Journal of Pathology and Translational Medicine

Case Study

Cystic Benign Phyllodes Tumor in the Inguinal Region: Jai Hyang Go; Korean J Pathol. 2013;47(6):583-586. Published online December 24, 2013; DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.6.583

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The present lesion was the first reported case of a benign intracystic phyllodes tumor in the inguinal region. We report the case of a 51-year-old female patient who presented with an inguinal mass. A clinical diagnosis of malignant lymphoma was considered in this case. The resected tumor was well-circumscribed and showed numerous papillary nodular protrusions into a central cystic cavity (3.5×2.5 cm). The microscopic findings showed hyperplastic epithelium-lined cysts with leaf-like intraluminal epithelium-lined bland stromal projections. The epithelial cell linings were strongly positive for estrogen and progesterone receptors.

Citations

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Benign phyllodes tumor arising from accessory breast tissue of the axilla: An inquisitive rarity
Sonam Sharma
Saudi Surgical Journal.2024; 12(1): 54. CrossRef
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P. M. Kotlyarov, I. D. Lagkueva, N. I. Sergeev
Russian Pulmonology.2019; 29(1): 112. CrossRef
Mama ectópica en la región inguinal
V.Y. Presas, L.M. Mastronardi, S. Saucedo, E. Rojas Bilbao
Clínica e Investigación en Ginecología y Obstetricia.2017; 44(2): 89. CrossRef

Case Report

Invasive Cribriform Carcinoma Arising in Malignant Phyllodes Tumor of Breast: A Case Report: Yoomi Choi, Kyoung Yul Lee, Min Hye Jang, Hyesil Seol, Sung-Won Kim, So Yeon Park; Korean J Pathol. 2012;46(2):205-209. Published online April 25, 2012; DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.2.205

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Abstract PDF

Phyllodes tumor is an uncommon fibroepithelial neoplasm of the breast. And it is characterized by expanded stroma with increased cellularity and elongated epithelium-lined clefts. Mammary carcinomas within phyllodes tumors have been rarely reported. To date, however, no reports have described the invasive cribriform carcinoma arising in malignant phyllodes tumor. Here, we report a 62-year-old woman who presented with a large breast mass. Microscopically, the mass was a typical malignant phyllodes tumor showing well developed leaf-like architecture and stromal overgrowth with high cellularity and nuclear pleomorphism. In a portion of the tumor, however, the epithelial component showed a cribriform pattern of proliferation in the absence of myoepithelial cells, suggestive of the invasive cribriform carcinoma. To our knowledge, this is rare and it is difficult to make a differential diagnosis of it. Here, we report our case with a review of literatures.

Citations

Citations to this article as recorded by

Management of Concurrent Malignant Phyllodes Tumor and Invasive Breast Carcinoma
Jie Jane Chen, Iowis Zhu, Akshat Patel, Gregor Krings, Yunn-Yi Chen, Florence Yuen, Rita A. Mukhtar, Michelle Melisko, Lisa Singer, Catherine C. Park, Nicolas D. Prionas
Advances in Radiation Oncology.2024; 9(5): 101448. CrossRef
High-grade ductal carcinoma in-situ detected by microcalcification within borderline phyllodes tumor: Report of a case and literature review
Wing Nam Yuen, Joshua J.X. Li, Man Yi Chan, Gary M. Tse
Human Pathology Reports.2023; 31: 300697. CrossRef
Cribriform carcinoma arising in a benign phyllodes tumor
Elia Shazniza Shaaya, Nurwahyuna Rosli, Nurismah M D Isa
Journal of Research in Medical Sciences.2023;[Epub] CrossRef
Unexpectedly High Coexistence Rate of In Situ/Invasive Carcinoma In Phyllodes Tumors. 10-Year Retrospective and Review Study
Öykü Dila Gemci, Serdar Altınay, Rümeysa İlbar Tartar, Sina Ferahman
European Journal of Breast Health.2022; 18(4): 343. CrossRef
A Case of Phyllodes Tumor Combined with Lobular Carcinoma of the Breast with Microinvasion
Daiki IMANISHI, Satoru NODA, Tsutomu TAKASHIMA, Yukie TAUCHI, Shinya NOMURA, Hiroshi OHTANI, Noriko SAKAIDA
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association).2022; 83(12): 2049. CrossRef
Invasive ductal carcinoma within borderline phyllodes tumor with lymph node metastases: A case report and review of the literature
DI WU, HAIPENG ZHANG, LIANG GUO, XU YAN, ZHIMIN FAN
Oncology Letters.2016; 11(4): 2502. CrossRef

