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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thirty cases of phyllodes tumour (cystosarcoma phyllodes) of the breast that presented to the Clinical Oncology Unit at Guy's Hospital were reviewed. Tumours were classified as benign, malignant or borderline according to the following histological criteria: mitotic rate, nuclear pleomorphism, stromal overgrowth and tumour margins. In 14 (46.5%) cases the tumours were considered histologically benign, in 11 (36.5%) malignant, and in five (17%) borderline. Recurrence was seen in a similar proportion of patients with tumours classified as benign (21%) and malignant (18%) according to histological criteria. Malignant lesions tended to recur earlier. Infiltrating tumour margins were noted in all patients and stromal overgrowth in all but one in whom recurrence was observed. Risk of recurrence also appeared to be related to tumour size. Only one patient developed distant metastases and died of her disease. Because of treatment variation no conclusion can be made regarding optimal therapy but the importance of adequate clearance, either through wide excision or mastectomy, is emphasized for all phyllodes tumours irrespective of histological features.
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PMID:Phyllodes tumours: a clinicopathological review of 30 cases. 132 60

The histologic features of 187 cases of cystosarcoma phyllodes of the breast were reviewed. The tumors were divided into histologically benign, borderline, and malignant categories. Correlation with clinical outcome was available in 100 cases. Overall rate of local recurrence was 28% (benign, 27%; borderline, 32%; malignant, 26%). Metastases occurred in eight of 100 cases (two borderline and six malignant). Although no histologic features were predictive of local recurrence, stromal overgrowth, mitotic rate greater than 15 per 50 high-power fields, and cytologically atypical stromal cells characterized seven of the eight tumors that metastasized. These features were not evident in the eighth case. Flow cytometric analysis of eight tumors (four benign, two borderline, and two malignant) showed discordance between histology and DNA content in three cases. There was slightly better correlation of histology and S-phase fractions. Based on these results demonstrating the difficulty in predicting clinical outcome, wide local excision remains an appropriate initial method of treatment. Simple mastectomy may be necessary for very large tumors and should be considered in histologically malignant tumors and cases with multiple recurrences, since some recurrent tumors in this series showed increasingly unfavorable histologic features.
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PMID:Cystosarcoma phyllodes of the breast: histologic features, flow cytometric analysis, and clinical correlations. 132 1

We reviewed 66 phyllodes tumors of the breast from 60 patients. Our patients included 59 women and one man ranging in age from 16 to 72 years. Fifty patients presented for primary treatment of newly diagnosed breast masses, nine presented with recurrent tumors, and one presented with soft tissue metastases 9 years after bilateral subcutaneous mastectomies and multiple chest wall recurrences of phyllodes tumor. After 0.3 to 53.2 years (mean, 15.5 years) of follow-up, 26 (43.3%) patients are free of disease without recurrence, 26 (43.3%) patients are dead of other (17 patients) or unknown (nine patients) causes, four (6.7%) patients had locally recurrent tumor 0.7 to 2.9 years after lumpectomy and are free of disease 3 months to 12 years after re-excision or simple mastectomy, two (3.3%) patients are lost to follow-up, and two (3.3%) patients died with metastatic disease 1.8 and 7 years after diagnosis. Histologic features and flow cytometric analysis showed no correlation with outcome. Fifty-six breast tumors were biphasic and nine were purely stromal tumors. Twenty-six (47%) biphasic tumors showed stromal overgrowth. Tumor margins were pushing in 20 (39%) and infiltrative in 29 (61%) of 49 evaluable cases. Twenty-one tumors were highly cellular and 17 showed cytologic atypia. Necrosis was identified in 16 tumors. Mitotic rates ranged from 0/10 high-power fields to 48/10 high-power fields. Twenty-four diploid, six aneuploid, three tetraploid, and one polyploid tumor were identified by flow cytometry. S-phase fractions tended to be higher in nondiploid tumors. Neither DNA content nor S-phase fraction correlated with outcome. Our results indicate that most mammary phyllodes tumors, including purely stromal tumors, behave as low-grade, nonmetastasizing neoplasms. Neither histologic evaluation nor DNA content provides reliable clues concerning the natural history of an individual tumor.
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PMID:Phyllodes tumor: clinicopathologic review of 60 patients and flow cytometric analysis in 30 patients. 132 8

