Abstract
Phyllodes tumor is an uncommon biphasic breast tumor, with the ability to recur and metastasize, and it behaves biologically like a stromal neoplasm. Traditionally, phyllodes tumors are graded by the use of a set of histologic data into benign, borderline, and malignant. In most series, all phyllodes tumors may recur, but only the borderline and malignant phyllodes tumors metastasize. On the basis of histologic features, prediction of behavior is difficult. The expression of many biological markers, including p53, hormone receptors, proliferation markers, angiogenesis group of markers, c-kit, CD10 and epidermal growth factor receptor have been explored, and many have been shown to be variably expressed, depending on the grade of the tumor. These markers are, however, of limited value in predicting the behavior of the tumor. Recently investigators have reported a plethora of genetic changes in phyllodes tumors, the most consistent of which seems to be 1q gain by comparative genomic hybridization. Some candidate genes have been mapped to various sites, and preliminary data suggest that some of these changes may be related to recurrence. It is foreseeable that more exciting data will be generated to help us to understand the etiology and pathogenesis of phyllodes tumor.
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References
Elston CW, Ellis IO. The breast. Systemic Pathology, 3rd ed., vol 13. Edinburgh: Churchill Livingstone; 2000. p. 147–86.
Tan PH, Jayabaskar T, Chuah KL, Lee HY, Tan Y, Hilmy M, et al. Phyllodes tumors of the breast. The role of pathologic parameters. Am J Clin Pathol. 2005;123:529–40.
Tse GM, Putti TC, Kung FY, Scolyer RA, Law BK, Lau TS, et al. Increased p53 protein expression in malignant mammary phyllodes tumors. Mod Pathol. 2002;15:734–40.
Moffat CJ, Pinders SE, Dixon AR, Elston CW, Blamey RW, Ellis IO. Phyllodes tumors of the breast: a clinicopathological review of thirty-two cases. Histopathology. 1995;27:205–18.
Parkers SJ, Harries SA. Phyllodes tumors. Postgrad Med J. 2001;77:428–35.
Grimes MM. Cystosarcoma phyllodes of the breast: histological features, flow cytometric analysis, and clinical correlation. Mod Pathol. 1992;5:232–9.
Mokbel K, Price RK, Mostafa A, Wells CA, Carpenter R. Phyllodes tumour of the breast: a retrospective analysis of 30 cases. Breast. 1999;8:278–81.
Reinfuss M, Mitus J, Smolak K, Stelmach A. Malignant phyllodes tumors of the breast. A clinical and pathological analysis of 55 cases. Eur J Cancer. 1993;29A:1252–6.
Staren ED, Lynch G, Boyle C, Witt TR, Bines SD. Malignant cystosarcoma phyllodes. Am Surg. 1994;60:583–5.
Ciatto S, Bonardi R, Cataliotti L, Cardona G. Phyllodes tumour of the breast: a multicenter series of 59 cases. Coordinating Center and Writing Committee of FONCAM (National Task Force for Breast Cancer), Italy. Eur J Surg Oncol. 1992;18:545–9.
Geisler DP, Boyle MJ, Malnar KF, McGee JM, Nolen MC, Fortner SM, et al. Phyllodes tumors of the breast: a review of 32 cases. Am Surg. 2000;66:360–6.
Bennett IC, Khan A, De Freitas R, Chaudary MA, Millis RR. Phyllodes tumors: a clinicopathological review of 30 cases. Aust N Z J Surg. 1992;62:628–33.
Reinfuss M, Mitus J, Duda K, Stelmach A, Rys J, Smolak K. The treatment and prognosis of patients with phyllodes tumour of the breast: an analysis of 170 cases. Cancer. 1996;77:910–6.
Hawkins RE, Schofield JB, Fisher C, Wiltshaw E, McKinna JA. The clinical and histological criteria that predict metastases from cystosarcoma phyllodes. Cancer. 1992;69:141–7.
Cohn-Cedermark G, Rutqvist LE, Rosendahl I, Silfversward C. Prognostic factors in cystosarcoma phyllodes. A clinicopathologic study of 77 patients. Cancer. 1991;68:2017–22.
Kapiris I, Nasiri N, A’Hern R, Healy V, Gui GP. Outcome and predictive factors of local recurrence and distant metastases following primary surgical treatment of high-grade malignant phyllodes tumors of the breast. Eur J Surg Oncol. 2001;27:723–30.