Original Articles

Cytohistologic Correlation of Phyllodes Tumors of the Breast: A Study on 17 Cases.: Young Ha Oh, Moon Hyang Park; Korean J Pathol. 2009;43(1):68-74.; DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.1.68

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Abstract PDF: Phyllodes tumor (PT) is a rare fibroepithelial tumor of the breast, and these tumors are subdivided into benign, borderline, and malignant tumors. The criteria for their histologic diagnosis have been relatively well-described. However, the cytologic diagnosis presents more difficulties and only a few cytologic studies concerned with their subclassification have been published. The objective of the current study is to describe the cytologic features of benign, borderline and malignant PTs in an attempt to distinguish one from the others. Cytohistologic correlation for 11 benign, 3 borderline and 3 malignant PTs was performed. For all these cases, the preoperative fine needle aspiration (FNA) findings were available for review. The features we examined were a necrotic background, cellularity, stromal tissue fragments, stromal pleomorphism and atypism, dissociated stromal cells and mitosis. The overall diagnostic accuracy of FNA for the PT grading was 88.2% (15/17). Two benign PTs were cytologically misinterpreted as "atypical epithelial and stromal cells" and "highly suspicious for ductal carcinoma". Nevertheless, the cytologic diagnosis and the grading of PTs on FNA were relatively reliable. Semiquantitative analysis for the cellular stromal tissue fragments, stromal pleomorphism and atypism, dissociated stromal cells and mitosis might be helpful for subclassifing PTs on FNA. In the case of encountering a markedly necrotic background, special concern about degenerative change such as infarction is needed.

DNA Ploidy Analysis as a Prognostic Indicator in Phyllodes Tumor of the Breast.: Hee Jung Kim, Jae Ho Han, Woo Hee Jung, Hy De Lee; Korean J Pathol. 1999;33(7):507-516.

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Abstract PDF: DNA ploidy analysis using flow cytometry was performed on sixty six cases of phyllodes tumor of the breast including benign, low grade and high grade malignant phyllodes tumor. The rate of aneuploidy was 41.2% in high grade malignant phyllodes tumor and 4.8% in benign phyllodes tumor. No aneuploidy was noted in low grade malignant phyllodes tumor. The recurrence rate according to DNA ploidy pattern revealed 16.7% of aneuploidy and 7.7% of diploidy. In the aneuploid cases, the DNA index of high grade malignant phyllodes tumor was higher than benign phyllodes tumor. Morever, in diploid cases, %SG2M were significantly higher in high grade malignant phyllodes tumor. Therefore, we conclude that DNA ploidy analysis as well as histologic characteristics such as cellularity, pleomorphism of stromal cells and mitoses is useful parameters in the diagnosis, recurrence and prognostic predictors of phyllodes tumor.

Case Report

Recurrent Malignant Phyllodes Tumor with Liposarcoma.: Ji Shin Lee, Hyung Seok Kim, Jong Jae Jung, Chong Dug Cho; Korean J Pathol. 2001;35(6):558-560.

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Abstract: Phyllodes tumors are an uncommon mammary tumors composed of benign epithelial elements and cellular, spindle cell stroma. Adipose differentiation is an uncommon stromal alteration in phyllodes tumors. Herein, a case of recurrent phyllodes tumors with liposarcomatous stroma is described. A 30-year-old female presented with a left breast mass. Histologic examination showed a phyllodes tumor with low-grade malignant potential exhibiting a few mitoses and moderate cellularity. It also contained mature adipose tissue as well as a well-differentiated liposarcomatous area. This tumor recurred 43 months later. The recurrent tumor had a higher cellular density and more mitoses than the primary tumor.

