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      Recurrent borderline phyllodes tumor of the breast submitted to mastectomy and immediate reconstruction: Case report

      case-report

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          Highlights

          • •

            Phyllodes tumors of the breast are rare fibroepithelial neoplasms.

          • •

            They are histologically classified into benign, borderline and malignant variants.

          • •

            Anatomopathological examination is considered the definitive diagnostic method.

          • •

            They have a high rate of local recurrence and the possibility of metastases.

          • •

            Surgery is the definitive treatment and adjuvant therapy is controversial.

          Abstract

          Introduction

          Phyllodes tumors are biphasic fibroepithelial tumors that account for fewer than 1% of mammary tumors. They usually appear in middle-aged women, with an average size of 4–7 cm and rapid growth.

          Presentation of case

          A 25-year-old woman sought care after excision of recurrent nodules in the right breast, with a diagnosis of borderline phyllodes tumor. She had no new lesions on physical examination. Imaging studies revealed an anechoic collection and nodular areas in a previous surgical site, correlated with pathology. Immuno-histochemical examination was positive for vimentin, calponin, Ki-67 and estrogen receptor. Systemic staging did not show metastases. Skin-reducing mastectomy was performed on the right side, followed by reconstruction and left reduction mammaplasty for symmetry. At 8-month follow-up, there was no relapse of the lesions on clinical and ultrasonographic examinations.

          Discussion

          Phyllodes tumors are rare neoplasms characterized by rapid growth, occurring in women between 35–55 years of age. They are classified as benign, borderline and malignant, according to histological parameters. There are reports of genetic mutations in TP53 associated with malignant phyllodes tumor. On immunohistochemistry, there is a greater tendency to malignancy in tumors with Ki-67 and estrogen receptor expression. Imaging methods may aid in diagnosis, which is only definitive after excision and histopathological analysis of the tumor. These tumors have high local recurrence rates and possibility of metastases, closely related to histology.

          Conclusion

          Phyllodes tumors are a great challenge to the surgeon. Treatment is surgical, with wide excision; radiotherapy and chemotherapy are controversial.

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          Most cited references17

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          Phyllodes tumours.

          Megan Parker, Catherine S Harries (2001)
          Phyllodes tumours are rare fibroepithelial lesions that account for less than 1% of all breast neoplasms. With the non-operative management of fibroadenomas widely adopted, the importance of phyllodes tumours today lies in the need to differentiate them from other benign breast lesions. All breast lumps should be triple assessed and the diagnosis of a phyllodes tumour considered in women, particularly over the age of 35 years, who present with a rapidly growing "benign" breast lump. Treatment can be by either wide excision or mastectomy provided histologically clear specimen margins are ensured. Nodal metastases are rare and routine axillary dissection is not recommended. Few reliable clinical and histological prognostic factors have been identified. Local recurrence occurs in approximately 15% of patients and is more common after incomplete excision. It can usually be controlled by further surgery. Repeated local recurrence has been reported without the development of distant metastases or reduced survival. Approximately 20% of patients with malignant phyllodes tumours develop distant metastases. Long term survival with distant metastases is rare. The role of chemotherapy, radiotherapy, and hormonal manipulation in both the adjuvant and palliative settings remain to be defined.
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            BRCA1 mutation in breast cancer patients: Analysis of prognostic factors and survival

            Joanna Huszno, Zofia Kołosza, Ewa A Grzybowska (2018)
            The presence of BRCA1 mutations is associated with an increased risk of breast and ovarian cancer. The present study compared clinicopathological characteristics and overall survival (OS) of hereditary and sporadic breast cancer. Using data collected from a previous study conducted between 2007–2016 at the Maria Skłodowska Curie Cancer Center and Institute of Oncology (Gliwice, Poland), the prognostic factors and survival in 60 breast cancer mutation carriers were analyzed. A control group was selected from the breast cancer patients without BRCA mutations (n=386). BRCA mutation carriers had significantly worse survival when compared with non-carriers (P=0.017). The 10-year OS rate was 78.0% for all analyzed groups: 65.9% for BRCA mutation carriers and 81.1% for non-carriers. In the univariate analyses, BRCA mutation carriers had a significantly higher risk of mortality in comparison to non-carriers [hazard ratio (HR)=1.87; 95% confidence interval (CI) 1.08–3.25]. Increased tumor size (HR=3.64), lymph node metastases (HR=2.45) and higher histological grade (HR=2.84) were significant factors for worse OS. Positive estrogen receptor status was associated with a better OS (HR=0.49, P=0.022). Age ≤40 years (HR=0.48, P=0.081) was an insignificantly favorable factor. The 10-year survival rate was significantly decreased in patients with BRCA1 mutation. Therefore, negative factors for OS in mutation carriers included lymph nodes metastases, negative steroid receptor status and increased tumor size.
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              Prognostic factors in breast phyllodes tumors: a nomogram based on a retrospective cohort study of 404 patients

