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Phyllodes tumor is an uncommon breast fibroepithelial neoplasm mainly found in middle-aged patients, presenting a morphologic continuum from benign to malignant. Juvenile papillomatosis represents a rare benign proliferative breast tumor primarily affecting young individuals and carries a potential elevated risk of subsequent breast cancer development. Juvenile fibroadenoma is a well-circumscribed biphasic neoplasm that often occurs in adolescent girls, characterized by a pericanalicular growth pattern with usual-type epithelial hyperplasia and gynaecomastia-like micropapillary proliferation. Herein, we present an unusual example of a 26-year-old woman with a left breast outer lower quadrant palpable mass. Ultrasonography identified a 5.9 cm lobulated hypoechoic solid mass with scattered small cysts. The preoperative biopsy initially diagnosed a fibroepithelial lesion, considering giant cellular fibroadenoma and phyllodes tumor in the differential. Subsequent complete excision revealed areas of benign phyllodes tumor features closely admixed with distinctive elements such as prominent multiple cysts exhibiting apocrine and papillary apocrine metaplasia, duct papillomatosis, and duct stasis characteristic of juvenile papillomatosis, and hyperplastic ductal epithelium with micropapillary projections demonstrating a pericanalicular growth pattern indicative of juvenile fibroadenoma. The diagnosis was conclusively established as a fibroepithelial lesion with combined features of benign phyllodes tumor, juvenile papillomatosis, and juvenile fibroadenoma. Further investigation uncovered a family history of breast cancer. Molecular analysis revealed a pattern of unique and overlapping mutations within these distinct histopathological areas. This unusual presentation with hybrid features within a single tumor is described for the first time in the literature along with the molecular signature of the individual components. [ABSTRACT FROM AUTHOR]

Background: A phyllodes tumor (PT) is a biphasic fibroepithelial lesion that is most commonly found in breast tissue, whereas it is uncommon in ureter tissue. Only one case has been documented so far. There are some similarities in histology and clinical characteristics between this type of tumor and PT of the female breast: the lesions can be surgically removed, but some recur locally and invade directly into the breast. This case of a primary PT of the ureter is useful for pathologists and clinicians. Highlights: I feel such great honor to have this opportunity to submit my paper to your magazine. Although this is a case report, There is only one case report published until now regarding benign phyllodes tumor of the distal end of ureter. The mechanism of this tumor still remained unclear. Thus, We hope that our finding will help clinicians and pathologists to understand the diagnosis further, treatment and prognosis of clinical ureteral phyllodes tumors. [ABSTRACT FROM AUTHOR]

Purpose: Primary breast cancer in children and adolescents is extremely uncommon and presents with different characteristics from those found in adult women. We aimed to conduct a population‐based cohort study to predict overall survival (OS) in pediatric patients with breast cancer. Methods: Demographic and clinicopathological data on pediatric breast cancer patients were obtained from the Surveillance, Epidemiology, and End Results database (2000–2019). The survival rates were measured using the Kaplan–Meier method. Univariate survival analysis used the log‐rank test, while multivariate analysis used Cox proportional hazards regression to identify factors influencing OS. Furthermore, we created a nomogram to predict OS in pediatric patients. Results: A total of 115 pediatric patients were analyzed, with a median age at diagnosis of 18 years (range: 2–19 years). In terms of tumor grade, 27 (23.4%) patients had well or moderately differentiated tumors and 32 (27.8%) had poorly or undifferentiated tumors. The predominant histological type was phyllodes tumor, accounting for 36.5%, followed by infiltrating duct carcinoma at 31.3%, and other types at 32.2%. The SEER and M stages were substantial independent indicators of OS. A nomogram was created to predict OS in pediatric breast cancer patients. Conclusions: Our findings confirmed that the SEER stage and M stage were the most critical predictors of OS in pediatric patients with breast cancer. By focusing on this rare demographic, our study fills an important gap in the literature, as there are few comprehensive studies available that explore a prognosis in pediatric breast cancer. [ABSTRACT FROM AUTHOR]

Many clinicopathological features have been examined as predictive factors for adverse outcomes in patients with phyllodes tumor (PT) of the breast, but there are still no definitive predictive markers to guide management, despite the persistent risk of recurrence, even in benign disease. Whether Ki67 has prognostic value in PT remains uncertain. We therefore conducted a systematic review and meta-analysis to examine whether Ki67 is associated with adverse clinical outcomes, especially recurrence, in patients with PT. The PubMed/MEDLINE, Web of Science, Scopus, Embase, and Cochrane Library databases were searched from inception to July 2024. Study characteristics and outcomes (recurrence and overall survival) according to Ki67 status were extracted from each eligible study, and pooled log odds ratios with 95% CI were derived using a fixed-effects model after testing for homogeneity of effect sizes with Cochran's Q-test. Five studies representing 280 cases were eligible for inclusion. The adverse outcome rate for the Ki67high (Ki67 >10% or >11.2%) population was 28.7% (95% CI 20.1 - 38.6%), while the adverse outcome rate for the Ki67low population was 9.4% (95% CI 5.4 - 13.5%). Ki67high was associated with an increased odds (log OR 1.34 (95% CI 0.65 - 2.02, p<0.001) of an adverse outcome compared with a Ki67low status. All five studies scored eight points on the Newcastle-Ottawa Scale, equivalent to "good" quality by AHRQ standards, and no significant publication bias was noted. This is the first meta-analysis of the predictive value of Ki67 in PT of the breast. A relatively high Ki67 index (greater than about 10%) is associated with recurrence. It is timely to re-evaluate the prognostic value of Ki67 in large retrospective cohorts with long follow-up to firmly establish whether it could contribute to identifying patients at risk of recurrence, especially those with histologically benign disease. Doing so could impact clinical practice by refining follow-up recommendations based on quality evidence. [ABSTRACT FROM AUTHOR]