A series of 59 phyllodes tumors of the breast was retrospectively reviewed (average follow-up = 3.9 years). Clinical features (age, size of tumor) and diagnostic tests (palpation, mammography, sonography and cytology) were found to be inaccurate in predicting benign (n = 22), borderline (n = 12) or malignant (n = 25) histological type. Limited surgery was associated with a relatively high proportion of local recurrence (enucleation/enucleoresection = 3/5, wide resection = 12/30) compared with mastectomy (2/24). No significant association was observed between the probability of local recurrence and patient's age, histological type or lesion size. Although the study confirms that limited surgery may cure phyllodes tumor, careful follow-up of all patients is needed, since no reliable risk factors for recurrence are available. In malignant cases, axillary node involvement was nil and distant metastases were infrequently observed (3/25). Axillary dissection and search for asymptomatic metastases is not recommended.
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PMID:Phyllodes tumor of the breast: a multicenter series of 59 cases. Coordinating Center and Writing Committee of FONCAM (National Task Force for Breast Cancer), Italy. 133 86

A multicenter retrospective series of 70 breast sarcomas (malignant cystosarcoma phyllodes (25), osteosarcoma (12), liposarcoma (10), stromal sarcoma (8), angiosarcoma (7), mixed types sarcoma (4), malignant histiocytoma (3), leiomyosarcoma (1)) was reviewed. The average follow-up was 5.9 years. Diagnostic tests (palpation, mammography, sonography and cytology) were poorly sensitive, and a large proportion of cases, appearing as regular, sharp bordered, rounded masses were diagnosed as benign fibroadenomas. Surgery (limited (29), mastectomy (41)) was the treatment of choice. Axillary nodes were rarely involved (2 of 31) at pathologic staging. No significant predictors of local recurrences (12 cases) were observed although recurrences were more frequent in larger lesions (0-20 mm = 1.1%, 21-50 mm = 1.7%, > 50 mm = 6.1% women-year) and in cases treated with limited surgery (limited surgery 4.6%, mastectomy 2.0% women-year). Distant metastases (16 cases) were less frequent in malignant cystosarcoma phyllodes or liposarcoma patients, but no other significant predictors of distant metastases were evidenced. Five-year disease-free or overall survival was 50% or 66%, respectively. The study confirms that breast sarcomas are rare, difficult to diagnose, but can be cured by surgical treatment in a considerable proportion of cases.
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PMID:Sarcomas of the breast: a multicenter series of 70 cases. 149 28

In this paper we report a case of cystosarcoma phyllodes malignum in a 45 years old female patient. A local relapse occurred 20 months after ablatio mammae. This tumor was histologically a benign fibroadenoma. 69 months postoperative metastases of the pleural diaphragma were found: the appearance was similar to that of a mesothelioma. The CEA was helpful in revealing the metastases and in indicating the progression. This case is discussed and compared to the review of the literature. Because of the high rate of local relapses a postoperative irradiation of the chest wall is proposed.
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PMID:[Malignant cystosarcoma phyllodes]. 164 81

The authors studied prognostic factors in 77 patients with primary cystosarcoma phyllodes (CSP) of the breast. Median patient age was 50 years of age, and the median follow-up time was 8 years. Sixteen patients (21%) had distant metastases and subsequently died of CSP. Clinical variables such as age, symptom duration, clinical tumor size, and type of surgery were not of prognostic value. Local recurrence was more common among patients treated with breast-conserving surgery than among those treated with mastectomy. However, there was no significant difference between these two subgroups in terms of distant metastasis-free survival or overall survival. The prognostic significance of several histopathologic parameters was also assessed, e.g., stromal cellularity, stromal cellular atypism, mitotic activity, atypic mitoses, stromal overgrowth, tumor contour, tumor necrosis, and heterologous stromal elements. In a multivariate Cox analysis, the only features that were found to be independent prognostic factors were tumor necrosis (P less than 0.05) and presence of stromal elements other than fibromyxoid tissue (P less than 0.01). In summary, additional studies of prognostic factors in CSP are warranted because of the conflicting results in published reports.
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PMID:Prognostic factors in cystosarcoma phyllodes. A clinicopathologic study of 77 patients. 165 34

