Liposarcoma of the breast arising in a malignant phyllodes tumor:A case report and review of the literature

Liposarcoma of the breast is a very rare malignant tumor. It can clinically manifest as a palpable breast mass and mimic primary breast cancer. We report an unusual case of a 51-year-old female who presented with an asymptomatic right breast mass, which was histologically diagnosed as well differentiated liposarcoma arisen within malignant phyllodes tumor. The patient underwent breast conserving surgery, received no adjuvant treatment and is disease-free after 2 years. Radiological and histopathological features are presented and described in detail. Data from the literature are presented and therapy recommendations discussed.

Giant benign phyllodes breast tumour with pulmonary nodule mimicking malignancy:A case report

BACKGROUND Phyllodes tumours(PTs)are fibroepithelial breast tumours,which can be classified as benign,borderline or malignant,according to their histological characteristics.While various huge borderline or malignant PTs have been previously described,a benign PT with a pulmonary nodule mimicking malignancy has not yet been reported.In order that doctors may have a comprehensive understanding of super-giant benign PTs(≥20 cm),we also performed a literature review to summarize the clinical features,differential diagnosis,and treatment of this disease.CASE SUMMARY A 42-year-old woman with severe anaemia presented with a rapidly enlarging right breast mass,measuring approximately 30 cm×25 cm×20 cm that was first noticed 1 year previously.A region of skin ulceration and necrosis(20 cm×15 cm)was observed on the lateral side of the mass.Computed tomography(CT)of the chest revealed a pulmonary nodule,which initially suggested a diagnosis of metastasis.CT showed that the boundaries between the pectoralis major and the mass were blurred,which was presumed to be due to tumour invasion.However,two core needle biopsies of the mass showed no evidence of malignancy.Following these results,the tumour was removed by mastectomy of the right breast.Interestingly,postoperative pathology finally proved the diagnosis of a benign PT.After 1 year of follow-up,wedge resection of the small pulmonary nodule was performed,and it was confirmed that the lung nodule was actually adenocarcinoma rather than metastatic breast cancer.The patient recovered very well without any postoperative treatment.CONCLUSION This case is unique in that the giant breast mass initially mimicking a malignantclinical presentation was eventually pathologically confirmed to be a benign PT,which misled the diagnosis and complemented the atypical features of benign PTs.The pathological and immunohistochemical results were important in the differential diagnosis.In addition,total mastectomy should be recommended due to difficulty in the precise diagnosis of PTs,especially in large breast masses.In the literature,almost one-half of super-giant benign cases were thought to be malignant tumours before surgery.This finding is a reminder to consider all conditions in order to make an accurate diagnosis and avoid excessive treatment.

Malignant phyllode tumor metastatic to the duodenum

Phyllode tumor （PT） is extremely rare tumor of the breast. Distant metastasis occurs in 10-20% of patients with malignant phyllode tumor. The most common sites of metastases are the lungs and bones. Although theoretically any organ may have metastasis, an isolated duodenum metastasis has not been documented as yet in the English-language literature. We report herein a case with a isolated duodenal metastasis from PT of breast in a 31 year-old-woman who underwent right mastectomy 4 years before because of the recurrent malignant PT. She presented to our hospital with massive upper gastrointestinal bleeding. Clinical evaluation revealed a huge mass originated from duodenum. Urgent laparotomy and pancreaticoduodenectomy were carried out in order to remove the bleeding duodenal mass. The pathologic examination of the resected specimen showed a malignant spindle cell tumor consistent with metastatic malignant PT. Our case of gastrointestinal bleeding due to an isolated duodenal metastasis as a result of hematogenous spread from malignant phyllode tumor of breast is unique in the English literature and pancreaticoduodenectomy is a curative treatment for patients with isolated duodenal involvement.

Giant phyllodes tumor of the breast:a case report

Objective： The aim of the study was to report a case with a giant phyllodes tumor of the left breast and discuss the diagnostic and management challenges. Methods： A 47-year-old female patient was admitted to our center （Department of General Surgery, the First Affiliated Hospital, Luzhou Medical College, China） due to a large left breast mass for about 2.5 years. Core tissue biopsy showed mixed epithelial-stromal proliferation suggestive of a phyllodes tumor. Left modified radical mastectomy with dissection of level Ⅰ and level Ⅱ lymph nodes was performed. Results： The pathologic findings of this proce- dure were consistent with borderline phyllodes tumor. The tumor measured 47.5 cm× 37,0 cm× 28.0 cm and weighed 9.79 kg ex vivo. Conclusion： To our knowledge, this patient presented one of the biggest phyllodes tumors of breast in all cases reported in English-language publications so far.