Background Malignant phyllodes tumors (MPT) are rare fibroepithelial breast cancers with no known effective systemic therapy; metastatic progression portends a dismal prognosis. We sought to describe the genomic landscape of MPTs through genomic profiling and immunotherapeutic biomarker analysis. Materials and methods Cases of sequenced MPT were identified from a Clinical Laboratory Improvement Amendments-certified, College of American Pathologists-accredited laboratory (Foundation Medicine). All cases underwent genomic profiling using adaptor ligation-based, next-generation sequencing assay of 324 genes. Tumor agnostic immunotherapy biomarkers, microsatellite instability, tumor mutational burden (TMB), and programmed death-ligand 1 (PD-L1) expression were evaluated. Fisher's Exact Tests and analysis of variance were used to test for differences between groups and for continuous variables as appropriate. Results Of 135 MPT cases identified; 94 (69.6%) were localized/locally recurrent and 41 (30.4%) were metastatic. Median age was 54 years (range 14-86). The median TMB was 2.5 mut/Mb and 3 were TMB-high (≥10 mut/Mb). 21.4% were PD-L1+ via Dako 22C3 assay (CPS ≥1). Most commonly altered genes included TERT- promoter (69.7%) , CDKN2A (45.9%), TP53 (37.8%), NF1 (35.6%), CDKN2B (33.3%), MED12 (28.9%), MTAP (27.7%), KMT2D (22.2%), PIK3CA (20.0%), PTEN (18.5%), and RB1 (18.5%). Several tumors harboring genomic alterations with US Food and Drug Administration-approved indications in other tumor types were found including NF1 , PIK3CA, EGFR Exon 19/20 insertions, and BRAF V600E mutations. Conclusions In the largest genomic evaluation of MPT to date, multiple clinically actionable mutations were found. Routine sequencing of metastatic MPT may provide additional information to guide treatment decisions and clinical trial enrollment. [ABSTRACT FROM AUTHOR]

Abstract Background A phyllodes tumor (PT) is a biphasic fibroepithelial lesion that is most commonly found in breast tissue, whereas it is uncommon in ureter tissue. Only one case has been documented so far. There are some similarities in histology and clinical characteristics between this type of tumor and PT of the female breast: the lesions can be surgically removed, but some recur locally and invade directly into the breast. This case of a primary PT of the ureter is useful for pathologists and clinicians.

The breast can be affected by a variety of specific and unique disorders during pregnancy and lactation. One of these disorders is spontaneous infarction of the breast which is a rare condition seen in physiologically hyperplastic mammary tissue associated with pregnancy and lactation. The causes and mechanism of the development of breast infarct remain largely unknown. Only 25 cases of breast infarct have been reported in the English literature. Phyllodes tumor is uncommon in pregnant women, and to date, only one report of spontaneous infarction of the phyllodes tumor has been reported in a postpartum woman. In this report, we describe the first case of coexistent infarction of the hyperplastic breast parenchyma with infarction of phyllodes tumor in a 25-year-old female.

Rare breast neoplasms are found by physicians in clinical practice. Phyllodes tumor of the breast accounting for 0.3–1% of all breast neoplasms is one of these neoplasms. Today, the phyllodes tumor etiology is unclear, the same as its pathogenesis. The paper reports an example of successful surgical treatment of malignant phyllodes tumor.

The case series outlines two cases of borderline phyllodes tumor which later on transformed into malignant phyllodes with metastasis. Malignant phyllodes tumors, although rare, exhibit unique clinicopathological features that necessitate prompt and accurate diagnosis to mitigate their higher recurrence rates. The current lack of consensus on optimal surgical techniques and the appropriate application of radiation and chemotherapy underscores the critical need for a standardized treatment protocol. This is particularly crucial in palliative care settings, where a standardized approach will play a vital role in reducing tumor recurrence and improving patient outcomes.

Background: Optimal surgical margin width for patients with phyllodes tumors (PTs) of the breast remains debated. The aim of this study was to assess the influence of margin width on long-term local recurrence risk. Patients and Methods: This was a single-institution retrospective review of patients with confirmed PT treated from 2008–2015. Margins were defined as positive (ink on tumor), narrow (no tumor at inked margin but < 10mm), or widely free (>/= 10mm). LR rates were estimated by the Kaplan–Meier method. Results: Among 117 female patients, histology included 55 (47%) benign, 29 (25%) borderline, and 33 (28%) malignant PT. Final margins were positive in 16 (14%), narrow in 32 (27%), widely free in 64 (55%), and unknown in 5 (4%) patients. Compared with margins > 10 mm, patients with positive and narrow margins had a higher LR risk [HR 10.57 (95% CI 2.48–45.02) and HR 5.66 (95% CI 1.19–26.99), respectively]. Among benign PTs, the 10-year LR-free rates were 100%, 94%, and 66% for widely negative, narrow, and positive margins, respectively (p = 0.056). For borderline/malignant PT, the 10-year LR-free rates were 93% and 57% for widely negative and narrow margins, respectively (p = 0.02), with no difference in LR between narrow and positive margin groups (p = 1.00). Conclusions: For benign PTs, a margin of no ink on tumor appears sufficient to optimize local control. In patients with borderline or malignant PTs, achieving a wide surgical margin may remain important as narrower margins were associated with LR rates comparable to those with positive margins. [ABSTRACT FROM AUTHOR]

