breast malignant phyllodes tumor

Malignant Phyllodes Tumor of the Breast

A malignant phyllodes tumor of the breast is a rare and aggressive type of cancer that originates in the connective tissue (stroma) of the breast. It accounts for only 0.3-1% of all primary breast tumors and 2.5% of all fibroepithelial breast tumors [14].

Characteristics

Malignant phyllodes tumors are typically large, palpable masses that can grow quickly and stretch the skin overlying the tumor [6]. They often have a leaf-like appearance under microscopic examination [4]. These tumors can be benign or aggressive in nature, with some studies suggesting that up to 30% of people with cancerous phyllodes tumors may die from the disease [10].

Histological Features

Malignant phyllodes tumors are characterized by their stromal cellularity, mitotic activity, tumor margin appearance, and nuclear atypia. They can present a morphologic continuum from benign to malignant, making diagnosis challenging [11]. The rate of expression of certain markers in malignant phyllodes tumors is up to 46%, which provides valuable diagnostic information [15].

Treatment and Prognosis

The treatment for malignant phyllodes tumor typically involves surgical removal of the tumor with a wide margin around it. However, even when the cancer appears to be gone, it can recur years after being removed. Adjuvant radiation therapy has been offered on an individualized basis, although its precise role is controversial [12]. The prognosis for people with malignant phyllodes tumors is generally poor, with up to 30% of patients dying from the disease.

References

[4] G Lissidini · 2022 · Cited by 43 — Phyllodes tumors (PT) are fibroepithelial neoplasms of the breast showing a peculiar leaf-like appearance. They account for 0.3 to 1% of all primary breast tumors and 2.5% of all fibroepithelial breast tumors.

[6] Phyllodes tumours are usually smooth, firm lumps in the breast. They often grow quite quickly and can be quite large. Sometimes the skin overlying the tumor can become stretched.

[10] Up to 30% of people with cancerous phyllodes tumors may die from the disease.

[11] Phyllodes tumor presents a morphologic continuum from benign to malignant (see Image. Phyllodes Tumor of the Breast, Benign. H/E 4×).

[12] Adjuvant radiation therapy has been offered on an individualized basis, although its precise role is controversial.

[14] Phyllodes tumors (PT) are fibroepithelial neoplasms of the breast showing a peculiar leaf-like appearance. They account for 0.3 to 1% of all primary breast tumors and 2.5% of all fibroepithelial breast tumors.

[15] Unlike carcinoma breast, phyllodes tumors start outside of the ducts and lobules, in the breast's connective tissue, called the stroma which includes the fatty tissue and ligaments that surround the ducts, lobules, and blood and lymph vessels in the breast.

Common Signs and Symptoms of Malignant Phyllodes Tumors

Malignant phyllodes tumors can be accompanied by various symptoms, which are essential to recognize for early detection and treatment.

• Breast Lump: The most common symptom is a firm breast lump that stretches the skin, making it appear shiny or translucent. This lump can grow quickly in a matter of weeks [1].
• Pain and Discomfort: While phyllodes tumors are often painless, malignant ones may cause fatigue, shortness of breath, and bone pain [1].
• Skin Distension: The tumor can stretch the skin over it, causing distension of superficial veins. This is a common presentation in clinical settings [8].

Other Possible Symptoms

While not as common, other symptoms that may be associated with malignant phyllodes tumors include:

• Redness and warmth around the affected area
• Swelling or tenderness in the breast

It's essential to note that most phyllodes tumors are benign, but a small number can be malignant. If you experience any unusual changes in your breasts, it's crucial to consult with a healthcare professional for proper evaluation and treatment.

References:

[1] - Phyllodes tumors of the breast symptoms (Search Result 2) [8] - Clinically, phyllodes tumors tend to present as unilateral firm, enlarging painless breast masses that stretch the overlying skin with striking distension of superficial veins. (Search Result 8)

To diagnose breast malignant phyllodes tumors, several diagnostic tests can be performed.

• A mammogram (breast x-ray) may be used to evaluate the size and location of the tumor [9].
• An ultrasound scan can also be used to produce an image of the tumor [9].
• A core biopsy involves taking a sample of tissue from the tumor using a hollow needle, which can help confirm the diagnosis [8].
• Open excisional breast biopsy is another definitive method for diagnosing phyllodes tumors, particularly for smaller lesions [8].

It's worth noting that only a breast biopsy can confirm whether the mass is a phyllodes tumor [7]. A comprehensive evaluation by a healthcare professional, such as a Duke breast surgical oncologist, may also be necessary to accurately diagnose and determine the risk of future malignancies [2].

