Progressive Metastatic Breast Phyllodes Tumor Turns into Spindle Cell Sarcoma: Report of Two Cases and Review of the Literature
Abstract
Background: Breast fibroepithelial lesions encompass a wide variety of tumors from benign fibroadenomas to malignant phyllodes tumors (PTs). Local recurrence was reported in 20% of all subgroups and 20-25% risk of distant metastasis though superaggressive tumors are rare. Two young patients with nonresponsive, frequent recurrences of phyllodes tumors turned into the aggressive metastatic sarcoma are presented.
Case Presentation: Case 1: A 34-year-old married woman referred with the chief complaint of a mass and pain in her right breast. There was a 3cm well defined mass in right breast. An intermediate grade benign phyllodes tumor was confirmed in biopsy. Patient underwent surgical wide excision, radiotherapy. Three weeks later the mass recurred in her right breast with severe pain and nonproductive cough without hemoptysis. A single lung metastasis is conformed in the CT scan. Total mastectomy and thoracoscopic metastasectomy was performed and spindle cell sarcomas in both specimens is confirmed. Chemotherapy was done. Two weeks after chemotherapy she presented with multiple bilateral lung metastasises and thoracic wall involvement. No regression in metastasis was seen receiving the second line chemotherapeutic agents. Case 2: A 17-year-old young girl was referred to the breast clinic with a 2 cm firm mobile mass in left breast. The histopathology of the mass was benign phyllodes tumor. (1.5 cm margins) The tumor recurred 3 months later treated. During radiotherapy, the patient referred to the emergency department with the complaint of dyspnea and sever pleural effusion. The cytology reported malignant cells. CT-guided biopsy showed a high grade sarcoma. During chemotherapy, large ulcer in the site of the breast was appeared and mastectomy with Latissmus dorsi flap was performed and angiosarcoma was confirmed. Despite the second and third line chemotherapy the disease was progressed and multiple lung metastasis were confirmed in chest CT scan.
Conclusion: It seems that some subtypes of breast sarcomas could have an extremely an aggressive behavior which threatens the life of the patients in a short period of time. Further studies is suggested to discriminate the aggressive subtypes at the first step.
Full text article
References
Pareja F, Geyer FC, Kumar R, Selenica P, Piscuoglio S, et al. Phyllodes tumors with and without fibroadenoma-like areas display distinct genomic features and may evolve through distinct pathways. NPJ Breast Cancer. 2017; 3:40.
Lee AH, Hodi Z, Ellis IO, Elston CW. Histological features useful in the distinction of phyllodes tumour and fibroadenoma on needle core biopsy of the breast. Histopathology. 2007;51(3):336-44.
Telli ML, Horst KC, Guardino AE, Dirbas FM, Carlson RW. Phyllodes tumors of the breast: natural history, diagnosis, and treatment. J Natl Compr Canc Netw. 2007;5(3):324-30.
Zhang Y, Kleer CG. Phyllodes Tumor of the Breast: Histopathologic Features, Differential Diagnosis, and Molecular/Genetic Updates. Arch Pathol Lab Med. 2016;140(7):665-71.
McKenna AM, Pintilie M, Youngson B, Done SJ. Quantification of the morphologic features of fibroepithelial tumors of the breast. Arch Pathol Lab Med. 2007;131(10):1568-73.
Abdelkrim SB, Trabelsi A, Bouzrara M, Boudagga MZ, Memmi A, et al. Phyllodes Tumors of the Breast: A Review of 26 Cases. World J Oncol. 2010;1(3):129-34.
Mitus JW, Blecharz P, Walasek T, Reinfuss M, Jakubowicz J, et al. Treatment of Patients with Distant Metastases from Phyllodes Tumor of the Breast. World J Surg. 2016;40(2):323-8.
Guerrero MA, Ballard BR, Grau AM. Malignant phyllodes tumor of the breast: review of the literature and case report of stromal overgrowth. Surg Oncol. 2003;12(1):27-37.
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;2018: 6491675.
Confavreux C, Lurkin A, Mitton N, Blondet R, Saba C, et al. Sarcomas and malignant phyllodes tumours of the breast--a retrospective study. Eur J Cancer. 2006;42(16):2715-21.
Wang F, Jia Y, Tong Z. Comparison of the clinical and prognostic features of primary breast sarcomas and malignant phyllodes tumor. Jpn J Clin Oncol. 2015;45(2):146-52.
Lu Y, Chen Y, Zhu L, Cartwright P, Song E, et al. Local Recurrence of Benign, Borderline, and Malignant Phyllodes Tumors of the Breast: A Systematic Review and Meta-analysis. Ann Surg Oncol. 2019;26(5):1263-75.
Tan EY, Tan PH, Yong WS, Wong HB, Ho GH, et al. Recurrent phyllodes tumours of the breast: pathological features and clinical implications. ANZ J Surg. 2006;76(6):476-80.
Macdonald OK, Lee CM, Tward JD, Chappel CD, Gaffney DK. Malignant phyllodes tumor of the female breast: association of primary therapy with cause-specific survival from the Surveillance, Epidemiology, and End Results (SEER) program. Cancer. 2006;107(9):2127-33.
Authors
Copyright (c) 2020 Archives of Breast Cancer
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright©. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International License, which permits copy and redistribution of the material in any medium or format or adapt, remix, transform, and build upon the material for any purpose, except for commercial purposes.