              Zhi-Rui Zhou, Chen-Chen Wang, Xiang-Jie Sun … (2018)
              Abstract The aim of this study was to explore the independent prognostic factors related to postoperative recurrence‐free survival (RFS) in patients with breast phyllodes tumors (PTBs). A retrospective analysis was conducted in Fudan University Shanghai Cancer Center. According to histological type, patients with benign PTBs were classified as a low‐risk group, while borderline and malignant PTBs were classified as a high‐risk group. The Cox regression model was adopted to identify factors affecting postoperative RFS in the two groups, and a nomogram was generated to predict recurrence‐free survival at 1, 3, and 5 years. Among the 404 patients, 168 (41.6%) patients had benign PTB, 184 (45.5%) had borderline PTB, and 52 (12.9%) had malignant PTB. Fifty‐five patients experienced postoperative local recurrence, including six benign cases, 26 borderline cases, and 22 malignant cases; the three histological types of PTB had local recurrence rates of 3.6%, 14.1%, and 42.3%, respectively. Stromal cell atypia was an independent prognostic factor for RFS in the low‐risk group, while the surgical approach and tumor border were independent prognostic factors for RFS in the high‐risk group, and patients receiving simple excision with an infiltrative tumor border had a higher recurrence rate. A nomogram developed based on clinicopathologic features and surgical approaches could predict recurrence‐free survival at 1, 3, and 5 years. For high‐risk patients, this predictive nomogram based on tumor border, tumor residue, mitotic activity, degree of stromal cell hyperplasia, and atypia can be applied for patient counseling and clinical management. The efficacy of adjuvant radiotherapy remains uncertain.
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                Author and article information

                Contributors
                Bruno Bisognin Garlet
                Luciano Zogbi
                Juliana Piveta de Lima
                Paulo Pereira de Souza Favalli
                Frederico Diefenthaeler Krahe
                Journal
                Journal ID (nlm-ta): Int J Surg Case Rep
                Journal ID (iso-abbrev): Int J Surg Case Rep
                Title: International Journal of Surgery Case Reports
                Publisher: Elsevier
                ISSN (Electronic): 2210-2612
                Publication date PMC-release: 05 June 2019
                Publication date Collection: 2019
                Publication date (Electronic): 05 June 2019
                Volume: 60
                Pages: 25-29
                Affiliations
                [a ]Department of Surgery, Federal University of Rio Grande (FURG), Visconde de Paranaguá Street, No. 102, 96203-900, Rio Grande, Brazil
                [b ]Postgraduate Program in Nursing, Federal University of Rio Grande (PPGEnf - FURG), Visconde de Paranaguá Street, No. 102, 96203-900, Rio Grande, Brazil
                [c ]Department of Plastic Surgery, Moinhos de Vento Hospital, Ramiro Barcelos Street, No. 910/604, 90035-004, Porto Alegre, Brazil
                [d ]Department of Breast Surgery, Moinhos de Vento Hospital, Ramiro Barcelos Street, No. 910/604, 90035-004, Porto Alegre, Brazil
                Author notes
                [* ]Corresponding author at: Venâncio Aires Avenue, No. 1611/02, 98005-096, Cruz Alta, Rio Grande do Sul, Brazil. bruno_garlet@ 123456hotmail.com
                Article
                Publisher ID: S2210-2612(19)30279-2
                DOI: 10.1016/j.ijscr.2019.05.032
                PMC ID: 6562175
                PubMed ID: 31195364
                SO-VID: 740cf6a5-19e1-4fe3-b85f-64f154fc29ed
                Copyright © © 2019 The Authors
                License:

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 4 April 2019
                Date revision received : 7 May 2019
                Date accepted : 16 May 2019
                Categories
                Subject: Article

                Keywords: phyllodes tumor,breast,mastectomy,mammaplasty,plastic surgery,case report
                Data availability:
                Keywords: phyllodes tumor, breast, mastectomy, mammaplasty, plastic surgery, case report

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