Background and Objectives: Phyllodes tumors are rare breast neoplasms with limited therapeutic options and poorly understood molecular characteristics. This study aimed to analyze genomic alterations and treatment outcomes in advanced phyllodes tumors using Japan's national clinical genomic testing registry (C-CAT database) to identify potential therapeutic targets and predictive markers. Materials and Methods: We conducted a retrospective analysis of 60 phyllodes tumor cases from 80,329 patients registered in the C-CAT database between June 2019 and August 2024. Comprehensive genomic profiling was performed using multiple platforms including FoundationOne CDx, NCC OncoPanel, and other approved tests. Treatment responses were evaluated according to RECIST criteria, and pathogenic variants were assessed using established databases including ClinVar and OncoKB. Results: The cohort's median age was 54 years (range: 13–79), with TERT promoter variants (70%), MED12 (52%), and TP53 (50%) mutations being the most frequent alterations. Forty patients received first-line chemotherapy, predominantly anthracycline-based regimens (n = 29). Although not reaching statistical significance, cases with CDKN2A and TERT alterations showed trends toward treatment resistance (OR > 3.0). One patient with a high tumor mutational burden (37/Mb) responded to pembrolizumab. Potential germline variants were identified in two cases (3.3%), involving MSH6 and TP53 alterations. Notably, no cases with CDKN2B alterations demonstrated treatment response (p = 0.09). Conclusions: Our findings suggest distinct molecular patterns in phyllodes tumors compared to other soft tissue sarcomas, with potential implications for treatment selection. The identification of specific genetic alterations associated with treatment resistance may guide therapeutic decision-making, while the presence of actionable mutations in select cases indicates potential opportunities for targeted therapy approaches. [ABSTRACT FROM AUTHOR]

Phyllodes tumors (PTs) are rare breast tumors showing overlapping features with fibroadenomas (FAs). Diagnosis on small biopsies is challenging. New diagnostic markers are needed. Here we evaluated immunohistochemical staining of histone 3 trimethyl‐lysine‐27 (H3K27me3) as a diagnostic and prognostic marker in a series of PTs. Surgically removed PTs at our institution (September 1990 and July 2022) and control FAs. Tissue micro‐arrays (4 cores, 2 mm Ø) stained with H3K27me3, and scored with QuPath‐derived H‐score. Fisher exact test, Mann–Whitney U‐test and chi‐squared test used for group comparison. ROC analysis applied to define cutoffs. Cox proportional hazards models were used for assessing disease‐free survival (DFS), overall survival (OS), and disease‐specific survival (DSS) in PTs. We included 81 patients with PTs and 44 patients with FAs. QuPath‐derived H‐scores of stromal H3K27me3 were statically significantly lower in PTs than in FAs (p < 0.001). We identified exploratory cutoffs to discriminate FAs from benign and malignant PTs (AUC = 0.78 and 0.73, respectively). No associations between DFS, OS, or DSS and H3K27me3 expression were found. H3K27me3 expression differs between FAs and PTs, indicating potential as diagnostic marker, but it is not predictive for DFS, OS or DSS in PTs. Further validation is needed. [ABSTRACT FROM AUTHOR]

Breast phyllodes tumor (PT) is a rare fibroepithelial neoplasm with potential malignant behavior. Long non-coding RNAs (lncRNAs) play multifaceted roles in various cancers, but their involvement in breast PT remains largely unexplored. In this study, microarray was leveraged for the first time to investigate the role of lncRNA in PT. We identified lncRNA ZFPM2-AS1 was significantly upregulated in malignant PT, and its overexpression endowed PT with high tumor grade and adverse prognosis. Furthermore, we elucidated that ZFPM2-AS1 promotes the proliferation, migration, and invasion of malignant PT in vitro. Targeting ZFPM2-AS1 through nanomaterial-mediated siRNA delivery in patient-derived xenograft (PDX) model could effectively inhibit tumor progression in vivo. Mechanistically, our findings showed that ZFPM2-AS1 is competitively bound to CDC42, inhibiting ACK1 and STAT1 activation, thereby launching the transcription of TNFRSF19. In conclusion, our study provides evidence that ZFPM2-AS1 plays a pivotal role in the pathogenesis of breast PT, and suggests that ZFPM2-AS1 could serve as a prognostic indicator for patients with PT as well as a promising novel therapeutic target.

BACKGROUND AND OBJECTIVES: Previous studies have identified racial-ethnic differences in the diagnostic patterns and recurrence outcomes of women with phyllodes tumors (PT). However, these studies are generally limited in size and generalizability. We therefore sought to explore racial-ethnic differences in age, tumor size, subtype, and recurrence in a large US cohort of women with PT. METHODS: We performed an 11-institution retrospective review of women with PT from 2007 to 2017. Differences in age at diagnosis, tumor size and subtype, and recurrence-free survival according to race-ethnicity. RESULTS: Women of non-White race or Hispanic ethnicity were younger at the time of diagnosis with phyllodes tumor. Non-Hispanic Other women had a larger proportion of malignant PT. There were no differences in recurrence-free survival in our cohort. CONCLUSIONS: Differences in age, tumor size, and subtype were small. Therefore, the workup of young women with breast masses and the treatment of women with PT should not differ according to race-ethnicity. These conclusions are supported by our finding that there were no differences in recurrence-free survival.

