Phyllodes Tumor of the Breast

Rakha, Emad A.; Ellis, Ian O.

doi:10.1002/9781118464557.ch17

Cited by 3 publications

(8 citation statements)

References 97 publications

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“…1,14,15 The median age of patients with a confirmed PT on excision was 31 years with a mean age of 33 years (range, 14-70 years). 34 patients were aged 34 years or younger (0.54% of patients in this age group) and 25 patients (0.18% of patients) were aged 35 years or older.…”

Section: Discussionmentioning

confidence: 99%

“…18 The presentation and incidence of PT in females aged under 30 years is important as recent studies have attempted to propose guidelines to establish which lesions in young females can be safely managed without biopsy to avoid unnecessary invasive procedures. 1 Maxwell and Pearson 11 outlined the clinical and ultrasonographic criteria by which needle sampling can be avoided in young females aged under 25 years. Their criteria included age less than 25 years; no known risk factors for breast malignancy; mass not rapidly enlarging; smooth discrete mobile mass on clinical examination or impalpable lesion; well-defined homogeneously isoechoic or mildly hypoechoic solid mass; ,3 cm in greatest dimension; ovoid shape, aligned parallel to the skin surface; smooth or gently lobulated contour (two or three lobulations only; no microlobulation); thin echogenic pseudocapsule; no calcification; and no acoustic shadowing.…”

Section: Discussionmentioning

confidence: 99%

“…1 In the literature, they have been described as occurring in females aged 35-55 years, typically 15-20 years older than females with fibroadenomas (FAs) and with a higher incidence in Asian females. 2,3 Imaging findings of PT and FA overlap and as such lesions may be misdiagnosed.…”

Section: Advances In Knowledgementioning

confidence: 99%

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Phyllodes tumours of the breast: radiological presentation, management and follow-up

McCarthy¹,

Kavanagh²,

O'Donoghue³

et al. 2014

The British Journal of Radiology

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Results: 53 patients with 54 lesions were diagnosed as having a PT. The median age was 27.5, 35.0 and 38.5 years for benign, borderline and malignant PT, respectively. Borderline and malignant PTs were larger than benign PTs, with mean sizes of 33 and 42 mm compared with 29 mm. 38% of PTs were labelled by the reporting radiologist as fibroadenomas, including two borderline PTs and one malignant PT. In 24% of cases, the radiologist raised the possibility of PT in the report. 17 patients (40%) developed a new fibroepithelial breast lesion during follow-up of which 4 were recurrent PTs. Conclusion: Despite adequate surgical management, the development of further fibroepithelial lesions in the ipsilateral breast is common. 3-year clinical surveillance, with the addition of 6-monthly ultrasound is advised for females with initial borderline or malignant PT histology. Advances in knowledge:We propose a follow-up protocol with ultrasound based on the grade of the PT diagnosed for 3 years to detect recurrence.Phyllodes tumours (PTs) are rare biphasic fibroepithelial neoplasms accounting for ,1% of all breast lesions. 1 In the literature, they have been described as occurring in females aged 35-55 years, typically 15-20 years older than females with fibroadenomas (FAs) and with a higher incidence in Asian females.2,3 Imaging findings of PT and FA overlap and as such lesions may be misdiagnosed. 4 Histologically, PTs can be identified by their distinctive leaf-like architecture and increased stromal cellularity. 5 Typically, PTs present as a palpable breast lump and were traditionally differentiated from FAs based on their larger size at presentation.6 However, with increased breast awareness and screening programmes, smaller and incidental lesions are being found on imaging. 6 In symptomatic breast clinics, including this institution, "triple assessment" consisting an initial physical examination, followed by radiological imaging (ultrasound and/or mammography) and histological sampling either by fine-needle aspiration cytology (FNAC) or core biopsy is the standard diagnostic pathway for palpable breast lesions. The purpose of triple assessment is to provide a more accurate pre-operative diagnosis to ensure proper surgical planning and avoiding re-excision or tumour recurrence. 7According to the World Health Organization criteria, there are two grading systems for PTs; a two-tiered system or a three-tiered system. 8 Our institution employs the threetiered system, the subgroups being benign, borderline and malignant. Grading is based on semi-quantitative assessment of stromal cellularity, cellular pleomorphism, mitotic activity, margin appearance and stromal distribution. The standard procedure for treatment, no matter what the grade of the PT, is surgical wide local excision, preferably with clear margins of at least 1 cm. However, owing to the fact that most PTs are not fully diagnosed pre-operatively, initial surgery does not always provide adequate margins necessitating frequent post-operative re-excision of the margi...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Phyllodes tumours of the breast: radiological presentation, management and follow-up

McCarthy¹,

Kavanagh²,

O'Donoghue³

et al. 2014

The British Journal of Radiology

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“…To have qualified for special type, the special type component needed to account for more than 90% of the tumor. To have qualified for mixed type, the special type component needed to account for 10% to 90% of the tumor . The percentage of ductal carcinoma in situ (DCIS) was also recorded.…”

Section: Methodsmentioning

confidence: 99%

Clinical, Epidemiologic, and Pathologic Significance of ERBB2-Low Expression in Breast Cancer

