Multidisciplinary management of phyllodes tumor: A case report and comprehensive approach from diagnosis to treatment
Main Article Content
Abstract
Phyllodes tumors are rare fibroepithelial tumors, accounting for 2% to 3% of these neoplasms and less than 1% of all breast tumors. The standard treatment for localized disease is surgical intervention with wide margins, ideally more than 1 cm, which significantly improves local control and reduces recurrence rates. This case report describes the diagnostic and therapeutic challenges encountered in managing a 46- year-old patient with a malignant phyllodes tumor. We discuss the multidisciplinary approach required for optimal management, including surgical techniques, and the controversial roles of radiotherapy and chemotherapy. The report underscores the necessity of personalized treatment plans and highlights the importance of accurate diagnosis and tailored therapeutic strategies to improve outcomes in these rare and complex tumors.
Keywords:
Phyllodes tumor, Surgery, Prognosis, Breast neoplasm, Fibroepithelial lesion
Article Details
How to Cite
CAMEJO, Natalia et al.
Multidisciplinary management of phyllodes tumor: A case report and comprehensive approach from diagnosis to treatment.
Medical Research Archives, [S.l.], v. 12, n. 7, july 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5580>. Date accessed: 05 aug. 2024.
doi: https://doi.org/10.18103/mra.v12i7.5580.
Section
Case Reports
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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9. Adesoye T, Neuman HB, Wilke LG, Schumacher JR, Steiman J, Greenberg CC. Current Trends in the Management of Phyllodes Tumors of the Breast. Ann Surg Oncol. 2016;23(10):3199-3205. Doi:10.1245/s10434-016-5314-0
10. Kılıç MÖ, Terzioğlu SG, Bozkurt B, Dağlar G. Phyllodes Tumor of the Breast: Analysis of 48 Patients. J Breast Health. 2016;12(4):158-164. Published 2016 Oct 1. Doi:10.5152/tjbh.2016.3100
11. 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):324-330. Doi:10.6004/jnccn.2007.0027
12. Dillon MF, Quinn CM, McDermott EW, O'Doherty A, O'Higgins N, Hill AD. Needle core biopsy in the diagnosis of phyllodes neoplasm. Surgery. 2006;140(5):779-784. Doi:10.1016/j.surg.2006.03.022
13. Tavassoli FA, Devilee P. Pathology and genetics of tumours of the breast and female genital organs. In: World Health Organization Classification of Tumours, IARC Press, Lyons 2003. p .99.
14. Fajdić J, Gotovac N, Hrgović Z, Kristek J, Horvat V, Kaufmann M. Phyllodes tumors of the breast diagnostic and therapeutic dilemmas. Onkologie. 2007;30(3):113-118. Doi:10.1159/000099580
15. Lu Y, Chen Y, Zhu L, 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):1263-1275. Doi:10.1245/s10434-018-07134-5
16. Reinfuss M, Mituś J, Duda K, Stelmach A, Ryś J, Smolak K. The treatment and prognosis of patients with phyllodes tumor of the breast: an analysis of 170 cases. Cancer. 1996;77(5):910-916. Doi:10.1002/(sici)1097-0142(19960301)77:5<910::aid-cncr16>3.0.co;2-6
17. Chen WH, Cheng SP, Tzen CY, et al. Surgical treatment of phyllodes tumors of the breast: retrospective review of 172 cases. J Surg Oncol. 2005;91(3):185-194. Doi:10.1002/jso.20334
18. Chao X, Chen K, Zeng J, et al. Adjuvant radiotherapy and chemotherapy for patients with breast phyllodes tumors: a systematic review and meta-analysis. BMC Cancer. 2019;19(1):372. Published 2019 Apr 23. Doi:10.1186/s12885-019-5585-5
19. Neron M, Sajous C, Thezenas S, et al. Surgical Margins and Adjuvant Therapies in Malignant Phyllodes Tumors of the Breast: A Multicenter Retrospective Study. Ann Surg Oncol. 2020;27(6):1818-1827. Doi:10.1245/s10434-020-08217-y
20. Rosenberger LH, Thomas SM, Nimbkar SN, et al. Contemporary Multi-Institutional Cohort of 550 Cases of Phyllodes Tumors (2007-2017) Demonstrates a Need for More Individualized Margin Guidelines. J Clin Oncol. 2021;39(3):178-189. Doi:10.1200/JCO.20.02647
21. Zeng S, Zhang X, Yang D, Wang X, Ren G. Effects of adjuvant radiotherapy on borderline and malignant phyllodes tumors: A systematic review and meta-analysis. Mol Clin Oncol. 2015;3(3):663-671. Doi:10.3892/mco.2015.503
