Malignant phyllodes tumor with heterologous differentiation: Clinicopathological spectrum of nine cases in a tertiary care institute in Eastern India

Abstract

Phyllodes tumors are uncommon fibroepithelial neoplasms of breast. Heterologous sarcomatous differentiation of malignant phyllodes tumor (MPT) is a rare phenomenon as shown in the literature. Herein we report a series of nine cases from a tertiary care centre in Eastern India. Patients demographic data and clinical details were obtained from the medical records. Histopathology and immunohistochemical studies were analysed and diagnosed accordingly. Out of 38 cases of PT, 13 were found to be MPT, of which 9 cases showed heterologous differentiation in the form of angiosarcoma, fibrosarcoma, undifferentiated sarcoma, extensive squamous differentiation and with lipomatous metaplasia. Proper diagnosis and subtyping of the sarcomatous component is essential for deciding the correct treatment modality and prognostication of the disease. However there is no clear cut treatment protocol is available because of paucity of data.

Unprecedented Case Study: Malignant Phyllodes Tumor Exhibiting Uncommon Rhabdomyosarcomatous Differentiation

“…PTs are interpreted as a continuum of the spectrum of fibroepithelial neoplasms of breast tissue; benign PTs can be difficult to distinguish from fibroadenomas while malignant PTs can grow in size quickly and metastasize early [6]. The metastatic spread of malignant PT is mainly hematogenous to lung, with infrequent lymphatic involvement, hence axillary lymph nodes are not palpable at presentation in most cases [8]. The characteristic histological features are related to the stroma and PTs are differentiated from fibroadenomas by marked stromal overgrowth and hypercellularity [6].…”

Gray lesions of the breast and its diagnostic significance: A retrospective study from rural India

“…Malignant phyllodes tumors are differentiated by other breast tumors with the help of immunomarkers such as CD 34, CD 117, Ki-67, and vimentin. [ 14 15 ] In the current study, these immunomarkers were also applied to differentiate and diagnose phyllodes tumor [Figures 5 and 6 ]. Scirrhous carcinomas are histologically characterized as hard, fibrous, and invasive carcinoma in which malignant cells occur singly or in small clusters in dense connective tissue.…”

Malignant phyllodes tumor with extensive lipomatous differentiation

“…Of those with malignant stromal differentiation, most display fibrosarcomatous components. Adipose stromal differentiation may also occur, ranging from mature fat to liposarcomatous transformation [5] , [6] , [7] , [8] . However, pure lipomatous differentiation is rare [9] .…”