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Phyllodes tumor and its malignization into invasive ductal carcinoma − a case report


Authors: A. Jesenková 1,6;  J. Mergancová 1,3;  J. Mergancová Jr. 1;  D. Dvořáková 2;  E. Šnáblová 3;  M. Hácová 4,5
Authors place of work: Chirurgická klinika, Pardubická nemocnice, Nemocnice Pardubického kraje, a. s., Pardubice 1;  Komplexní onkologické centrum Pardubického kraje, Multiscan, s. r. o., Pardubice 2;  EUC klinika, a. s., Pardubice 3;  Oddělení patologie, Pardubická nemocnice, Nemocnice Pardubického kraje, a. s., Pardubice 4;  Fakulta zdravotnických studií Pardubice, Univerzita Pardubice 5;  Lékařská fakulta v Hradci Králové, Univerzita Karlova, Praha 6
Published in the journal: Rozhl. Chir., 2021, roč. 100, č. 6, s. 295-301.
Category: Case Report
doi: https://doi.org/10.33699/PIS.2021.100.6.295–301

Summary

Introduction: Phyllodes tumors of the breast are rare and very distinct types of mammary neoplasms. They are characterized by their biphasicity, i.e. the presence of stromal and epithelial components at the same time. Malignancy is determined by the degree of stromal differentiation. The coexistence of the malignant epithelial component is a very rare phenomenon. Dozens of cases of simultaneous phyllodes tumor and epithelial malignancy have been reported so far. Nevertheless, the biological nature of this process is still an unexplained and a controversial topic.

Case report: In this paper, we present a case of a patient with a suddenly enlarging lesion in the breast. According to the first surgical resection, a diagnosis of high-grade malignant phyllodes tumor was made with fibrosarcoma differentiation, stromal overgrowth and suppression of the epithelial component. Examination of scar resistence in early postoperative period revealed a triple-negative invasive low-differentiated breast carcinoma with very high proliferative activity, thus malignization of the epithelial component of the tumor occurred. Shortly, a diagnosis of second recurrence was made, treatment included axillary lymph node dissection (ALND) with a negative histological findings. The patient underwent complex adjuvant chemotherapy and radiotherapy and remained disease free 3 years after the surgery.

Conclusion: Coexistence of phyllodes tumor and the breast carcinoma is very rare. The article describes the first published case, which documents the subsequent development of invasive low-differentiated ductal carcinoma immediately after resection of high-grade phyllodes tumor. Treatment and prognosis are generally determined by the characteristics of the carcinomatous component.

Keywords:

phyllodes tumor – breast neoplasm – ductal carcinoma – case report


Zdroje

1. Ditsatham C, Chongruksut W. Phyllodes tumor of the breast: diagnosis, management and outcome during a 10-year experience. Cancer Manag Res. 2019 Aug 19;11:7805−7811. doi:10.2147/CMAR. S215039.

2. Lakhani SR, Ellis IO, Schnitt SJ, et al. World Health Organization classification of tumours of the breast. Lyon, IARC Press 2019.

3. Widya RL, Rodrigues MF, Truong PT, et al. Malignant epithelial transformation in phyllodes tumor: A population- based case series. Cureus 2017 Nov 3;9(11):e1815. doi:10.7759/cureus.1815.

4. Lui SA, Oh HB, Wang S, et al. Ductal carcinoma in-situ arising within benign phyllodes tumours. Ann R Coll Surg Engl. 2018 Apr;100(4):e97−e102. doi:10.1308/ rcsann.2018.0024.

5. Tan PH, Jayabaskar T, Chuah KL, et al. Phyllodes tumors of the breast: the role of pathologic parameters. Am J Clin Pathol. 2005 Apr;123(4):529−540. doi:10.1309/ U6DV-BFM8-1MLJ-C1FN.

6. Saimura M, Koga K, Anan K, et al. Diagnosis, characteristics, and treatment of breast carcinomas within benign fibroepithelial tumors. Breast Cancer 2018 Jul;25(4):470−478. doi:10.1007/s12282-018-0847-7.

7. Amir RA, Rabah RS, Sheikh SS. Malignant phyllodes tumor of the breast with metastasis to the pancreas: A case report and review of literature. Case Rep Oncol Med. 2018 Jun 27;2018:6491675. doi:10.1155/2018/6491675.

8. Bozkurt H, Karakaya IB, Aktas E, Irkorucu O. Coexistence of phylloides tumour and invasive ductal cancer in the breast. Niger J Clin Pract. 2019 Aug;22(8):1169−1171. doi:10.4103/njcp.njcp_602_18.

9. Tan BY, Acs G, Apple SK, et al. Phyllodes tumours of the breast: a consensus review. Histopathology 2016 Jan;68(1):5−21. doi:10.1111/his.12876.

10. Onkendi EO, Jimenez RE, Spears GM, et al. Surgical treatment of borderline and malignant phyllodes tumors: the effect of the extent of resection and tumor characteristics on patient outcome. Ann Surg Oncol. 2014 Oct;21(10):3304−3309. doi:10.1245/s10434-014-3909-x.

11. Carter BA, Page DL. Phyllodes tumor of the breast: local recurrence versus metastatic capacity. Hum Pathol. 2004 Sep;35(9):1051−1052. doi:10.1016/j. humpath.2004.08.001.

12. Nayak M, Patra S, Mishra P, et al. Malignant phyllodes tumor with heterologous differentiation: Clinicopathological spectrum of nine cases in a tertiary care institute in Eastern India. Indian J Pathol Microbiol. 2017 Jul–Sep;60(3):371−376. doi:10.4103/IJPM.IJPM_426_16.

13. Buchberger W, Strasser K, Heim K, et al. Phylloides tumor: findings on mammography, sonography, and aspiration cytology in 10 cases. AJR Am J Roentgenol. 1991 Oct;157(4):715−719. doi:10.2214/ ajr.157.4.1654022.

14. Co M, Tse GM, Chen C, et al. Coexistence of ductal carcinoma within mammary phyllodes tumor: A review of 557 cases from a 20-year region-wide database in Hong Kong and Southern China. Clin Breast Cancer 2018 Jun;18(3):e421−e425. doi:10.1016/j.clbc.2017.06.001.

15. Vyzula R, Adámková Krákorová D, Arenberger P, et al. Zhoubný novotvar prsu. In: Modrá kniha České onkologické společnosti. 25. aktualizace. Brno: KAPCZ. Vydal Masarykův onkologický ústav 2019:70−88.

Štítky
Surgery Orthopaedics Trauma surgery

Článok vyšiel v časopise

Perspectives in Surgery

Číslo 6

2021 Číslo 6
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