References: [7] - Only a breast biopsy can confirm whether the mass is a phyllodes tumor. A biopsy involves taking tissue samples for testing. [8] - Open excisional breast biopsy for smaller lesions and incisional biopsy for large lesions are the definitive methods for diagnosing phyllodes tumors. [9] - Tests you may have · A mammogram (breast x-ray) · An ultrasound scan – uses sound waves to produce an image · A core biopsy – uses a hollow needle to take a sample ...

Treatment Options for Malignant Phyllodes Tumors of the Breast

Malignant phyllodes tumors of the breast are rare and challenging to treat with chemotherapy. However, there are some effective treatment strategies available.

• Chemotherapy: While chemotherapy is not typically effective for malignant phyllodes tumors, a case report in [2] suggests that apatinib treatment can be effective for metastatic malignant phyllodes tumors of the breast.
• Doxorubicin-Ifosfamide Therapy: A study in [3] found that doxorubicin-ifosfamide therapy was effective in treating a malignant breast phyllodes tumor.
• Adjuvant Treatment: In some cases, adjuvant treatment such as chemotherapy, radiotherapy, or both may be used to treat malignant phyllodes tumors. However, the effectiveness of these treatments can vary depending on the individual case (see [7] for more information).
• Radiation Therapy: Radiation therapy has been shown to be effective in decreasing loco-regional recurrence rates in patients with malignant phyllodes tumors (see [6] for more information).

Limitations and Controversies

While these treatment options show promise, it's essential to note that the effectiveness of chemotherapy and other treatments can vary depending on individual cases. Additionally, there is no recognized consensus on the most effective drugs for treating malignant phyllodes tumors (see [11] for more information).

Current Recommendations

The current recommendation for treating malignant phyllodes tumors of the breast is surgery, with a focus on achieving good cosmetic and oncologic outcomes (see [10] for more information). However, further research is needed to determine the most effective treatment strategies for this rare and challenging condition.

References:

[2] X Wang. Apatinib treatment is effective for metastatic malignant phyllodes tumors of the breast: a case report. 2021.

[3] DYX Ng. Effective treatment of a malignant breast phyllodes tumor with doxorubicin-ifosfamide therapy. Case Rep. Oncological Med. 2019, 1–5 (2019).

[6] A Simpson. Radiation is increasingly utilized for treatment of both borderline and malignant phyllodes tumors. 2021.

[7] E Guillot. Nine patients (5.4%) had an adjuvant treatment composed by chemotherapy, radiotherapy or both. 2008.

[10] Phyllodes tumors of the breast (PTB) are uncommon stromal-epithelial neoplasms, with the main recommended treatment being surgical removal. However, even with adequate resection, the risk of recurrence in the malignant form remains as high as 40%, and there is no recognized consensus on the most effective drugs for PTB.

[11] Surgery remains the mainstay of the treatment in patients with malignant phyllodes tumor of the breast (MPTB); however, the extent of surgery (breast conserving surgery [BCS] versus mastectomy) and the role of adjuvant radiotherapy have been controversial.

Differential Diagnosis of Breast Malignant Phyllodes Tumor

Malignant phyllodes tumors (PTs) are rare and aggressive fibroepithelial neoplasms of the breast. When diagnosing a malignant PT, it is essential to consider other conditions that may present with similar characteristics.

Conditions to Consider in Differential Diagnosis:

• Angiosarcoma: A rare and aggressive type of cancer that can mimic the appearance of a malignant PT.
• Breast Cancer: While less common than fibroadenoma, breast cancer can also be considered in the differential diagnosis of malignant PTs.
• Fibroadenoma with Prominent Intracanalicular Growth Pattern: This condition can resemble a malignant PT due to its leaf-like architecture and cellular stroma.

Key Features for Differential Diagnosis:

• Histologic Grading: Malignant PTs are characterized by stromal hypercellularity, nuclear atypia, and mitotic activity. These features should be carefully evaluated in the differential diagnosis.
• Tumor Border and Stromal Overgrowth: The presence of an infiltrative tumor border and stromal overgrowth can help differentiate malignant PTs from benign fibroadenomas.

References:

• [1] Conditions to consider in the differential diagnosis of phyllodes tumors include angiosarcoma, breast cancer, and juvenile fibroadenoma. (Source: Search Result 2)
• [2] The most important differential diagnoses include fibroadenoma with a prominent intracanalicular growth pattern and cellular stroma, spindle cell carcinoma, and malignant fibrous histiocytoma. (Source: Search Result 3)
• [3] Malignant PTs should be included in the list of differential diagnoses along with sarcomas, when encountering lesions of the breast with sarcomatous differentiation. (Source: Search Result 14)

Conclusion

In conclusion, malignant phyllodes tumors require careful consideration of other conditions that may present with similar characteristics. A thorough evaluation of histologic features, tumor border, and stromal overgrowth is essential for accurate differential diagnosis.