Year: 2024
Type: article
Abstract: We read the case study by Frias et al. about a 54-years-old woman with a left breast phyllodes tumor (PT) with 2024 g and 30.0 x 28.0 x 19.5 cm, infiltrating the skin and the papillary areolar complex, that evolved during six years before the mastectomy 1 .Grossly, the tumoral mass presented with a grayish color, irregular edges, imprecise limits, and a nodular ulcerated surface, being classified as T4BN0M0 and 7 IIIB 1 .Histopathologic study showed an epithelial component with intraductal hyperplasia, and a mesenchymal component of numerous atypical spindle cells with irregular nuclei 1 .Immunohistochemistry revealed CD34, Ki-67, P53 protein, actin alpha-smooth muscle, CD10/CALLA Ab-2, and cytokeratin estrogen and progesterone receptors positivity 1 .The authors stressed the successful management with the zetaplasty repair for the scar closure, and the unusual follow-up without recurrence of a severe and advanced tumor 1 .In this setting, the aim of the following short comments on more recent literature is enhancing the awareness of non-specialists about this uncommon challenging tumor [2][3][4][5][6][7][8][9][10] .Chen et al. reviewed data of 1902 women with diagnoses of malignant PT of breast between 2000 and 2019 with a median follow-up of 87.5 months; and mastectomy occurred in 898 (47.2%) cases including 210 undergoing radiotherapies after surgery 2 .Age did not independently predict cause-specific survival (CSS) in tumors larger than 10 cm; mastectomy had worse CSS compared with conserving surgery in tumors smaller than 10 cm; and conserving surgery got better survival for the small tumors (T1 or T2) 2 .The authors concluded that treatment should be selected based on different tumor sizes 2 .Chen et al. reviewed recurrences and metastases of PT from 2008 to 2022; among 82 cases, 69 were malignant and 13 were borderline tumors, 96.3% had surgical treatment 3 .The median follow-up was 55.5 months, 20 patients had metastasis within 3 years in over than 80% of cases, and 32 had recurrence without deaths due to disease progression 3 .The survival was related to surgical method, tumor size and biological behavior; besides, the combination of antiangiogenic drugs improved the mean progression-free survival; while lactate dehydrogenase was an independent prognosis predictor for malignant PTs 3 .Hashmi et al. reviewed 146 biopsy-proven cases of PTs submitted to lumpectomy or mastectomy, and results were classified into benign, borderline, and malignant tumors 4 .PTs mean age was 40.65 ± 12.17 years, the mean size was 9.40 ± 6.49 cm, malignant PTs were more prevalent (43.2%), followed by borderline (34.9%) and benign (21.9%) 4 .Patients with malignant and borderline PTs were of older age groups (mean 42.82 ± 12.94 and 42.05 ± 11.31 years, respectively) than the benign PTs (mean age 34.12 ± 9.75 years); and the malignant had larger (mean 11.46 ± 6.08) sizes compared with the others types 4 .Ruan et al. studied a new stage-and age-stratification system and prognostic model for malignant PT, comparing 1085 patients with 382,718 invasive ductal carcinomas 6 .New T stage 1: tumor < 49 mm in greatest dimension; new T stage 2: tumor size: ≥ 49 mm, but < 100 mm in greatest dimension; new T stage 3: tumor size ≥ 100 mm in greatest dimension; and new T stage 4: tumor of any size with direct extension to the chest wall or to skin; new stablished Age Groups were: 1) age < 71 years, and 2) age ≥ 71 years 6 .They stressed the role of multi-data verification to survivalprediction of the new model.Sain et al. analyzed data of patients previously diagnosed or presented with PTs from 1996 to 2021, 87 patients presented with PTs, and 46 (52.87%) had actual recurrences 7 .All were females, with a mean age of 39 (15-70) years; those aged <40 years had the highest incidence of recurrence (54.35%), followed by the aged >40 years (45.65%);55.4% of PTs were primary and 44.6% recurrent at presentation; the mean time to local recurrence from the treatment end was 13.8 months, and to systemic was 15.29 months; the authors highlighted the adjuvant radiotherapy favoring a minimal recurrence of PT 7 .Sars et al. performed a survey from July 2021 to February 2022 involving sixteen countries in four
Source: Colloquium Vitae
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4402632874