A pulmonary metastatic breast phyllodes tumor and clinicopathology analysis

Objective Breast phyllodes tumors(PTs) are rare fibroepithelial tumors that are characterized by formation of foliation patterns. Behaviorally, only relatively poor prediction of PTs is possible based on their histological appearance. PTs are frequently misdiagnosed because they are difficult to differentiate from soft tissue tumors. In this report, we describe the pathological features of a rare case of PT and review the relevant literature, summarizing the essentials of the diagnosis and differential diagnosis, while attempting to avoid misdiagnosis or missed diagnosis of the tumor to the best of our abilities.Methods We present a case of pulmonary metastatic lobular tumor, analyzing the morphological [hematoxylin-eosin(HE) staining] and immunohistochemical(streptavidin perosidase method, SP) features of the tissue.Results Long spindle-shaped tumor cells were observed using microscopy. The cells were arranged in bundles, with a whirlpool pattern, and braided. The proliferation of the spindle cells was markedly atypical and karyokinesis was elevated. Residual ductal epithelium was detected in some areas, and the margins of the tumor tissues showed invasive growth. Immunohistochemical studies of the spindle-shaped tumor cells were positive for actin, PR, CD10, SMA, Bcl-2, and negative for CKP, S-100, CD34, ER. The Ki-67 index was 40%.Conclusion The spindle cell tumor identified in the lung should first be considered as a metastatic neosplasm, because most soft-tissue sarcomas commonly metastasize through the bloodstream to the lungs. Although malignant breast PTs are rare, a detailed medical history that includes prior surgical history is required to avoid wrongful or missed diagnosis.

Voluminous Phyllode Tumour of the Breast: A Case Report and Literature Review from Loandjili General Hospital in Pointe-Noire, Congo

Introduction: Breast phyllodes are rare. Histologically, it is a fibro-epithelial tumour that differs from the fibro-adenoma by a more abundant and more cellular stroma. Observation: We report a case of a large breast phyllode tumour in a 42-year-old woman in the Obstetric and Gynaecology Department of Loandjili General Hospital. This tumor has evolved for 3 years. It is by discomfort due to chest pain. The clinical examination showed a voluminous right breast in the form of a calabash that hung down the body with a large collateral circulation, associated with an appearance of “orange peel”, and an axillary lymph node. In addition, there were necrotic areas and retraction of the nipple. In addition to the clinical characteristics, the ultrasound images and the histological analyses following the biopsy made it possible to evoke the diagnosis of phyllode tumour of the breast. The treatment consisted of a full right simple mastectomy with a 50 cm breast with a major axis that weighed 9465 grams, supplemented by homolateral axillary lymph node dissection. At the section of the tumour measuring 40 cm long, the sectional sections alternately showed solid and cystic areas. The histological examination confirmed the phyllode nature of the tumour with intermediate grade 2 malignancy. The lymph nodes showed an inflammatory appearance, with no signs of malignancy. Early post operation period was uneventful. The patient’s follow-up was annual, and the last check dated 09/01/2017 proved to be normal. Conclusion: The phyllode tumor is a rare pathology. In our environment, it can be greatly increased by the lack of diagnosis and early management. In all cases, any tumour of the breast operated, must benefit from an anatomo-pathological analysis, to determine the benign or malignant character of it, allowing proposing a plan of management better adapted.