The transformation of a benign phyllodes tumor (PT) into a malignant PT and/or carcinoma is extremely uncommon. We present a case of a 66-year-old female with a huge mass on the left breast which was successfully removed by surgical resection. The pathological diagnosis was infiltrating lobular carcinoma with pure rhabdoid features and the malignant transformation of a benign phyllodes tumor. The first time this rare case was reported, it is demonstrated a special phenomenon through the synchronous transformation of PT grades and the carcinomatous transformation of PT. [ABSTRACT FROM AUTHOR]

Background: Phyllodes tumor (PT), an uncommon fibroepithelial neoplasm accounts for less than 1% of all primary tumors of the breast. MPT with osseous differentiation often gets misdiagnosed on imaging as benign giant calcifications resulting in treatment delay. We describe a rare case of MPT with heterologous osteosarcomatous differentiation and osteoclast-like giant cells and review the literature to discuss clinical-radiological findings, differential diagnosis and treatment options. Case Presentation: A 34-year-old female presented with a right breast lump. Mammography showed a high-density irregular mass with amorphous dense calcification, suggesting neoplastic etiology. Preoperative core needle biopsy raised the possibility of a phyllodes tumor versus a giant cell tumor. A wide local excision was performed to confirm the diagnosis, which revealed the presence of a biphasic tumor with an osteoid-like matrix and numerous osteoclastic giant cells. Immunohistochemistry was used to rule out metaplastic carcinoma or carcinosarcoma. The stromal cells were negative for panCK and P63 and positive for vimentin, CD10 and BCL-2. The osseous component was positive for Osteonectin and SATB2. Thus, a final diagnosis of malignant phyllodes tumor with heterologous osteosarcomatous differentiation and osteoclast-like giant cells was made. Conclusion: MPT with osteosarcomatous differentiation is a rare and challenging entity associated with a poor clinical outcome. Accurate diagnosis requires a multidisciplinary approach involving breast surgeons, pathologists, and radiologists, along with careful histopathological examination. Wide local excision with close surveillance is crucial for the timely detection of tumour recurrence and metastasis. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the immunoreactivity of Ki67 and p53 in Phyllodes tumors (PTs) of the breast and assess their correlation with clinicopathological features, including PT grade and clinical parameters. Methodology: A comparative, analytical cross-sectional design was employed to evaluate Ki67 and p53 immunoreactivity in the Phyllodes tumors. The research was conducted at the Histopathology Department, DDRRL/DUHS, Karachi, over an 8-month period. Ethical approval was also obtained from DUHS's board. Purposive nonprobability sampling was used to select the patients. Immunohistochemistry, performed on FFPE tissue blocks, involved evaluating Ki67 and p53 staining. Statistical analysis (descriptive, chi-squared, and Kruskal Wallis tests) was carried out using IBM SPSS version 26, and a p-value <0.05 was considered statistically significant. Results: The research involved 50 patients, comprising benign 19 (38%), borderline 23 (46%), and malignant 08 (16%) PTs. Malignant tumors exhibited significantly higher expression of Ki67 and p53 compared to benign and borderline tumors (p < 0.005). Clinicopathological parameters, such as tumor mobility, skin ulceration, tumor borders, leaf-like architecture, stromal overgrowth, necrosis, and surgical margins, showed significant associations with Ki67 and p53 expression (p < 0.005). These results recommend that Ki67 and p53 may serve as valuable diagnostic and prognostic markers in PTs. Conclusion: The study's results indicate that the immunohistochemical evaluation of Ki67 and p53 could be beneficial in the diagnosis of PTs. The association between Ki67 and p53 expression and various clinicopathological features, particularly PT grade, highlights their potential clinical significance. Further research could contribute to the advancement of standardized diagnostic and prognostic criteria for PTs, improving patient management and outcomes. [ABSTRACT FROM AUTHOR]

An 82-year-old woman with a known chronic small "clot" in the heart presented with rapidly progressive dyspnea. A [18F]fluoro-2-deoxy-D-glucose ([18F]FDG) and cardiac-MRI demonstrated rapid enlargement of the right ventricular presumed clot now expanding and obliterating the right ventricular cavity. Patient continued to deteriorate despite urgent cardiac surgery to remove the mass and died 8 days later. Cardiac explant pathology demonstrated phyllodes tumor. [ABSTRACT FROM AUTHOR]

Breast phyllodes tumor (PT) is a rare fibroepithelial neoplasm with potential malignant behavior. Long non-coding RNAs (lncRNAs) play multifaceted roles in various cancers, but their involvement in breast PT remains largely unexplored. In this study, microarray was leveraged for the first time to investigate the role of lncRNA in PT. We identified lncRNA ZFPM2-AS1 was significantly upregulated in malignant PT, and its overexpression endowed PT with high tumor grade and adverse prognosis. Furthermore, we elucidated that ZFPM2-AS1 promotes the proliferation, migration, and invasion of malignant PT in vitro. Targeting ZFPM2-AS1 through nanomaterial-mediated siRNA delivery in patient-derived xenograft (PDX) model could effectively inhibit tumor progression in vivo. Mechanistically, our findings showed that ZFPM2-AS1 is competitively bound to CDC42, inhibiting ACK1 and STAT1 activation, thereby launching the transcription of TNFRSF19. In conclusion, our study provides evidence that ZFPM2-AS1 plays a pivotal role in the pathogenesis of breast PT, and suggests that ZFPM2-AS1 could serve as a prognostic indicator for patients with PT as well as a promising novel therapeutic target. ZFPM2-AS1 is competitively bound to CDC42, inhibiting ACK1 and STAT1 activation and launching the transcription of TNFRSF19, thereby promoting the proliferation, migration, and invasion of malignant breast phyllodes tumor. [Display omitted] [ABSTRACT FROM AUTHOR]

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Purposeof Review: Phyllodes tumors (PT) are rare fibroepithelial lesions of the breast. It is critical to understand the behavior of benign, borderline, and malignant PT so as to recommend appropriate treatment. This review describes findings on diagnostic testing and pathology that differentiate these tumors, as well as recommended management. Recent Findings: Better understanding of outcomes following PT resection has led to changes in local therapy recommendations, with wide margins (> 1 cm) strongly recommended for malignant PT only. Other PT may be resected with smaller (or no) margin without impact on local recurrence risk. Adjuvant radiation should be considered in malignant PT or when local recurrence would lead to significant morbidity. Summary: Benign and borderline PT may not require wide margins at excision for optimal local control. Malignant PT should be resected with wide margins and consideration given to adjuvant radiation therapy. [ABSTRACT FROM AUTHOR]