Keelan PA, Myers JL, Wold LE, Katzmann JA, Gibney DJ. Phyllodes tumour: clinicopathologic review of 60 patients and flow cytometric analysis in 30 patients. Hum Pathol. 1992;23:1048–54.
Millar EK, Beretov J, Marr P, Sarris M, Clarke RA, Kearsley JH, et al. Malignant phyllodes tumors of the breast display increased stromal p53 protein expression. Histopathology. 1999;34:491–6.
Feakins RM, Mulcahy HE, Nickols CD, Wells CA. p53 expression in phyllodes tumors is associated with histological features of malignancy but does not predict outcome. Histopathology. 1999;35:162–9.
Kuenen-Boumeester V, Henzen-Logmans SC, Timmermans MM, van Staveren IL, van Geel A, Peeterse HJ, et al. Altered expression of p53 and its regulated proteins in phyllodes tumors of the breast. J Pathol. 1999;189:169–75.
Shpitz B, Bomstein Y, Sternberg A, Klein E, Tiomkin V, Kaufman A, et al. Immunoreactivity of p53, Ki-67, and c-erbB-2 in phyllodes tumors of the breast in correlation with clinical and morphologic features. J Surg Oncol. 2002;79:86–92.
Tan PH, Jayabaskar T, Yip G, Tan Y, Hilmy M, Selvarajan S, et al. p53 and c-kit (CD117) protein expression as prognostic indicators in breast phyllodes tumors: a tissue microarray study. Mod Pathol. 2005;18:1527–34.
Chan YJ, Chen BF, Chang CL, Yang TL, Fan CC. Expression of p53 protein and Ki-67 antigen in phyllodes tumor of the breast. J Chin Med Assoc. 2004;67:3–8.
Yonemori K, Hasegawa T, Shimizu C, Shibata T, Matsumoto K, Kouno T, et al. Correlation of p53 and MIB-1 expression with both the systemic recurrence and survival in cases of phyllodes tumors of the breast. Pathol Res Pract. 2006;202(10):705–12.
Umekita Y, Yoshida H. Immunohistochemical study of hormone receptor and hormone-regulated protein expression in phyllodes tumour: comparison with fibroadenoma. Virchows Arch. 1998;433:311–4.
Tse GM, Lee CS, Kung FY, Scolyer RA, Law BK, Lau TS, et al. Hormonal receptors expression in epithelial cells of mammary phyllodes tumors correlates with pathologic grade of the tumour: a multicenter study of 143 cases. Am J Clin Pathol. 2002;118:522–6.
Sapino A, Bosco M, Cassoni P, Castellano I, Arisio R, Cserni G, et al. Estrogen receptor-beta is expressed in stromal cells of fibroadenoma and phyllodes tumors of the breast. Mod Pathol. 2006;19:599–606.
Kocova L, Skalova A, Fakan F, Rousarova M. Phyllodes tumour of the breast: immunohistochemical study of 37 tumors using MIB1 antibody. Pathol Res Pract. 1998;194:97–104.
Umekita Y, Yoshida H. Immunohistochemical study of MIB1 expression in phyllodes tumour and fibroadenoma. Pathol Int. 1999;49:807–10.
Niezabitowski A, Lackowska B, Rys J, Kruczak A, Kowalska T, Mitus J, et al. Prognostic evaluation of proliferative activity and DNA content in the phyllodes tumour of the breast: immunohistochemical and flow cytometric study of 118 cases. Breast Cancer Res Treat. 2001;65:77–85.
el-Naggar AK, Ro JY, McLemore D, Garnsy L. DNA content and proliferative activity of cystosarcoma phyllodes of the breast. Potential prognostic significance. Am J Clin Pathol. 1990;93:480–5.
Tse GM, Lui PC, Scolyer RA, Putti TC, Kung FY, Law BK, et al. Tumor angiogenesis and p53 protein expression in mammary phyllodes tumors. Mod Pathol. 2003;16:1007–13.
Tse GM, Ma TK, Chan KF, Law BK, Chen MH, Li KH, et al. Increased microvessel density in malignant and borderline mammary phyllodes tumors. Histopathology. 2001;38:567–70.