Recurrent Giant Phyllodes Tumour of the Breast Pathological Considerations and Management Approach for Recurrence and Metastasis

Phyllodes tumours are rare and account for 0.4% of all breast tumours. The majority of them tend to be less than 5 cms in size with giant tumours larger than 10 cms being about 20% of these cases. They display a broad range of clinical and pathological behavior and are regarded as falling within the spectrum of fibroepithelial neoplasms. Surgery has been the primary modality of treatment. However the extent of resection and the role of adjuvant radiotherapy and chemotherapy are still controversial. The risk of recurrence is (4.7% - 30%) for benign phyllodes tumour and (30% - 65%) for borderline and malignant phyllodes tumour. A case of giant phyllodes tumour measuring 36 × 30 cm and weighing 6.8 kg is presented, which had recurred following a previous resection 5 years back. The literature is reviewed with regards to pathology, the role of investigations, nature of resection and the risk factors for recurrence and

LncRNA ZFPM2-AS1 promotes phyllodes tumor progression by binding to CDC42 and inhibiting STAT1 activation

Breast phyllodes tumor(PT)is a rare fibroepithelial neoplasm with potential malignant behavior.Long non-coding RNAs(lncRNAs)play multifaceted roles in various cancers,but their involvement in breast PT remains largely unexplored.In this study,microarray was leveraged for the first time to investigate the role of lncRNA in PT.We identified lncRNA ZFPM2-AS1 was significantly upregulated in malignant PT,and its overexpression endowed PT with high tumor grade and adverse prognosis.Furthermore,we elucidated that ZFPM2-AS1 promotes the proliferation,migration,and invasion of malignant PT in vitro.Targeting ZFPM2-AS1 through nanomaterial-mediated siRNA delivery in patient-derived xenograft(PDX)model could effectively inhibit tumor progression in vivo.Mechanistically,our findings showed that ZFPM2-AS1 is competitively bound to CDC42,inhibiting ACK1 and STAT1 activation,thereby launching the transcription of TNFRSF19.In conclusion,our study provides evidence that ZFPM2-AS1 plays a pivotal role in the pathogenesis of breast PT,and suggests that ZFPM2-AS1 could serve as a prognostic indicator for patients with PT as well as a promising novel therapeutic target.

CD146 promotes malignant progression of breast phyllodes tumor through suppressing DCBLD2 degradation and activating the AKT pathway

Background As a rapid-progressing tumor,breast malignant phyllodes tumors(PTs)are challenged by the lack of effective therapeutic strategies and suitable prognostic markers.This study aimed to clarify the role and mechanism of CD146 on promoting PTs malignant progression,and to identify a novel prognosis marker and treatment target of breast malignant PTs.Methods The expression and prognostic significance of CD146 in PTs was detected through single-cell RNA-sequencing(scRNA-seq),immunostaining,real-time PCR and other methodologies.Functional experiments including proliferation assay,colony formation assay,transwell assay,and collagen contraction assay were conducted to validate the role of CD146 in malignant progression of PTs.The efficacy of anti-CD146 monoclonal antibody AA98 against malignant PTs was corroborated by a malignant PT organoid model and a PT patient-derived xenograft(PDX)model.Transcriptome sequencing,proteomic analysis,co-immunoprecipitation,and pull-down assay was employed to identify the modulating pathway and additional molecular mechanism.Results In this study,the scRNA-seq analysis of PTs disclosed a CD146-positive characteristic in theα-SMA+fibroblast subset.Furthermore,a progressive elevation in the level of CD146 was observed with the malignant progression of PTs.More importantly,CD146 was found to serve as an independent predictor for recurrence in PT patients.Furthermore,CD146 was found to augment the viability and invasion of PTs.Mechanistically,CD146 acted as a protective“shield”to prevent the degradation of Discoidin,CUB,and LCCL domain-containing protein 2(DCBLD2),thereby activating the phosphoinositide 3-kinase(PI3K)/protein kinase B(AKT)signaling pathway and enhancing malignant behaviors of PT cells.In the malignant PT organoid and PDX model,a significant suppression of malignant PT growth was observed after the application of AA98.Conclusions These findings suggested that CD146 served as an efficacious marker for predicting PT malignant progression and showed promise as a prognosis marker and treatment target of breast malignant PTs.The study further unveiled the essential role of the CD146-DCBLD2/PI3K/AKT axis in the malignant progression of PTs.

Pulmonary metastases 12 years after a mastectomy for borderline phyllodes tumor

Phyllodes tumor is a rare breast tumor. A 45-year-old woman who underwent left mastectomy 12 years ago was found to have infiltrates in both lungs in a health examination. Combining histological examinations of the lung and breast samples the diagnosis of borderline phyllodes tumor metastases to the lung was made. It is the longest interval to our knowledge that the metastases occurred 12 years after primary phyllodes tumor.