Khoury,

Mendicino,

Payne Ondracek

et al. 2024

JAMA Netw Open

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ImportanceIt is unclear whether breast cancer (BC) with low ERBB2 expression (ERBB2-low) is a distinct clinical, pathological, and epidemiological entity from BC classified as no ERBB2 expression (ERBB2-negative).ObjectiveTo evaluate the clinical, pathological, and epidemiologic features of BC with ERBB2-low expression compared with ERBB2-negative BC in a large population study.Design, Setting, and ParticipantsThis cohort study was conducted as part of the Pathways Study, a prospective, racially and ethnically diverse cohort study of women with BC enrolled between 2006 and 2013 in Kaiser Permanente Northern California (KPNC). The hematoxylin and eosin slides underwent centralized pathology review, including the percentage of tumor infiltrating lymphocytes (TILs). Breast biomarker results were extracted from pathology reports, and women were included if they had a documented ERBB2 value that was not classified ERBB2-positive. Data were analyzed from February 2023 through January 2024.ExposureClinical and tumor characteristics associated with BC and ERBB2-low or ERBB2-negative status.Main Outcome and MeasuresERBB2-low was defined as immunohistochemistry score of 1+ or 2+ (negative by in situ hybridization); ERBB2-negative was defined as immunohistochemistry score of 0+. Other data were collected by self-report or extraction from electronic health records, including BC risk factors, tumor characteristics, treatment modality, and survival outcomes, with recurrence-free survival (RFS) as the primary outcome and overall survival (OS) and BC-specific mortality (BCSM) as secondary outcomes. The clinical, pathological, and epidemiological variables were compared between ERBB2-low and ERBB2-negative BC.ResultsOf 2200 eligible patients (all female; with mean [SD] age, 60.4 [11.9] years), 1295 (57.2%) had tumors that were ERBB2-low. Hormone receptors were positive in 1956 patients (88.9%). The sample included 291 Asian patients (13.2%), 166 Black patients (7.5%), 253 Hispanic patients (11.5%), 1439 White patients (65.4%), and 51 patients (2.3%) who identified as other race or ethnicity (eg, American Indian or Alaska Native and Pacific Islander). Within the hormone receptor–negative group, patients whose tumors had ERBB2-low staining, compared with those with ERBB2-negative tumors, had better OS (hazard ratio [HR], 0.54; 95% CI, 0.33-0.91; P = .02), RFS (HR, 0.53; 95% CI, 0.30-0.95; P = .03), and BCSM (HR, 0.43; 95% CI, 0.22-0.84; P = .01). In multivariable survival analysis stratified by hormone receptor status and adjusted for key covariates, patients with ERBB2-low and hormone receptor–negative tumors had lower overall mortality (HR, 0.48; 95% CI, 0.27-0.83; P = .009), RFS (HR, 0.45; 95% CI, 0.24-0.86; P = .02), and BCSM (subdistribution HR, 0.21; 95% CI, 0.10-0.46; P &lt; .001) compared with patients with ERBB2-negative and hormone receptor–negative tumors. Within the hormone receptor–negative subtype, patients with ERBB2-low and high TILs tumors had better survival across all 3 outcomes compared with patients with ERBB2-negative and low TILs tumors. Additionally, patients with ERBB2-low and low TILs tumors had better BCSM (subdistribution HR, 0.36; 95% CI, 0.14-0.92; P = .03).Conclusions and RelevanceThese findings suggest that there were clinical, pathological, and epidemiological differences between ERBB2-low and ERBB2-negative BC, raising the possibility that ERBB2-low might be a unique biologic entity.

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“…Phyllodes tumors (PTs) are rare biphasic broepithelial neoplasms accounting for < 1% of all breast lesions . The least aggressive form [1] may behave similar to broadenomas, yet with a high local recurrence rate if excised without wide margins, while its malignant form can give distant metastasis . Typically, PTs present as a palpable breast lump [2,3] and were traditionally differentiated from FAs based on their larger size at presentation.…”

Section: Introductionmentioning

confidence: 99%

Retrospective Study of Recurrent Phyllodes Tumors and Assessment of the Role of Adjuvant Radiotherapy to Reduce the Recurrence Further.

Bhattacharya

2020

ijsr

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Background: Phyllodes tumors (PTs) are rare biphasic fibroepithelial neoplasms accounting for < 1% of all breast lesions[1]. Aim: To reduce the recurrence rate of phyllodes tumor of breast. Materials and Methods: A retrospective study which reviewed the recurrent phyllodes tumors for last 10 yrs in our hospital. Results: We found that out of 14 patients, all underwent radical surgery. 9 patients (64%) received post operative radiotherapy after radical surgery. After a follow up period of 1- 2 yrs. only 1 patient (11%) develops local recurrence, among the post radiotherapy group. In the non irradiated group of 5(36%), 3 patients (60%) develop local recurrence. Conclusion: The study reflects that radiotherapy following radical surgery reduce the recurrence rate.

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Phyllodes Tumor of the Breast

Cited by 3 publications

References 97 publications

Phyllodes tumours of the breast: radiological presentation, management and follow-up

Phyllodes tumours of the breast: radiological presentation, management and follow-up

Clinical, Epidemiologic, and Pathologic Significance of ERBB2-Low Expression in Breast Cancer

Retrospective Study of Recurrent Phyllodes Tumors and Assessment of the Role of Adjuvant Radiotherapy to Reduce the Recurrence Further.

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