phyllodes tumors of the breast final
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BACK GROUND Cystosarcoma phyllodes (CP) is an extremely rare form of
breast lesion with an unpredictable clinical course.
This accounts for 0.30.9% of all breast neoplasms and
approximately 2%-3% of all fibro-epithelial lesions of the
breast.
Given their rarity, epidemiologic data are scant.
Study-Los Angeles county -17 yr period
Average annual incidence rate was 2.1 per million women,
Higher incidence in Latina whites, as compared to non-Latina whites, Asians,
and African American women
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BACK GROUND This neoplasm is manifested in women of all ages, including
adolescent and elderly.
Median age at presentation is 42 to 45 (10 to 82 yrs)
Data - Tumor grade increases with mean age at diagnosis
Some case reports describe these tumors in men, usually in
association with gynecomastia
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BACK GROUND No etiologic or predisposing factors - exception of Li-Fraumeni
syndrome,
Rare autosomal dominant condition - development of multipletumors
They tend to be large, very fast-growing breast tumors that
evolve in a 'leaf-shaped' growth pattern.
Hence the diagnosis should be considered in all rapidly
growing breast nodules.
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BACKGROUND- GROSS HISTOLOGY Round to oval multinodular masses with a grayish white
appearance that resemble the head of a cauliflower
May be indistinguishable from fibroadenomas.
Grow radially creating a pseudocapsule through which tongues
of stroma may protrude and grow into adjacent breast tissue
Necrosis and hemorrhage can occur in larger tumors.
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BACKGROUND- MICROSCOPIC
APPEARENCE Range of appearances covers the spectrum from resembling a
benign fibroadenoma to a high-grade sarcoma.
Characteristic leaf-like architecture consists of elongated cleft-
like spaces that contain papillary projections of epithelial-lined
stroma with varying degrees of hyperplasia and atypia.
The stromal elements are a key component in the
differentiation of phyllodes tumors from fibroadenomas and in
distinguishing a benign from a malignant phyllodes tumor
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BACK GROUND
Histologically, phyllodes tumors are classified as benign,
borderline or malignant.
The most commonly accepted criteria used for classification of
benign versus malignant tumors are as follows.
The degree of stromal cellular atypia
Mitotic activity
Infiltrative as compared to circumscribed tumor margins.
Presence or absence of stromal overgrowth (ie, presence of pure stroma
devoid of epithelium).
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BACK GROUND
Benign -increased stromal cellularity with mild to moderate cellular atypia,
circumscribed tumor margins and low mitotic rate (less than 4 mitoses per
10 high power fields) and lack of stromal overgrowth.
Borderline -greater degree of stromal cellularity and atypia, a mitotic rate
from 4 to 9 mitosis per 10 high power fields , microscopic infiltrative
borders and lack of stromal overgrowth.
Malignant - marked stromal cellularity and atypia, infiltrative margins, highmitotic rate (more than 10 mitosis per 10 high power fields examined), and
by the presence of stromal overgrowth.
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BACK GROUND In most large series, more than 50 percent - benign
Approximately 25 percent of phyllodes tumors are malignant,
The histological classification of these neoplasms into benign,
borderline and malignant has not proven to be successful,
because
Benign form of cystosarcoma phyllodes could manifest metastases.
Malignant variant of cystosarcoma resulted in an excellent prognosis.
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AIMS AND OBJECTIVES
This study aims to report the experience of the during
a 2-year period and also to review the spectrum ofhistopathological findings in our subset of population.
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MATERIALS AND METHODS
The data of Pathological specimens of patients with
primary breast neoplasms, who were evaluated and
treated in Osmania General Hospital from August
2009 to September 2011 were analyzed.
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RESULTS Total number of breast tumours evaluated over a period of
2 years126 cases
Total diagnosed as Phyllodes tumour- 11(8.7%)
All diagnosed were Females.
Mean age at presentation 47.18 (Range 30-74 Years)
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AGE DISTRIBUTION
AGE GROUP NUMBER (%)
30-49 YEARS 5 (45.45%)
50-70 YEARS 5 (45.45%)
>70 YEARS 1(9.1%)
TOTAL 11(100%)
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Malignant vs Benign
Phyllodes tumour Number (%)
Benign 6(54.5%)
Malignant 5(45.5%)
Total 11(100%)
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Malignant vs BenignNo. Of Cases Mean Age at
presentation
Range
Benign 6(54.5%) 44.67 14.16 Yrs 30-68 Yrs
Malignant 5(45.5%) 50.2 18.06 Yrs 30-74 Yrs
Total 11(100%) 47.18 15.46 Yrs 30-74 Yrs
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Patterns of MalignancyPatterns of Malignancy Number (%)
Necrosis and increased mitotic activity, 3 cases (60%)
Stromal pleomorphism with stromal
outgrowth
1 case (20%)
Infiltrating margin and necrosis. 1 case (20%)
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Circumscribed border of tumour
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Benign Phyllodes
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Spindle cells with plump nuclei (arrow). Mitosis (double arrows)
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Distribution of LesionsPresent Study S Abdelkrim etal 1
M. S. Lenhard
et al 2
Stamatkos et al
3
Benign 6 (54.5%) 13 (50%) 12 (40% 15 (68%)
Borderline 0 (0%) 7 (27%) 8 (27%) 2 (9%)
Malignant 5 (45.5%) 6 (23%) 10 (33%) 5 (23%)
Total 11 (100%) 26 (100%) 30 (100%) 22 (100%
1. Soumaya Ben Abdelkrim et al. World Journal of Oncology 2010,
2. M. S. Lenhard et al.Journal of Clinical Oncology, 2006 ASCO Annual Meeting Proceedings
Part I. Vol 24, No. 18S (June 20 Supplement), 2006.
3. Michael Stamatakos et al.International Seminars in Surgical Oncology 2009, 6:6
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Age at Presentation- Comparison
Present Study S Abdelkrim et al M. S. Lenhard et al
No. of Cases 11 26 30
Mean age at
Presentation
47.18 15.46 Yrs 40 Yrs 47 Years
Range 30-74 Yrs 19-66 Yrs -
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Population Characteristics By GradePresent Study
Mean Age (Range In Yrs)
S Abdelkrim et al
Mean Age (Range In Yrs)
Benign 44.67 (30 - 68) 35.8 (19 - 55)
Borderline - 44.7 (34 - 52)
Malignant 50.2 (30 - 74) 45.2 (29 - 66)
Total 47.18 (30 - 74) 40 (19 - 66)
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