22. Sapino A, Bosco M, Cassoni P, et al. Estrogen receptor-beta is expressed in stromal cells of fibroadenoma and phyllodes tumors of the breast. Mod Pathol. 2006;19(4):599-606. Doi:10.1038/modpathol.3800574
2. Guillot E, Couturaud B, Reyal F, et al. Management of phyllodes breast tumors. Breast J. 2011;17(2):129-137. Doi:10.1111/j.1524-4741.2010.01045.x
3. Bernstein L, Deapen D, Ross RK. The descriptive epidemiology of malignant cystosarcoma phyllodes tumors of the breast. Cancer. 1993;71(10):3020-3024. Doi:10.1002/1097-0142(19930515)71:10<3020::aid-cncr2820711022>3.0.co;2-g
4. Lerwill MF, Lee AHS, Tan PH. Fibroepithelial tumours of the breast-a review. Virchows Arch. 2022;480(1):45-63. Doi:10.1007/s00428-021-03175-6
5. Zhang Y, Kleer CG. Phyllodes Tumor of the Breast: Histopathologic Features, Differential Diagnosis, and Molecular/Genetic Updates. Arch Pathol Lab Med. 2016;140(7):665-671. Doi:10.5858/arpa.2016-0042-RA
6. Rosenberger LH, Thomas SM, Nimbkar SN, et al. Germline Genetic Mutations in a Multi-center Contemporary Cohort of 550 Phyllodes Tumors: An Opportunity for Expanded Multi-gene Panel Testing. Ann Surg Oncol. 2020;27(10):3633-3640. Doi:10.1245/s10434-020-08480-z
7. Birch JM, Alston RD, McNally RJ, et al. Relative frequency and morphology of cancers in carriers of germline TP53 mutations. Oncogene. 2001;20(34):4621-4628. Doi:10.1038/sj.onc.1204621
8. Boland PA, Ali Beegan A, Stokes M, et al. Management and outcomes of phyllodes tumours - 10 year experience. Breast Dis. 2021;40(3):171-176. Doi:10.3233/BD-201059
9. Adesoye T, Neuman HB, Wilke LG, Schumacher JR, Steiman J, Greenberg CC. Current Trends in the Management of Phyllodes Tumors of the Breast. Ann Surg Oncol. 2016;23(10):3199-3205. Doi:10.1245/s10434-016-5314-0
10. Kılıç MÖ, Terzioğlu SG, Bozkurt B, Dağlar G. Phyllodes Tumor of the Breast: Analysis of 48 Patients. J Breast Health. 2016;12(4):158-164. Published 2016 Oct 1. Doi:10.5152/tjbh.2016.3100
11. 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):324-330. Doi:10.6004/jnccn.2007.0027
12. Dillon MF, Quinn CM, McDermott EW, O'Doherty A, O'Higgins N, Hill AD. Needle core biopsy in the diagnosis of phyllodes neoplasm. Surgery. 2006;140(5):779-784. Doi:10.1016/j.surg.2006.03.022
13. Tavassoli FA, Devilee P. Pathology and genetics of tumours of the breast and female genital organs. In: World Health Organization Classification of Tumours, IARC Press, Lyons 2003. p .99.
14. Fajdić J, Gotovac N, Hrgović Z, Kristek J, Horvat V, Kaufmann M. Phyllodes tumors of the breast diagnostic and therapeutic dilemmas. Onkologie. 2007;30(3):113-118. Doi:10.1159/000099580
15. Lu Y, Chen Y, Zhu L, 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):1263-1275. Doi:10.1245/s10434-018-07134-5
16. Reinfuss M, Mituś J, Duda K, Stelmach A, Ryś J, Smolak K. The treatment and prognosis of patients with phyllodes tumor of the breast: an analysis of 170 cases. Cancer. 1996;77(5):910-916. Doi:10.1002/(sici)1097-0142(19960301)77:5<910::aid-cncr16>3.0.co;2-6
17. Chen WH, Cheng SP, Tzen CY, et al. Surgical treatment of phyllodes tumors of the breast: retrospective review of 172 cases. J Surg Oncol. 2005;91(3):185-194. Doi:10.1002/jso.20334
18. Chao X, Chen K, Zeng J, et al. Adjuvant radiotherapy and chemotherapy for patients with breast phyllodes tumors: a systematic review and meta-analysis. BMC Cancer. 2019;19(1):372. Published 2019 Apr 23. Doi:10.1186/s12885-019-5585-5
19. Neron M, Sajous C, Thezenas S, et al. Surgical Margins and Adjuvant Therapies in Malignant Phyllodes Tumors of the Breast: A Multicenter Retrospective Study. Ann Surg Oncol. 2020;27(6):1818-1827. Doi:10.1245/s10434-020-08217-y
20. Rosenberger LH, Thomas SM, Nimbkar SN, et al. Contemporary Multi-Institutional Cohort of 550 Cases of Phyllodes Tumors (2007-2017) Demonstrates a Need for More Individualized Margin Guidelines. J Clin Oncol. 2021;39(3):178-189. Doi:10.1200/JCO.20.02647
21. Zeng S, Zhang X, Yang D, Wang X, Ren G. Effects of adjuvant radiotherapy on borderline and malignant phyllodes tumors: A systematic review and meta-analysis. Mol Clin Oncol. 2015;3(3):663-671. Doi:10.3892/mco.2015.503
22. Sapino A, Bosco M, Cassoni P, et al. Estrogen receptor-beta is expressed in stromal cells of fibroadenoma and phyllodes tumors of the breast. Mod Pathol. 2006;19(4):599-606. Doi:10.1038/modpathol.3800574