Original Article

Cytologic Features of Benign Phyllodes Tumors as Compared to Fibroadenomas of the Breast.: Jae Hee Suh, Gyung Yub Gong, Jeong Mi park, Sei Hyun Ahn, On Ja Kim; Korean J Cytopathol. 1996;7(2):151-156.

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Abstract PDF: Phyllodes tumor(PT) is a rare distinctive fibroepithelial breast tumor that occasionally shows unpredictable clinical behavior. Wide excision should be the primary treatment of PT and enucleation, the standard procedure for fibroadenoma(FA), is proscribed due to high frequency of local recurrence. Therefore an accurate preoperative diagnosis of PT is essential in order to ensure proper surgical treatment. However, the differentiation between benign PT and FA is often difficult on the basis of cytologic findings. In an attempt to better understand the cytologic features of benign PT and possibly to differentiate PT from FA on the findings of fine needle aspiration(FNA)smears, we reviewed cytologic smears from 22 histologically diagnosed cases each of benign PT and FA, respectively. The cytologic features assessed were cellularity and atypia of both epithelial and stromal components, and shape of epithelial cell clusters. Atypia of stromal cells was more frequent in PT, while blunt branching pattern of epithelial cells was more frequent in FA. The specific cytologic diagnosis of PT is not possible in many cases, but the abundance of stromal cells with moderate nuclear atypia in the correct clinical setting such as older age and larger size(>4cm) allows the diagnosis.

Case Report

Cytologic Features of Pseudoangiomatous Stromal Hyperplasia of the Breast: A Case Report with Review of Literature.: Jin Sook Lee, Jee Yeon Kim, Dong Hoon Shin, Do Youn Park, Kyung Un Choi, Chang Hoon Lee, Mee Young Sol; Korean J Cytopathol. 2005;16(1):25-30.

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Abstract PDF: Pseudoangiomatous stromal hyperplasia(PASH) was initially described by Vuitch et al. as a benign breast lesion, consisting of mammary stromal proliferations which simulate vascular lesions, and which might be mistaken for a low-grade angiosarcoma. This condition occasionally presents as a palpable mass in postmenopausal women, but is more frequently encountered as an incidental component in premenopausal women. Clinical, radiological, and fine-needle aspiration(FNA) findings associated with this condition can mimic those observed in conjunction with a phyllodes tumor or a fibroadenoma. The cytological features of PASH are generally nonspecific, and its diagnosis by FNA cytology is fairly difficult. In this study, we report a case of PASH, manifesting as a palpable mass

Original Article

Immunohistochemical Phenotypes of Phyllodes Tumor of the Breast.: Joo Yeon Song, Hye Kyoung Yoon; Korean J Pathol. 2008;42(3):151-156.

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Abstract PDF: BACKGROUND
The aim of the study is to evaluate the difference of immunophenotypes of stromal cells between the pure phyllodes tumor (PT) type and the co-existent type of phyllodes tumor and fibroadenoma, and between benign and malignant PT.
METHODS
Immunohistochemical staining for actin, CD34, CD10, c-kit, bcl-2, p53 and MIB-1 was performed using tissue microarray blocks that contained 25 cases of pure PT (16 benign tumors, 4, borderline malignant tumors, and 5 malignant tumors) and 6 cases of co-existent type.
RESULTS
The expression rates of CD34 and MIB-1 in the pure PT type were significantly higher and the expression rate of actin in the pure PT was significantly lower than that of the co-existent type. However, there were no significant differences in the bcl-2, CD10, and p53 expressions between the pure PT type and the co-existent type, and no c-kit expression was observed in both types. No significant differences in the CD34, actin, bcl-2, CD10, and p53 expressions between the benign and borderline/malignant PT cases were found. However, a significant difference of the MIB-1 expression rate was noted.
CONCLUSIONS
The stromal cells of the pure PT type are regarded as less mature myofibroblasts, and the CD10 reactivity in some phyllodes tumors suggests a myoepithelial origin. The MIB-1 labeling index would be useful for the grading of phyllodes tumor.