Tse GM, Lui PC, Lee CS, Kung FY, Scolyer RA, Law BK, et al. Stromal expression of vascular endothelial growth factor correlates with tumour grade and microvessel density in mammary phyllodes tumors: a multicenter study of 185 cases. Hum Pathol. 2004;35:1053–7.
Sawyer EJ, Poulsom R, Hunt FT, Jeffery R, Elia G, Ellis IO, et al. Malignant phyllodes tumors show stromal overexpression of c-myc and c-kit. J Pathol. 2003;200:59–64.
Tse GM, Putti TC, Lui PC, Lo AW, Scolyer RA, Law BK, et al. Increased c-kit (CD117) expression in malignant mammary phyllodes tumors. Mod Pathol. 2004;17:827–31.
Carvalho S, e Silva AO, Milanezi F, Ricardo S, Leitão D, Amendoeira I, et al. c-KIT and PDGFRA in breast phyllodes tumors: overexpression without mutations? J Clin Pathol. 2004;57:1075–9.
Tse GM, Tsang AK, Putti TC, Scolyer RA, Lui PC, Law BK, et al. Stromal CD10 expression in mammary fibroadenomas and phyllodes tumors. J Clin Pathol. 2005;58:185–9.
Tsai WC, Jin JS, Yu JC, Sheu LF. CD10, actin, and vimentin expression in breast phyllodes tumors correlates with tumor grades of the WHO grading system. Int J Surg Pathol. 2006;14:127–31.
Leibl S, Moinfar F. Mammary NOS-type sarcoma with CD10 expression: a rare entity with features of myoepithelial differentiation. Am J Surg Pathol. 2006;30:450–6.
Tse GM, Lui PC, Vong JS, Lau KM, Putti TC, Karim R, et al. Increased epidermal growth factor receptor (EGFR) expression in malignant mammary phyllodes tumors. Breast Cancer Res Treat 2008;114:441–8.
Kersting C, Kuijper A, Schmidt H, Packeisen J, Liedtke C, Tidow N, et al. Amplifications of the epidermal growth factor receptor gene (egfr) are common in phyllodes tumors of the breast and are associated with tumor progression. Lab Invest. 2006;86:54–61.
Lu YJ, Birdsall S, Osin P, Gusterson B, Shipley J. Phyllodes tumors of the breast analyzed by comparative genomic hybridization and association of increased 1q copy number with stromal overgrowth and recurrence. Genes Chromosomes Cancer. 1997;20:275–81.
Sawyer EJ, Hanby AM, Ellis P, Lakhani SR, Ellis IO, Boyle S, et al. Molecular analysis of phyllodes tumors reveals distinct changes in the epithelial and stromal components. Am J Pathol. 2000;156:1093–8.
Jee KJ, Gong G, Ahn SH, Park JM, Knuutila S. Gain in 1q is a common abnormality in phyllodes tumors of the breast. Anal Cell Pathol. 2003;25:89–93.
Jones AM, Mitter R, Springall R, Graham T, Winter E, Gillett C, et al. Phyllodes Tumor Consortium. A comprehensive genetic profile of phyllodes tumors of the breast detects important mutations, intra-tumoral genetic heterogeneity and new genetic changes on recurrence. J Pathol. 2008;214:533–44.
Laé M, Vincent-Salomon A, Savignoni A, Huon I, Fréneaux P, Sigal-Zafrani B, et al. Phyllodes tumors of the breast segregate in two groups according to genetic criteria. Mod Pathol. 2007;20:435–44.
Lv S, Niu Y, Wei L, Liu Q, Wang X, Chen Y. Chromosomal aberrations and genetic relations in benign, borderline and malignant phyllodes tumors of the breast: a comparative genomic hybridization study. Breast Cancer Res Treat. 2008;112:411–8.
Jones AM, Mitter R, Poulsom R, Gillett C, Hanby AM, Tomlinson IP, et al. Phyllodes Tumor Consortium. mRNA expression profiling of phyllodes tumors of the breast: identification of genes important in the development of borderline and malignant phyllodes tumors. J Pathol. 2008;216:408–17.
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Tse, G.M.K., Niu, Y. & Shi, HJ. Phyllodes tumor of the breast: an update. Breast Cancer 17, 29–34 (2010). https://doi.org/10.1007/s12282-009-0114-z
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DOI: https://doi.org/10.1007/s12282-009-0114-z