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Malignant phyllodes tumour with liposarcomatous differentiation, invasive tubular carcinoma, and ductal and lobular carcinoma in situ: case report and review of the literature.

Abdul Aziz M, Sullivan F, Kerin MJ, Callagy G - Patholog Res Int (2010)

Bottom Line: Carcinoma is more commonly found within the confines of benign PTs; whereas it is more often found surrounding the PT or in the contralateral breast in malignant PTs.The aetiology of co-existing carcinoma is unclear but the rarity of previous radiotherapy treatment suggests that it is incidental.This case highlights the diverse pathology that can occur with PTs, which should be considered when evaluating pathology specimens as they may impact on patient management.

View Article: PubMed Central - PubMed

Affiliation: Division of Anatomic Pathology, Galway University Hospitals, Galway, Ireland.

ABSTRACT
A 43-year-old woman presented with a right breast lump that had enlarged over 5 months. She had chemoradiotherapy for non-Hodgkin's lymphoma in 1989. Histology revealed a malignant phyllodes tumour (PT) with liposarcomatous differentiation and ductal carcinoma in situ (DCIS) within the tumour with invasive tubular carcinoma, DCIS, and lobular carcinoma in situ in the surrounding breast. She had surgery and adjuvant radiotherapy. One year follow-up showed no recurrence or metastatic disease. Liposarcomatous differentiation is uncommon in PTs, and coexisting carcinoma is rare with 38 cases in 31 reports in the literature. Carcinoma is reported in malignant (n = 19), benign (n = 16) and in borderline PTs (n = 3) with invasive carcinoma (n = 18) and pure in situ carcinoma (n = 19) recorded in equal frequency. Carcinoma is more commonly found within the confines of benign PTs; whereas it is more often found surrounding the PT or in the contralateral breast in malignant PTs. Previous radiotherapy treatment is reported in only two cases. The aetiology of co-existing carcinoma is unclear but the rarity of previous radiotherapy treatment suggests that it is incidental. This case highlights the diverse pathology that can occur with PTs, which should be considered when evaluating pathology specimens as they may impact on patient management.

No MeSH data available.


Related in: MedlinePlus

Pathological features within phyllodes tumour: (a) leaf-like architecture of the phyllodes tumour (H&E, original magnification 40x); (b) fibrosarcomatous stroma (H&E, original magnification 100x); (c) liposarcomatous differentiation in the stroma. Note the presence of lipoblasts (H&E, original magnification 200x); (d) DCIS, intermediate nuclear grade (H&E, original magnification 400x).
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fig2: Pathological features within phyllodes tumour: (a) leaf-like architecture of the phyllodes tumour (H&E, original magnification 40x); (b) fibrosarcomatous stroma (H&E, original magnification 100x); (c) liposarcomatous differentiation in the stroma. Note the presence of lipoblasts (H&E, original magnification 200x); (d) DCIS, intermediate nuclear grade (H&E, original magnification 400x).

Mentions: The wide local excision of the left breast, 75 × 60 × 30 mm, contained a well-defined, partly encapsulated tumor, 25 × 35 × 27 mm, with a papillary texture. A PT was confirmed histologically. The tumour showed the characteristic enhanced intracanalicular growth pattern with leaf-like projections into dilated cysts, extensive stromal overgrowth, and marked stromal hypercellularity (Figure 2(a)). Frankly malignant stromal features including nuclear pleomorphism and a high mitotic count (19 per 10 high power fields) were seen (Figure 2(b)). In many areas, liposarcomatous differentiation, characterized by pleomorphic lipoblasts, was present (Figure 2(c)). The margins of the PT were focally infiltrative. The epithelial component within the PT exhibited hyperplasia of usual type as well as foci of DCIS, intermediate grade, with cribriform and solid growth patterns, without necrosis (Figure 2(d)). A small invasive carcinoma, 2 mm in size, was present at the periphery of the PT close to the deep margin of the specimen (Figure 3(a)). This was composed of well-formed tubules that lacked a myoepithelial layer (Smooth Muscle Heavy Chain Myosin and p63 negative) and was regarded as a grade 1 tumour [3] although it was too small to grade accurately based on the absence of sufficient high power fields for scoring of mitotic activity. Oestrogen receptor was strongly expressed and Her-2 was negative. The invasive tumour was adjacent to a small duct with morphological features of low-grade DCIS but there was no morphological transition between invasive carcinoma and the stromal or epithelial components of the adjacent PT. Multiple scattered foci of LCIS were also present peripheral to the PT, confirmed by downregulation of E-Cadherin staining (Figures 3(b) and 3(c)). The scattered nature of the LCIS precludes accurate measurement of its size.


