Risk Factors for Recurrence and Death After Primary Surgical Treatment of Malignant Phyllodes Tumors

Asoğlu, Oktar; Uğurlu, Mustafa; Blanchard, Kay; Grant, Clive S.; Reynolds, Carol; Steven, Sebastian; Donohue, John H.

doi:10.1245/aso.2004.02.001

Cited by 161 publications

(178 citation statements)

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“…The commonest sites for distant metastasis are the lungs (66%), bones (28%), and brain (9%) and in rare instances, the liver and heart [7]. Metastasis to axillary lymph nodes occurred in only 2% [8]. Various other malignancies as angiosarcoma, chondrosarcoma, osteosarcoma, liposarcoma, leiomyosarcoma, and rhabdomyosarcoma, are rarely encountered in malignant phyllodes tumors.…”

Section: Discussionmentioning

confidence: 99%

“…Since an excision with the required margins is often impossible in giant phyllodes tumors, mastectomy should be reserved for larger tumors and should be considered in recurrent tumors, especially of the malignant histotype [8]. Depending on the size of the breast and the location of the phyllodes tumor, mastectomy may also be required for tumors that are between 5 and 10 cm in diameter [9].…”

Section: Discussionmentioning

confidence: 99%

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Recurrent Malignant Phylloides Tumor: A Rare Entity

Malik¹,

Gupta²

2015

J Cytol Histol

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Phylloides tumor of breast is a rare tumor of fibroepithelial origin forming only about 0.3-0.5% of all breast malignancies. Malignant phylloids tumor is even more rarely encountered lesion of very unpredictable clinical outcome with high chances of recurrence and distant metastasis. Accurate preoperative pathological diagnosis is mandatory to allow correct planning of the surgical treatment which can be either wide excision or mastectomy with an intent to have a negative surgical margin of at least 1 cms. This rare and enigmatic tumor should be kept in mind while dealing with breast lumps. Here, we present a case of recurrent malignant phylloides tumor in a young female alongwith review of literature of this rare entity. Aim and Objective:To present a case of recurrent malignant phylloides tumor in a young female alongwith its cytology images and to have a review of literature of this enigmatic entity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Recurrent Malignant Phylloides Tumor: A Rare Entity

Malik¹,

Gupta²

2015

J Cytol Histol

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“…Nowadays, a more conservative surgical approach is preferred based on the notion that local recurrences (LR) do not appear to be related to the systemic spread of the disease. [23,24] However, studies have reported results contrary to this view too. [15,25] The recent trend towards breast conservation has had a variable impact on the risk of local recurrence (reported as 20-30% for malignant tumors) without an apparent adverse effect on overall survival (OS).…”

Section: Surgerymentioning

confidence: 92%

“…[22] series with mastectomy being performed in some of the cases to achieve negative margin. [24,25,27] Notably, a study by Barth et al in a large review found that the recurrence rate for borderline and malignant PTs remained high even after WLE to the tune of 29 and 35%, respectively. [15] Similar results were also observed by Hassan et al with LR rate after WLE being 0, 36.4, and 40% for benign, borderline, and malignant PTs, respectively.…”

Section: Histological Classificationmentioning

confidence: 99%

Phyllodes tumor of the breast: Wolf inside the sheep’s skin!

Wadasadawala¹,

Swain²,

Bajpai³

2016

Oncobiology and Targets

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Phyllodes tumor, previously known as cystosarcoma phyllodes, is a rare fibro-epithelial tumor of breast constituting <1% of all the breast tumors. It is classified into benign, borderline, and malignant subtypes depending upon the histological criteria defined by the World Health Organization and also has an independent prognostic significance. Accurate pretreatment histological diagnosis is important for the optimal management of phyllodes tumor so that low recurrence rates, improved survival, and optimal long-term cosmetic result can be achieved. Despite surgery being the standard of care, the best type of surgery for each histological type is yet to be defined. The higher rate of local recurrence after surgery alone in borderline and malignant phyllodes tumor raises the question regarding the need of adjuvant treatment, especially radiotherapy, which remains underutilized. The perspective of the current review is to provide the state-of-the-art management of phyllodes tumor of the breast and highlight the risk factors associated with recurrence.