Case Reports

A Positive Hybrid (HMW-CK and E-Cadherin) Carcinoma in situ Arising in a Phyllodes Tumor of the Breast: A Case Report.: Yun Kyung Kang, Young Hyeh Ko; Korean J Pathol. 2008;42(2):113-117.

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Abstract PDF: Malignant transformation in phyllodes tumor (PT) is uncommon and almost always confined to the stromal component. Epithelial changes like hyperplasia, metaplasia, and varying degrees of atypia are not uncommon in PT, whereas carcinomatous change is extremely rare. We report a 37-year-old woman with carcinoma in situ (CIS) arising in a benign PT. Grossly, it was a well circumscribed, 4.5 cm-sized mass. The CIS component was confined to the PT and showed overlapping ductal and lobular features with coexpression of E-cadherin and high molecular weight cytokeratin (HMW-CK). The present case emphasizes that careful investigation of multiple microscopic sections is mandatory to find a small carcinomatous lesion within PT. Expression of E-cadherin and HWM-CK in this hybrid CIS suggests that intraepithelial neoplasia of the breast arising in PT may be derived from a common progenitor of the terminal duct-lobular unit.

Invasive Ductal Carcinoma Arising in a Recurrent Malignant Phyllodes Tumor: A Case Report.: Ahwon Lee, Gyeongsin Park, Kyo Young Lee, Chang Suk Kang, Byung Kee Kim, Sang In Shim; Korean J Pathol. 2005;39(2):134-136.

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Abstract PDF: We report here on a case of invasive ductal carcinoma arising in a recurrent malignant phyllodes tumor. The patient was a 33-year-old woman who presented with a left breast mass, and an excision was then performed. The mass, measuring 7.0 x 4.0 cm in size, was relatively well demarcated with a nodular contour and showed pale gray and solid cut surface with clefts on it. Histologically, the mass mainly consisted of stromal components that were characterized by high cellularity, marked nuclear atypism and brisk mitosis. The sparse glandular components were leaf-like in shape and lined by bland ductal epithelium without any nuclear atypism. Sixteen months later, the patient revisited our hospital with a recurrent mass, and underwent total mastectomy. The recurrent mass contained foci of definite invasive ductal carcinoma in the background of malignant phyllodes tumor, which was identical to the primary mass. This case demonstrates that it is possible that an invasive ductal carcinoma might arise within, at least with, a recurrent malignant phyllodes tumor.

Original Article

Pathological Analysis of 15 Cases of Phyllodes Tumors of the Breast.: Sung Nam Kim, Woo Ho Kim, Sang Kook Lee; Korean J Pathol. 1993;27(1):19-26.

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Abstract PDF: Retrospective clinicopathologic analysis of 15 patients with the phyllodes tumors(PT) of the breast, diagnosed at SNUH over 6 years period, was done. By light microscopy, 8 cases were diagnosed as benign, and 7 cases were diagnosed as malignant. Mean ages o the patients were 37 and 34 years in malignant and benign, respectively. Most of those cases were presented with a palpable mass of the breast. None of the patients with malignant PT had distant metastasis, Local recurrences were experienced in 3 patients among the malignant PT, and one patient among the benign PT. One of 7 malignant PT was coexisted with simultaneous ipsilateral infiltrating duct carcinoma. The clinical course was not well correlated with pathologic features. The prognostic significances of several histopathologic parameters were assessed for possible correlation with local recurrence, metastasis and death; stromal cellularity, stromal cellular atypism, mitotic activity, tumor contour, necrosis, tumor size and heterologous stromal elements. Immunohistochemistry using antibody to vimentin, proliferating cell nuclear antigen(PCNA) and epidermal growth factor receptor(EGF-R) were analysed. In the 5 cases of benign PT, the stromal cells stained diffusely positive for vimentin and 3 cases of malignant tumors show similar staining for vimentin. The percentage of PCNA-positive cells were higher in the malignant PT than in the benign ones; they were 3.5% to 60% in malignancy, while they were less than 60% in all benign PT. The results of EGF-R staining were correlated with the histologic classification; only 2 cases out of 8 benign PT show diffusely positive staining of EGF-R in the cytoplasm, but 6 cases out of 7 malignant PT show positive findings.

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