Benign and malignant breast lesions in children and adolescents are rare compared to adults. Most tumors are benign. Malignant breast lesions are extremely rare. Fibroadenomas are the most common, accounting for 95% of all lesions. Diagnosis is based on history and physical examination of the breast and armpit. Imaging studies include ultrasound, mammography, and magnetic resonance imaging. Ultrasound is the most commonly used imaging test. Other tests are used in cases of diagnostic doubt. Core needle biopsy should be considered for appropriate diagnostic management. Excisional biopsy should be considered for complex clinical conditions and imaging studies. Except in doubtful situations in children and adolescent girls, a conservative approach and observation of the lesions along with periodic ultrasound examination initially every 6–12 months is advisable. Management of malignant breast lesions in children typically involves a multidisciplinary team consisting of pediatric oncologists, surgeons, radiation oncologists, pathologists, and other specialists and depends on the clinical condition of the patient. An important aspect is the experience of the clinician and radiologist in the treatment of breast lesions, as well as increasing patient and family awareness of possible breast lesions and self-examination. This review aims to provide a scoping overview of the available literature on benign and malignant lesions of the breast in pediatric and adolescent populations to assist physicians and surgeons in making decisions regarding the appropriate diagnosis and management of pediatric breast disease.

Phyllodes tumors are rare fibroepithelial neoplasms and comprise less than 1% of all breast tumors. Heterologous sarcomatous differentiation is rarely observed in phyllodes tumors and in this study, a case of phyllodes tumor containing heterologous liposarcoma component is presented. A rapidly expanding mass in the left breast of an 86-year-old woman led to her admission to the general surgery outpatient clinic. A BI-RADS 4 nodular lesion was detected in the mammographic examination and was evaluated as suspicious for phyllodes tumor. Left modified radical mastectomy material was sent to our laboratory. Macroscopic examination revealed a nodular mass measuring 9.5x9x8 cm with focal infiltrative borders in breast tissue sections. In histological sections, the tumoral lesion was noted to have hypercellular, pleomorphic stroma and in some places the typical leaf-like architecture of phyllodes tumor. A well-differentiated liposarcoma component was observed in the tumor, containing lipoblast-like cells with single and multiple vacuoles, clear cytoplasm, and hyperchromatic nuclei. In the light of all the findings, the case was reported as malignant phyllodes tumor containing heterologous liposarcoma component. Phyllodes tumors showing heterologous sarcomatous differentiation are quite rare and when sarcomatous neoplasia is seen in the breast, phyllodes tumor ought to be taken into account while making a differential diagnosis. In order to distinguish phyllodes tumor with sarcomatous differentiation from primary breast sarcomas, it is very important to show the benign epithelial component of the tumor by taking multiple samples. [ABSTRACT FROM AUTHOR]

Synopsis: This is a systematic review and meta-analysis comparing surgical excision with percutaneous ultrasound-guided vacuum-assisted excision (USVAE) for the treatment of benign phyllodes tumor (PT) using local recurrence (LR) as the endpoint. Objective: To determine the frequency of local recurrence (LR) of benign phyllodes tumor (PT) after ultrasound-guided vacuum-assisted excision (USVAE) compared to the frequency of LR after surgical excision. Method: A systematic review and meta-analysis [following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard] was conducted by comparing LR in women older than 18 years treated for benign PT by US-VAE compared with local surgical excision with at least 12 months of follow-up. Studies were retrieved from PubMed, Scopus, Web of Science, and Embase. The pooled effect measure used was the odds ratio (OR) of recurrence. Results: Five comparative prospective or retrospective observational studies published between January 1, 1992, and January 10, 2022, comparing surgical excision with percutaneous US-VAE for LR of benign PT met the selection criteria. Four were retrospective observational cohorts, and one was a prospective observational cohort. A total of 778 women were followed up. Of them, 439 (56.4%) underwent local surgical excision, and 339 (43.6%) patients had US-VAE. The median age of patients in the five studies ranged from 33.7 to 39 years; the median size ranged from 1.5 cm to 3.0 cm, and the median follow-up ranged from 12 months to 46.6 months. The needle gauge ranged from 7G to 11G. LR rates were not statically significant between US-VAE and surgical excision (41 of 339 versus 34 of 439; OR 1.3; p = 0.29). Conclusion: This meta-analysis suggests that using US-VAE for the removal of benign PT does not increase local regional recurrence and is a safe minimally invasive therapeutic option. [ABSTRACT FROM AUTHOR]

Giant phyllodes tumors, typically exceeding 10 cm in size, are neoplastic lesions with malignant potential. Surgical excision in small-breasted Asian women presents unique challenges where expected poor aesthetic outcomes may delay timely medical intervention. The periareolar mastopexy technique offers a comprehensive solution, enabling complete tumor removal alongside mastopexy to achieve optimal breast contouring. This approach consistently delivers favorable aesthetic outcomes, enhancing symmetry and contour. Additionally, the periareolar approach minimizes visible scarring, thereby enhancing patient satisfaction with the cosmetic outcome. Herein, we present a case report of Asian women with giant phyllodes tumors exceeding 10 cm, successfully managed using the periareolar mastopexy technique, emphasizing the importance of optimizing aesthetic outcomes in these challenging cases. [ABSTRACT FROM AUTHOR]

