Missed Diagnosis of Phyllodes Tumour And Its Implications - A Case Report (original) (raw)
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Clinical and cytopathological aspects in phyllodes tumors of the breast
PubMed, 2009
The frequency of mesenchymal breast tumors is very low, being represented mostly by tumors with biphasic proliferation (phyllodes tumors) and less by other types of non-epithelial tumors. From clinical point of view, phyllodes tumors (PT) can mimic a breast carcinoma. Therefore, the preoperative diagnosis by cytological examination on material obtained by fine needle aspiration (FNA) is very important for adequate treatment of these tumors. In current study, we assessed clinical aspects of 79 phyllodes tumors regarding patient's age and localization of the tumors. In 17 out of 79 cases, it has been performed FNA within the tumors with further cytological examination on the smears obtained. The median age of the patients was 46.07-year-old, being progressively higher with grade of the tumors with significant values between benign and borderline tumors (p=0.04954) and between benign and malignant ones (p=0.02890). The distinguish on the smears of stromal fragments and naked stromal nuclei with variable grade of atypia regarding the tumoral type, in detriment of epithelial elements have been conclusive for fibroepithelial lesion as cytopathological diagnosis. The preoperative differentiation between a breast phyllodes tumor and a breast carcinoma is extremely important for avoiding of a useless radical surgery for the patient. If the fine needle aspiration was correctly performed, the accuracy of the cytodiagnosis has been 82% in current study.
Phyllodes tumor of the breast-Cytohistological study
IP Innovative Publication Pvt. Ltd., 2018
Introduction: Phyllodes tumor constitutes an uncommon group of mammary fibroepithelial neoplasm, having incidence of about 0.3% to 1% of breast tumors. The median age of occurrence of disease is 40 to 50 years. These tumors were first recognized by Muller, who used the term “cystosarcoma phyllodes” (phyllos = leaf, Greek). The differential diagnosis between phyllodes tumor & fibroadenoma and histological grading of phyllodes tumor is challenging. Material and Methods: Retrospective data from cytology and histopathology record in pathology Department, Muzaffarnagar Medical College, Muzaffarnagar showed seven cases of phyllodes tumor. In all cases, Fine Needle Aspiration Cytology (FNAC) was initially performed and was further confirmed on histopathology. Results: The age range of these patients was from 18 to 61 years. The size of the breast lesion ranged from 6x5 cms to 40x30 cms. Tumors were classified according to WHO grading system based on the degree of stromal cellularity and atypia, presence or absence of stromal overgrowth, mitotic count and nature of tumor margin. Out of seven cases, two cases of were reported as benign phyllodes tumor, four as borderline and one as malignant. Two cases recurred within one year, one was benign and other one was diagnosed as borderline. Conclusion: Preoperative diagnosis and proper management is important in phyllodes tumor to minimize the recurrence and malignant potential. So, accurate diagnosis of phyllodes tumor is crucial so that they are effectively treated. Treatment include wide surgical excision with negative margins. Keywords: Breast, Phyllodes, Fibroadenoma, Classification, Fibroepithelial neoplasm.
A large benign phyllodes tumour of the breast: A case report and literature review
International Journal of Surgery Case Reports, 2017
INTRODUCTION: Phyllodes tumours are uncommon fibroepithelial lesions that typically grow up to 4 cm in size but 10 cm tumours known as giant phyllodes tumours have been described. We present a case report of a 20 cm benign phyllodes tumour and a literature review. PRESENTATION OF CASE: A 54 years old lady with an enlarging left breast mass measuring 20 cm of 6 months duration presented to our outpatient breast clinic. She also had an incidental right parotid lump. Core biopsy of the left breast mass returned as a cellular fibroepithelial lesion. A mastectomy and axillary lymph node sampling were done and skin cover was obtained from a split skin graft from the thigh. Final histology returned as a benign phyllodes tumour. Her post-operative recovery was uneventful. DISCUSSION: Phyllodes tumours are suspected in middle age women with rapidly enlarging painless breast masses. Though there are some suggestive features on ultrasound and MRI, the key to diagnosis is still histopathology. However, a pre-operative diagnosis may not always be possible as the interpretation of stromal cellularity and degree of atypia needed to differentiate cellular fibroadenoma from a phyllodes tumour is subjective. When a phyllodes tumour is suspected, adequate margins should be taken for optimal outcome. CONCLUSION: Successful management of phyllodes tumour involves obtaining a pre-operative diagnosis via a core biopsy when possible and planning for adequate margins.
ANZ Journal of Surgery, 2018
Background: To assess the efficacy of the diagnostic modalities used in the preoperative assessment of phyllodes tumours. Methods: In this retrospective study of patients treated at Princess Alexandra Hospital, 51 phyllodes tumours in 49 patients diagnosed between 2005 and 2016 were reviewed with regard to their preoperative findings to assess which modalities, including clinical findings, mammography, ultrasound, fine needle aspiration and core biopsy, were most diagnostically discriminating. Data on demographics and management were also collected. Results: While 90.2% of lesions were clinically palpable and an abnormality was seen in 86.1% of lesions subjected to mammography, the findings in relation to these two modalities were essentially those of non-discriminatory masses. Furthermore, although 100% of the phyllodes lesions were sonographically visible, suspicion of a phyllodes tumour was only noted in 21.6% of cases. Fine needle aspiration yielded results suspicious for phyllodes in 21.1% of cases while core biopsy resulted in confirmed or suspected phyllodes tumour diagnoses in 69.2% of instances. Serial measurements of phyllodes tumours yielded an average growth rate of 8.04 mm per 365 days. Conclusion: In the preoperative diagnosis of phyllodes tumours of the breast, ultrasound was a more discriminating imaging modality compared to mammography, and core biopsy demonstrated a superior accuracy of diagnosis over fine needle biopsy. A significant increase in lesion size over a short timeframe should also alert to the possibility of a phyllodes tumour.