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“…Benign phyllodes tumor has a 21 % risk of local recurrence, while that of the malignant variety ranges from 20 to 32 %. In patients with malignant phyllodes tumor, the rate of distant metastases ranges from 25 to 40 % [3][4][5][6]. The most frequent sites of distant metastasis include the lungs, bone, heart and liver.…”

mentioning

confidence: 99%

Malignant Phyllodes Tumor of the Breast Metastasizing to the Vulva: 18F-FDG PET-CT Demonstrating Rare Metastasis from a Rare Tumor

Khangembam

Sharma

Singla

et al. 2012

Nucl Med Mol Imaging

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Phyllodes tumors are extremely rare fibroepithelial neoplasms accounting for 0.3 to 0.5 % of all female breast tumors with an incidence of 2.1 per 1 million women [1]. They are classified histologically into benign, borderline and malignant varieties [2]. The majority of them are benign, with only 25 % being malignant. Surgery remains the mainstay of treatment. One characteristic is that although the malignant variety tends to metastasize and recur, the benign form has also been found to behave in a similar manner. Benign phyllodes tumor has a 21 % risk of local recurrence, while that of the malignant variety ranges from 20 to 32 %. In patients with malignant phyllodes tumor, the rate of distant metastases ranges from 25 to 40 % [3][4][5][6]. The most frequent sites of distant metastasis include the lungs, bone, heart and liver. Lymph nodal metastasis is uncommon as this tumor spreads by hematogeneous route [7]. Other sites for distant metastasis have been reported sporadically, including the duodenum, pancreas, brain, nasal cavity, forearm, parotid, skin, oral cavity, skeletal muscle, mandible and maxilla [8][9][10]. We present a rare case of recurrent malignant phyllodes tumor with metastasis to the vulva, which has not been reported in the literature to the best of our knowledge. A 49-year-old female who had undergone lumpectomy and locoregional radiotherapy 1 year previously for malignant phyllodes tumor of the right breast presented with difficulty in breathing and cervical lymphadenopathy. Chest X-ray showed multiple pulmonary nodules suggestive of metastasis. She was referred for restaging with 18F-fluorodeoxyglucose (FDG) positron emission tomography computed tomography (PET-CT) FDG PET-CT (Fig. 1). Maximum intensity projection (MIP) PET images revealed multiple FDG-avid enlarged cervical lymph nodes, bilateral pulmonary nodules along with left pleural effusion and extensive bone marrow metastases (a). The interesting finding was an intensely FDGavid (SUV max -21.4) subcutaneous soft tissue density lesion (measuring 2.0×2.2×2.0 cm) in the vulva, which was later proved to be metastatic from a malignant phyllodes tumor on FNAC (a-g; arrow). However, there was no evidence of local recurrence. This is in agreement with the existing literature on phyllodes tumor, showing that most recurrences with distant metastases occur without evidence of local recurrence, and the two do not seem to be related [11]. In spite of the scarce literature because of the rarity of the disease, there are sporadic reports highlighting the usefulness of FDG PET-CT in phyllodes tumor [12]. However, our case is unique in that over and above the extensive systemic metastases revealed, FDG PET-CT could detect metastatic deposit to the vulva, which is a very rare site for metastasis, even in the case of other common and rapidly metastasizing tumors. FDG PET-CT, thus, is useful in recurrent phyllodes tumor and can demonstrate rare unsuspected sites of metastasis.

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Risk Factors for Recurrence and Death After Primary Surgical Treatment of Malignant Phyllodes Tumors

Abstract: Stromal overgrowth in MPT carries a grave prognosis. Close surgical margins and large tumor size, but not type of operation, significantly increased LR. Either WLE with adequate margins or mastectomy is an appropriate treatment for patients with MPT.

Cited by 161 publications

References 32 publications

Recurrent Malignant Phylloides Tumor: A Rare Entity

Recurrent Malignant Phylloides Tumor: A Rare Entity

Phyllodes tumor of the breast: Wolf inside the sheep’s skin!

Malignant Phyllodes Tumor of the Breast Metastasizing to the Vulva: 18F-FDG PET-CT Demonstrating Rare Metastasis from a Rare Tumor

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