Background. Fibroadenoma (FA) and benign phyllodes tumor (PT) of the breast often have similar appearances on imaging. While an exact diagnosis of biopsy specimens is required to choose adequate treatment, including surgical procedures, it is sometimes difficult to pathologically differentiate these 2 tumors due to histological resemblances. To elucidate markers for distinguishing FA from benign PT, we analyzed clinical samples immunohistochemically. Methods. We retrospectively investigated 80 breast fibroepithelial lesions. As a discovery set, 60 surgical excision samples (30 FA and 30 benign PT) were examined. Twenty biopsy samples (10 FA and 10 benign PT) were examined as a validation set. To determine targets for immunohistochemistry, we first tested some proteins based on previous reports. As a result, Ki67 was chosen for differentiating FA and PT; thus further examinations were conducted with this protein. Results. Among the proteins examined, stromal Ki67 was significantly higher in PT than in FA. Benign PT had significantly higher stromal Ki67 expression both at random and at hotspots (p <.001 and <.001, respectively). The receiver operating characteristic curve analysis identified 3.5% and 8.5% (at random spots and hotspots, respectively) as the optimal cutoff values of stromal Ki67 for distinguishing between these 2 tumors. In the validation cohort employing needle biopsy specimens, we confirmed that these 2 cutoff values properly classified these 2 tumors (p =.043 and.029, respectively). Conclusion. We revealed that stromal Ki67 might be a potential marker for distinguishing FA from benign PT. [ABSTRACT FROM AUTHOR]

The case series outlines two cases of borderline phyllodes tumor which later on transformed into malignant phyllodes with metastasis. Malignant phyllodes tumors, although rare, exhibit unique clinicopathological features that necessitate prompt and accurate diagnosis to mitigate their higher recurrence rates. The current lack of consensus on optimal surgical techniques and the appropriate application of radiation and chemotherapy underscores the critical need for a standardized treatment protocol. This is particularly crucial in palliative care settings, where a standardized approach will play a vital role in reducing tumor recurrence and improving patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Phyllodes tumors are rare fibroepithelial neoplasms. They represent less than 0.5–1% of all primary breast tumors and their presentation is even rarer in children. Case description: A 15-year-old female with Autism Spectrum Disorder (ASD) was seen in the outpatient surgery clinic due to bilateral breast masses. She underwent core-needle aspiration. biopsy of both masses and the results were suspicious of fibroadenomas. Two days later the patient presented to the emergency room with ulceration and bleeding from the left breast mass. She was scheduled for an urgent nipple-sparing mastectomy, which was uneventful. The pathology revealed a multifocal, aggressive type tumor with moderate stromal cellularity, moderate stromal atypia and high mitotic index, corresponding to a borderline phyllodes tumor. Based on this result, she underwent an elective right nipple-sparing mastectomy. The pathology of the right breast mass was similar to the left breast mass. Conclusion: Core-needle aspiration biopsy is not reliable for the diagnosis of phyllodes tumor. If a phyllodes tumor is diagnoses in one breast, a contralateral breast mass should be considered a phyllodes tumor until proven otherwise.

Introduction: Spindle cell sarcomas are rare breast lesions which are difficult to diagnose due to resemblance with other breast lesions. Histopathological examination and immunohistochemical staining are essential for diagnosis. Case Presentation: We present a rare case of a 15-year-old female presenting with high-grade rapidly progressive spindle cell sarcoma of the breast, differentiated as phyllodes tumor, with axillary lymph node involvement. Her lesion, on the left breast, measured 16.9 × 10.1 × 13.7 cm. Histology revealed malignant neoplasm arranged in sheets and individual neoplastic cells with an epithelioid to spindled morphology with scant cytoplasm and irregular nuclear membranes. Immunohistochemistry showed weakly positive focal CD-99, and negative WT-1, Myogenin, Desmin, p63, Cytokeratin, Synaptophysin, and CD-34 markers. She was successfully managed with modified radical mastectomy and discharged with regular follow-up advised. Conclusion: Spindle cell sarcomas have a very aggressive course and prompt diagnosis, and management is mandatory for better patient outcomes. Modified radical mastectomy is the mainstay of treatment.

Background and Objectives: Phyllodes tumors are rare breast neoplasms with limited therapeutic options and poorly understood molecular characteristics. This study aimed to analyze genomic alterations and treatment outcomes in advanced phyllodes tumors using Japan’s national clinical genomic testing registry (C-CAT database) to identify potential therapeutic targets and predictive markers. Materials and Methods: We conducted a retrospective analysis of 60 phyllodes tumor cases from 80,329 patients registered in the C-CAT database between June 2019 and August 2024. Comprehensive genomic profiling was performed using multiple platforms including FoundationOne CDx, NCC OncoPanel, and other approved tests. Treatment responses were evaluated according to RECIST criteria, and pathogenic variants were assessed using established databases including ClinVar and OncoKB. Results: The cohort’s median age was 54 years (range: 13–79), with TERT promoter variants (70%), MED12 (52%), and TP53 (50%) mutations being the most frequent alterations. Forty patients received first-line chemotherapy, predominantly anthracycline-based regimens (n = 29). Although not reaching statistical significance, cases with CDKN2A and TERT alterations showed trends toward treatment resistance (OR > 3.0). One patient with a high tumor mutational burden (37/Mb) responded to pembrolizumab. Potential germline variants were identified in two cases (3.3%), involving MSH6 and TP53 alterations. Notably, no cases with CDKN2B alterations demonstrated treatment response (p = 0.09). Conclusions: Our findings suggest distinct molecular patterns in phyllodes tumors compared to other soft tissue sarcomas, with potential implications for treatment selection. The identification of specific genetic alterations associated with treatment resistance may guide therapeutic decision-making, while the presence of actionable mutations in select cases indicates potential opportunities for targeted therapy approaches.