Peculiarities of Diagnosis in the Phyllodes Tumor
Journal of Surgical Sciences, 2015
Phyllodes tumor (PT) is an uncommon and distinct category of breast cancer, being a particular form of intracanalicular fibroadenoma. A definitive diagnosis is difficult to make just based on imaging investigations and fine needle biopsy; also PTs are frequently misinterpreted as breast fibroadenomas. In the case of of a 26-year old woman with a suspected PT (based on clinical investigation) which was first diagnosed as a fibroadenoma using ultrasonography and preoperative biopsy, further investigation was needed. A limited resection was performed and the postoperative histopathology confirmed the diagnosis as PT.
Phyllodes Tumor of the Breast: A Clinicopathological Evaluation of 55 Cases
European Journal of Breast Health, 2019
Objective: Phyllodes tumors are biphasic tumors consisting of epithelial and stromal components that account for less than 1% of all breast tumors. According to the World Health Organization (WHO) phyllodes tumors are classified into three categories as benign, borderline and malignant. It has been reported that these tumors are usually benign and both the stromal component and the epithelial component may progress to malignancy. In this descriptive study, it was aimed to present the cases of phyllodes tumor and to evaluate the clinicopathological features of these tumors in the light of the literature. Materials and Methods: In our study, 55 cases of phyllodes tumor diagnosed between 2005-2018 in the Department of Medical Pathology were retrospectively studied. A total of 55 cases were included in the study. Results: All cases were female with a mean age of 39.7+15.2 years. Fifty-seven tumors diagnosed in 55 cases were classed as benign in 20 cases (35.1%), borderline in 14 cases (24.6%) and malignant phyllodes tumors in 23 cases (40.3%). Ductal carcinoma in situ (solid and cribriform type) were detected in one case with malignant phyllodes tumor, whereas invasive ductal carcinoma was detected in one case. Bilateral ductal carcinoma in situ was present in the patient with invasive ductal carcinoma. Conclusion: These tumors which rapidly grow into large masses can be clinically and pathologically confused with benign lesions, macroscopic and microscopic evaluation of concomitant in situ-invasive carcinomas should be considered. Phyllodes tumors have an important role in breast surgery and pathology.
Phyllodes tumors of breast: An experience in a tertiary care centre
IP innovative publication pvt ltd, 2020
Phyllodes tumors are uncommon fibroepithelial tumors of breast that have potential for recurrence and metastasis. Triple assessment by clinical, radiological and histological examination forms the fundamental basis for the evaluation of phyllodes tumor. Treatment could be either by wide excision or mastectomy provided that clear histological margins are achieved. Wide local excision with at least 1 cm clear margin is currently the standard of treatment of phyllodes tumor in most institutions. Most of these behave in benign fashion however, malignant tumors have higher tendency for local recurrence and systemic dissemination to lungs, brain. Lymph node involvement is rare.
A Rare Case of Phyllodes Tumour
2014
Phyllodes tumours are rare and account for 0.4% of all breast tumours (Dyer et al., 1966). 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 1 . 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 (Popescu et al., 1991). A 45 year old female presented with complaints of lump in the left breast for six months. No other associated symptoms. On examination a swelling of sized 10x8 cms occupied in the entire breast with individual mobility within the breast. All basic investigations were normal except bilateral mammogram showed grade 4 ...
Phyllodes tumours of the breast: a consensus review
Histopathology, 2015
Phyllodes tumours constitute an uncommon but complex group of mammary fibroepithelial lesions. Accurate and reproducible grading of these tumours has long been challenging, owing to the need to assess multiple stratified histological parameters, which may be weighted differently by individual pathologists. Distinction of benign phyllodes tumours from cellular fibroadenomas is fraught with difficulty, due to overlapping microscopic features. Similarly, separation of the malignant phyllodes tumour from spindle cell metaplastic carcinoma and primary breast sarcoma can be problematic. Phyllodes tumours are treated by surgical excision. However, there is no consensus on the definition of an appropriate surgical margin to ensure completeness of excision and reduction of recurrence risk. Interpretive subjectivity, overlapping histological diagnostic criteria, suboptimal correlation between histological classification and clinical behaviour and the lack of robust molecular predictors of outcome make further investigation of the pathogenesis of these fascinating tumours a matter of active research. This review consolidates the current understanding of their pathobiology and clinical behaviour, and includes proposals for a rational approach to the classification and management of phyllodes tumours.
Phyllodes tumor of the breast: diagnosis, management and outcome during a 10-year experience
Cancer Management and Research
Background: Phyllodes tumor is a very rare tumor of the breast, incidence being 0.3-0.9% of all breast tumors. Phyllodes tumors are classified into three grades: benign, borderline or malignant. The aim of this study was to investigate patient characteristics, imaging characteristic findings, surgical treatment and outcome of phyllodes tumor. Materials and methods: This is a retrospective review of phyllodes tumor patients who had undergone surgical management between