth, and malignant pathology in the reported gestational PTs.</jats:p>

Malignant Phyllodes Tumor of the Breast and Pregnancy: A Rare Case Report and Literature Review

“…In the literature, we found less than 10 cases of singular case reports of malignant PT in pregnancy and lactation, and a systematic review that included 37 studies with 43 cases [21]. The latter included all types of PT in pregnancy, 60% (26 cases) of these being malignant.…”

“…However, from the cases that were described by US imaging, there were no specific findings to discriminate a benign PT from a malignant tumor, since contour irregularities were seen in both types of tumors, and positive Doppler scans were equally distributed between benign and malignant PT. Therefore, the diagnosis was made retrospectively on the surgical specimen [21]. Although mastectomy is likely to be recommended for some locally advanced tumors, breast-conserving surgery remains a good option for cases were surgical clear margins can be achieved.…”

“…Patients were followed up at least 12 months (for 13 out of 26 patients) after diagnosis and the prognosis was generally good. Six of these cases had local recurrence or distant metastases, and two patients died 2 years and 11 years after diagnosis from recurrence or widespread metastases [21,27,28]. Although exposure to female sex hormones might incline towards malignant transformation of PT, only 2 out of 26 patients have had hormonal stimulation for infertility, so this hypothesis is difficult to be sustain, since data is limited for these cases.…”

“…Although exposure to female sex hormones might incline towards malignant transformation of PT, only 2 out of 26 patients have had hormonal stimulation for infertility, so this hypothesis is difficult to be sustain, since data is limited for these cases. Further data is needed, since there has been no comparison made between malignant PT for pregnant and non-pregnant patients who undergo infertility stimulation treatment [21,28].…”

Effect of pregnancy and lactation on a benign phyllodes tumour

“…Phyllodes tumours in pregnancy and lactation are rare, with only 43 cases reported in a recent systematic review 1. Most cases presented as rapidly enlarging masses.…”