Phyllodes tumors (PTs) are rare fibroepithelial malignancies of the breast, accounting for less than 1% of malignant breast tumors. PTs are usually solitary tumors but can be associated with other malignancies, such as DCIS or invasive carcinomas and sarcomas. Osteosarcomatous differentiation of a malignant phyllodes tumor is rare, and differentiation of this rare breast tumor from other entities is of vital importance to clinicians due for appropriate treatment and prognosis. We present a case of rare high-grade phyllodes tumor with osteosarcomatous differentiation presenting on mammogram as a calcified lobulated mass; ultrasound revealed a 1.5 cm irregularly calcified mass, suggestive of bone. An ultrasound-guided core biopsy and subsequent lumpectomy revealed a cellular stroma with osteoid stromal matrix and cytologic atypia with bone formation. At 18 months postprocedure, a recurrence was identified at the previous surgical site, and the patient underwent a mastectomy. Here we present a single case of high-grade PT with osteosarcomatous differentiation and a comprehensive literature review, highlighting the mammographic and histologic characteristics of this rare presentation.

SynopsisThis is a systematic review and meta-analysis comparing surgical excision with percutaneous ultrasound-guided vacuum-assisted excision (US-VAE) for the treatment of benign phyllodes tumor (PT) using local recurrence (LR) as the endpoint.ObjectiveTo determine the frequency of local recurrence (LR) of benign phyllodes tumor (PT) after ultrasound-guided vacuum-assisted excision (US-VAE) compared to the frequency of LR after surgical excision.MethodA systematic review and meta-analysis [following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard] was conducted by comparing LR in women older than 18 years treated for benign PT by US-VAE compared with local surgical excision with at least 12 months of follow-up. Studies were retrieved from PubMed, Scopus, Web of Science, and Embase. The pooled effect measure used was the odds ratio (OR) of recurrence.ResultsFive comparative prospective or retrospective observational studies published between January 1, 1992, and January 10, 2022, comparing surgical excision with percutaneous US-VAE for LR of benign PT met the selection criteria. Four were retrospective observational cohorts, and one was a prospective observational cohort. A total of 778 women were followed up. Of them, 439 (56.4%) underwent local surgical excision, and 339 (43.6%) patients had US-VAE. The median age of patients in the five studies ranged from 33.7 to 39 years; the median size ranged from 1.5 cm to 3.0 cm, and the median follow-up ranged from 12 months to 46.6 months. The needle gauge ranged from 7G to 11G. LR rates were not statically significant between US-VAE and surgical excision (41 of 339 versus 34 of 439; OR 1.3; p = 0.29).ConclusionThis meta-analysis suggests that using US-VAE for the removal of benign PT does not increase local regional recurrence and is a safe minimally invasive therapeutic option.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42022309782.

Phyllodes Tumor is a rare fibroepithelial neoplasm that represents 0.3 to 1% of all breast neoplasms. According to histopathologic classification, 12 to 26% are borderline type and approximately 15% of these tumors recur after surgical excision. The recommended treatment for all types of Phyllodes Tumor is surgical excision, and in the case of giant tumors, the treatment should be multidisciplinary. We present the case of a 46-year-old woman with a Phyllodes Tumor in the left breast that recurred 4 years after surgical excision. The anatomopathological study qualified it as a giant tumor and the histopathological study reported a Borderline Phyllodes Tumor. She underwent surgical excision with a left mastectomy and breast reconstruction employing a latissimus dorsi flap plus fat graft. The patient presented a favorable evolution without recurrence. In conclusion, the Recurrent Giant Borderline Phyllodes tumor is rare and its surgical management represents a challenge both in breast excision and reconstruction.

The axillary tail, also known as spencer's tail or axillary process, is a continuation of tissue from the upper lateral quadrant of the breast that travels into the axilla through a foramen of Langer in the deep fascia. Axillary inflammation or lump is a typical clinical symptom that necessitates imaging evaluation. Since the axilla consists of lymph nodes as well as nonlymphatic tissue such as accessory breast tissue, skin, fat, muscles, nerves, and blood vessels, it has a wide variety of differential diagnoses. The radiologists should be well acquainted with axillary anatomy and imaging aspects of various axillary lesions. Here, we present a 35-year-old female with a right axillary lump which was suggestive of benign tumor on ultrasonography and was proven to be benign phyllodes tumor on histopathology.

Introduction: Spindle cell sarcomas are rare breast lesions which are difficult to diagnose due to resemblance with other breast lesions. Histopathological examination and immunohistochemical staining are essential for diagnosis. Case Presentation: We present a rare case of a 15-year-old female presenting with high-grade rapidly progressive spindle cell sarcoma of the breast, differentiated as phyllodes tumor, with axillary lymph node involvement. Her lesion, on the left breast, measured 16.9 × 10.1 × 13.7 cm. Histology revealed malignant neoplasm arranged in sheets and individual neoplastic cells with an epithelioid to spindled morphology with scant cytoplasm and irregular nuclear membranes. Immunohistochemistry showed weakly positive focal CD-99, and negative WT-1, Myogenin, Desmin, p63, Cytokeratin, Synaptophysin, and CD-34 markers. She was successfully managed with modified radical mastectomy and discharged with regular follow-up advised. Conclusion: Spindle cell sarcomas have a very aggressive course and prompt diagnosis, and management is mandatory for better patient outcomes. Modified radical mastectomy is the mainstay of treatment. [ABSTRACT FROM AUTHOR]

Phyllodes tumor of the breast with malignant transformation to fibrosarcoma of the breast is a rare entity. Breast fibrosarcoma is uncommon, accounting for less than 1% of all breast tumors. Prognosis of fibrosarcoma of the breast is poor. Due to its rarity, survival rates are not defined. A 23-year-old woman presented with a mass in the left breast, and another 48-year-old woman presented with right breast mass. Both patients underwent for surgery. The histological & immunohistochemical examination confirms the diagnosis of a malignant transformation from borderline phyllodes tumor to fibrosarcoma. We concluded that the phyllodes tumor is mostly benign but local recurrence is common. As the tumor progresses toward malignancy, due to the difficulty in the diagnosis of borderline phyllodes tumors, total mastectomy with axillary resection must be recommended. [ABSTRACT FROM AUTHOR]