Malignant phyllodes tumour with liposarcomatous differentiation, invasive tubular carcinoma, and ductal and lobular carcinoma in situ: case report and review of the literature.

Abdul Aziz M, Sullivan F, Kerin MJ, Callagy G - Patholog Res Int (2010)

Pathological features within phyllodes tumour: (a) leaf-like architecture of the phyllodes tumour (H&E, original magnification 40x); (b) fibrosarcomatous stroma (H&E, original magnification 100x); (c) liposarcomatous differentiation in the stroma. Note the presence of lipoblasts (H&E, original magnification 200x); (d) DCIS, intermediate nuclear grade (H&E, original magnification 400x).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2990446&req=5

fig2: Pathological features within phyllodes tumour: (a) leaf-like architecture of the phyllodes tumour (H&E, original magnification 40x); (b) fibrosarcomatous stroma (H&E, original magnification 100x); (c) liposarcomatous differentiation in the stroma. Note the presence of lipoblasts (H&E, original magnification 200x); (d) DCIS, intermediate nuclear grade (H&E, original magnification 400x).
Mentions: The wide local excision of the left breast, 75 × 60 × 30 mm, contained a well-defined, partly encapsulated tumor, 25 × 35 × 27 mm, with a papillary texture. A PT was confirmed histologically. The tumour showed the characteristic enhanced intracanalicular growth pattern with leaf-like projections into dilated cysts, extensive stromal overgrowth, and marked stromal hypercellularity (Figure 2(a)). Frankly malignant stromal features including nuclear pleomorphism and a high mitotic count (19 per 10 high power fields) were seen (Figure 2(b)). In many areas, liposarcomatous differentiation, characterized by pleomorphic lipoblasts, was present (Figure 2(c)). The margins of the PT were focally infiltrative. The epithelial component within the PT exhibited hyperplasia of usual type as well as foci of DCIS, intermediate grade, with cribriform and solid growth patterns, without necrosis (Figure 2(d)). A small invasive carcinoma, 2 mm in size, was present at the periphery of the PT close to the deep margin of the specimen (Figure 3(a)). This was composed of well-formed tubules that lacked a myoepithelial layer (Smooth Muscle Heavy Chain Myosin and p63 negative) and was regarded as a grade 1 tumour [3] although it was too small to grade accurately based on the absence of sufficient high power fields for scoring of mitotic activity. Oestrogen receptor was strongly expressed and Her-2 was negative. The invasive tumour was adjacent to a small duct with morphological features of low-grade DCIS but there was no morphological transition between invasive carcinoma and the stromal or epithelial components of the adjacent PT. Multiple scattered foci of LCIS were also present peripheral to the PT, confirmed by downregulation of E-Cadherin staining (Figures 3(b) and 3(c)). The scattered nature of the LCIS precludes accurate measurement of its size.

Bottom Line: Carcinoma is more commonly found within the confines of benign PTs; whereas it is more often found surrounding the PT or in the contralateral breast in malignant PTs.The aetiology of co-existing carcinoma is unclear but the rarity of previous radiotherapy treatment suggests that it is incidental.This case highlights the diverse pathology that can occur with PTs, which should be considered when evaluating pathology specimens as they may impact on patient management.

View Article: PubMed Central - PubMed

Affiliation: Division of Anatomic Pathology, Galway University Hospitals, Galway, Ireland.

ABSTRACT
A 43-year-old woman presented with a right breast lump that had enlarged over 5 months. She had chemoradiotherapy for non-Hodgkin's lymphoma in 1989. Histology revealed a malignant phyllodes tumour (PT) with liposarcomatous differentiation and ductal carcinoma in situ (DCIS) within the tumour with invasive tubular carcinoma, DCIS, and lobular carcinoma in situ in the surrounding breast. She had surgery and adjuvant radiotherapy. One year follow-up showed no recurrence or metastatic disease. Liposarcomatous differentiation is uncommon in PTs, and coexisting carcinoma is rare with 38 cases in 31 reports in the literature. Carcinoma is reported in malignant (n = 19), benign (n = 16) and in borderline PTs (n = 3) with invasive carcinoma (n = 18) and pure in situ carcinoma (n = 19) recorded in equal frequency. Carcinoma is more commonly found within the confines of benign PTs; whereas it is more often found surrounding the PT or in the contralateral breast in malignant PTs. Previous radiotherapy treatment is reported in only two cases. The aetiology of co-existing carcinoma is unclear but the rarity of previous radiotherapy treatment suggests that it is incidental. This case highlights the diverse pathology that can occur with PTs, which should be considered when evaluating pathology specimens as they may impact on patient management.

No MeSH data available.


Related in: MedlinePlus