We report 3 new cases of phyllodes type of atypical prostatic hyperplasia. This lesion is characterized by epithelial and stromal proliferation. Stromal changes are the most characteristic finding in phyllodes type of atypical prostatic hyperplasia, which show atypical cells with enlarged, hyperchromatic sarcomatoid nuclei. Mitotic figures are not present. Although the histological appearance may mimic that of cystosarcoma phyllodes of the breast, this pattern is present only focally or not at all in phyllodes type of atypical prostatic hyperplasia. On computerized tomographic imaging phyllodes type of atypical prostatic hyperplasia has a distinct appearance. These patients can be expected to have a benign clinical course and distant metastases have not been reported. Treatment is by surgical excision as in benign prostatic hyperplasia.
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PMID:Phyllodes type of atypical prostatic hyperplasia: a report of 3 new cases. 244 22

134 Cystosarcoma phyllodes were been observed in the course of 12 years among the diagnostic and consultative (n = 121) material. 133 tumors occurred in the female, one in the male breast. In 21 cases local recurrences and in 4 cases metastases developed. 6 recurrences following local excision were observed more than once: in one case 10 subsequent recurrent tumors, the last of these in the chest wall after mastectomy. Histopathologically, the recurrences were identified as benign (1 case), as borderline tumors (2 cases) and as malignant cystosarcoma (8 cases). In 10 further cases (48% of the recurrences) a stromal sarcoma was predominant. In accordance with the literature, we found in most cases a more aggressive growth and an enhanced malignancy. It is emphasized, that angioinvasive growth in the recurrent tumors can indicate distant metastases. The frequency of the recurrent cystosarcoma in our series was 16%, multiple subsequent tumors occurred in 29% of them. Recurrences are caused by proliferative remnants of the primary tumor following local excision, or they are tumors-de-novo induced by a extratumoral stromal hypercellularity of the surroundings like a new benign cystosarcoma. Therefore an initial wide excision is recommended for the benign and a mastectomy for the malignant cystosarcoma. The site of distant metastases of the 4 cases were the lung and the skeleton (rib and femur). In one case an axillary lymph node was involved by a recurrent giant cell stromal sarcoma. The interval between primary and metastases was 7 months to 5 years, between recurrent tumor and metastases 6 to 24 months or both tumors were observed simultaneously. Following the recent literature, distant metastases occur at an average rate of 19% of the malignant cystosarcomas. In single cases it is impossible to make a sure prognosis of cystosarcoma phyllodes, because recurrences and metastases are observed in all subtypes, but predominantly in the malignant cystosarcomas.
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PMID:[Recurrences and metastases of cystosarcoma phylloides (phylloid tumor, WHO). On the 150th birthday of a controversial diagnostic concept]. 253 47

Two cases of malignant Cystosarcoma phyllodes seen in Jos University Teaching Hospital over a 9-year period are being reported. One occurred in a 16-year girl now dead and the other in a 52-year old woman probably dead. Both cases showed metastases, the axillary nodes being involved in the deceased, cervical nodes in the elderly patient, and both had pulmonary and presumably hepatic metastasis. These were the 2 cases seen out of a total of 696 surgical breast specimens reviewed thus constituting 0.3 percent. It is not certain if chemotherapy has been beneficial but one might need more cases well organised trials to arrive at definitive conclusions.
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PMID:Malignant Cystosarcoma phyllodes: report of two cases. 255 12


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