The molecular pathogenesis of breast fibroepithelial tumors continues to be elucidated. Recently, highly recurrent MED12 mutations arising in exon 2 at codon 44 were discovered in fibroadenomas and phyllodes tumors. In addition, a high prevalence of TERT promoter mutations in two hotspots (124 and 126 bp upstream from the translation start site) was discovered in up to 65% of phyllodes tumors. Breast periductal stromal tumors are a potentially distinct category of fibroepithelial lesions that are exceptionally rare with controversial classification and pathogenesis. Herein, we report the first comprehensive molecular genetic workup of a breast periductal stromal tumor that harbored a TERT promoter −124C > T mutation, supporting a relation to phyllodes tumors. [ABSTRACT FROM AUTHOR]

Primary sarcomas of the breast are extremely rare and heterogenous malignancies; they should be differentiated from phyllodes tumors. They are characterized by their high rate of recurrence, rapid growth and aggressive coarse. We present a case of a 41-year-old Palestinian female who presented with a recurrent breast mass. Biopsy showed primary sarcoma and imaging confirmed metastasis to axillary lymph nodes. The patient received six cycles of ifosfamide–adriamycin protocol resulting in complete pathological response. She underwent left sided modified radical mastectomy followed by radiation and six more cycles of the same protocol as adjuvant. Primary breast sarcomas are rare neoplasms that require multidisciplinary discussion to guide treatment. The approach to these tumors is chemotherapy followed by surgical resection when operable, in addition to local control via radiotherapy and adjuvant chemotherapy. [ABSTRACT FROM AUTHOR]

Background: Phyllodes tumors (PTs) are rare tumors of the breast. The current National Comprehensive Cancer Network (NCCN) guidelines recommend excision of benign PTs, accepting close or positive margins. Controversy about the optimal treatment for benign PTs remains, especially regarding the preferred margin width after surgical excision and the need for follow-up evaluation. Methods: A nationwide retrospective study analyzed the Dutch population from 1989 to 2022. All patients with a diagnosis of benign PT were identified through a search in the Dutch nationwide pathology databank (Palga). Information on age, year of diagnosis, size of the primary tumor, surgical treatment, surgical margin status, and local recurrence was collected. Results: The study enrolled 1908 patients with benign PT. The median age at diagnosis was 43 years (interquartile range [IQR], 34–52 years), and the median tumor size was 30 mm (IQR, 19–40 mm). Most of the patients (95%) were treated with breast-conserving surgery (BCS). The overall local recurrence rate was 6.2%, and the median time to local recurrence was 31 months (IQR, 15–61 months). Local recurrence was associated with bilaterality of the tumor (odds ratio [OR], 4.91; 95% confidence interval [CI], 2.95–28.30) and positive margin status (OR, 2.51; 95% CI 1.36–4.63). The local recurrence rate was 8.9% for the patients with positive excision margins and 4.0% for the patients with negative excision margins. Notably, for 27 patients (22.6%) who experienced a local recurrence, histologic upgrading of the recurrent tumor was reported, 7 (5.9%) of whom had recurrence as malignant lesions. Conclusions: This nationwide series of 1908 patients showed a low local recurrence rate of 6.2% for benign PT, with higher recurrence rates following positive margins. [ABSTRACT FROM AUTHOR]

This article discusses a study conducted in India on phyllodes tumors (PT) of the breast. The study aimed to analyze the clinical and histopathological findings, treatment modalities, and outcomes of patients with PT. The study included 42 patients and found that the majority of PTs were benign, with a few cases being borderline or malignant. The study highlights the importance of preoperative diagnosis, proper treatment, and clear surgical margins in preventing recurrence of PT. The article was published in the National Journal of Physiology, Pharmacy and Pharmacology in 2023 and focuses on the treatment of PT in a single tertiary center. The authors found their treatment approach to be effective. No conflicts of interest or sources of support were mentioned in the article. [Extracted from the article]

BackgroundPhyllodes tumors are rare fibroepithelial neoplasms that are classified by tiered histopathologic features. While there are protocols for the reporting of cancer specimens, no standardized reporting protocol exists for phyllodes.MethodsWe performed an 11-institution contemporary review of phyllodes tumors. Granular histopathologic details were recorded, including the features specifically considered for phyllodes grade classification.ResultsOf 550 patients, median tumor size was 3.0 cm, 68.9% (n = 379) of tumors were benign, 19.6% (n = 108) were borderline, and 10.5% (n = 58) were malignant. All cases reported the final tumor size and grade classification. Complete pathologic reporting of all histopathologic features was present in 15.3% (n = 84) of cases, while an additional 35.6% (n = 196) were missing only one or two features in the report. Individual details regarding the degree of stromal cellularity was not reported in 53.5% (n = 294) of cases, degree of stromal atypia in 58.0% (n = 319) of cases, presence of stromal overgrowth in 56.2% (n = 309) of cases, stromal cell mitoses in 37.5% (n = 206) of cases, and tumor border in 54.2% (n = 298) of cases. The final margin status (negative vs. positive) was omitted in only 0.9% of cases, and the final negative margin width was specifically reported in 73.8% of cases. Reporting of details was similar across all sites.ConclusionIn this academic cohort of phyllodes tumors, one or more histopathologic features were frequently omitted from the pathology report. While all features were considered by the pathologist for grading, this limited reporting reflects a lack of reporting consensus. We recommend that standardized reporting in the form of a synoptic-style cancer protocol be implemented for phyllodes tumors, similar to other rare tumors.