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E-JCRT CORRESPONDENCE
Year : 2015  |  Volume : 11  |  Issue : 4  |  Page : 1032

Pleomorphic liposarcoma arising in a malignant phyllodes tumor of breast: A rare occurrence


1 Department of Pathology, Tata Medical Center, Kolkata, West Bengal, India
2 Department of Breast Surgery, Tata Medical Center, Kolkata, West Bengal, India

Date of Web Publication15-Feb-2016

Correspondence Address:
Sankalp M Sancheti
Department of Pathology, Tata Medical Center, Kolkata, 14 Main Arterial Road, New Town, Rajarhat, West Bengal - 700 156
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.154013

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 > Abstract 

Primary malignant phyllodes tumor of the breast accounts for 0.3-1% of all the tumors of breast and only a couple of cases of pleomorphic liposarcoma (PL) arising in a malignant phyllodes (MP) tumor have been reported. A thorough sampling is most essential in phyllodes tumor, not only to detect high grade component of the neoplasm but also to diagnose heterologous elements in the same lesion elsewhere, as it may affect the prognosis adversely and may have a greater metastatic potential.

Keywords: Breast, malignant phyllodes, pleomorphic liposarcoma


How to cite this article:
Sancheti SM, Sawaimoon SK, Ahmed R. Pleomorphic liposarcoma arising in a malignant phyllodes tumor of breast: A rare occurrence. J Can Res Ther 2015;11:1032

How to cite this URL:
Sancheti SM, Sawaimoon SK, Ahmed R. Pleomorphic liposarcoma arising in a malignant phyllodes tumor of breast: A rare occurrence. J Can Res Ther [serial online] 2015 [cited 2019 Sep 21];11:1032. Available from: http://www.cancerjournal.net/text.asp?2015/11/4/1032/154013


 > Introduction Top


Pleomorphic liposarcoma (PL) of the breast arising in a malignant phyllodes (MP) tumor is a rare phenomenon. Frequency of MP tumor is less than 1% and only a few cases of PL arising in a MP tumor have been reported in the published literature. [1],[2],[3],[4] We emphasize on adequate sampling of the neoplasm not only to make an accurate diagnosis but also for the detection of the heterologous elements in other areas of the lesion.


 > Case report Top


We present a case of 27-year-old lady who presented with a breast lump with recent rapid enlargement but without any nipple discharge or pain. On examination, contralateral breast, bilateral axilla and hematological parameters were normal. There was no past history of any prolonged illness or radiation therapy. X-ray chest and ultrasonography of the abdomen were unremarkable. Mammography showed well-defined lobulated radio-dense mass lesion predominantly in the infero-medial quadrant of the right breast at 3-4 o'clock position in the periareolar region, correlated with ultrasonography as a BI-RADS 4a lesion. Lumpectomy of the mass was done, which on gross examination revealed a well circumscribed, polypoidal, friable mass measuring 5.0 × 5.0 × 3.5 cms in size with grayish white cut surface. Different areas of the mass were sampled (Two sections per centimeter) and examined. Sections revealed malignant phyllodes tumor with sarcomatous stromal component. The ductal epithelial components and malignant stromal components were seen in most of the sections. Only two sections revealed large areas of liposarcomatous areas composed of adipocytes with atypical nuclei, lipoblasts and multinucleate tumor giant cells as shown in [Figure 1] and [Figure 2]. Many mitotic figures were also noted. Necrosis was not seen. Immunohistochemistry done for S-100 protein was strongly positive in the lipoblast (nuclear) as shown in [Figure 2]. A diagnosis of pleomorphic liposarcoma arising in a malignant phyllodes tumor was made.
Figure 1: Composite photomicrograph showing-(a) Leaf like pattern of phyllodes tumor with stromal component composed of pleomorphic spindle cells; (100 × magnification, hematoxylin and eosin). (b) Photomicrograph showing pleomorphic liposarcoma arising in the phyllodes tumor. (400 × magnification, hematoxylin and eosin)

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Figure 2: Composite photomicrograph showing-(a) Typical lipoblast with multivacuolation and indented nuclei in the malignant stroma of phyllodes tumor; (400 × magnification, hematoxylin and eosin). (b) Photomicrograph showing positive immunohistochemical staining for S-100 protein in lipoblast

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 > Discussion Top


Phyllodes tumors are characterized by increased stromal cellularity and characteristic broad "leaf like" papillae inserted into cleft-like spaces. Phyllodes tumors of breast show variable clinicopathological behavior ranging from benign to malignant. Grading of benign, borderline and malignant tumor is based on the stromal cellularity, stromal cytological atypia, mitotic activity and circumscribed versus invasive margin. [1] The majority of these lesions are completely benign with no metastatic potential. Malignancies develop in the mesenchymal component of phyllodes tumor, whereas the ductal component is usually benign. The sarcomatous stromal component may contain heterologous elements such as angiosarcoma (particularly post radiation), leiomyosarcoma, chondrosarcoma, liposarcoma and osteosarcoma, but these are rarely encountered in malignant phyllodes tumor. [1],[2],[3] In the present case, less than 20% of the sarcomatous component was liposarcomatous. Without adequate sampling some of these heterologus elements can be missed and can affect the prognosis of the disease. Heterologous liposarcomatous differentiation in MP tumor is more common than primary liposarcoma of the breast. PL has 30-50% risk of metastasis, however in the present case there was no evidence of distant metastasis. [1]



 
 > References Top

1.
Tan PH, Tse G, Lee A, Simpson JF, Hanby AM. Fibroepithelial tumours. In: Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, van de Vijver MJ, editors. WHO Classification of Tumours of the Breast. 4 th ed. Lyon France: IARC Press; 2012. p. 142-47.  Back to cited text no. 1
    
2.
Rosen PP. Fibroepithelial neoplasms. In: Rosen PP, editor. Rosen's Breast Pathology. 3 rd ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2009. p. 187-229.  Back to cited text no. 2
    
3.
Carter BA, Page DL. Phyllodes tumor of the breast: Local recurrence versus metastatic capacity. Hum Pathol 2004;35:1051-2.  Back to cited text no. 3
    
4.
Mardiana AA, Sullivan F, Kerin MJ, Callagy G. Malignant phyllodes tumour with liposarcomatous differentiation, invasive tubular carcinoma, and ductal and lobular carcinoma in situ: Case report and review of the literature. Pathol Res Int 2010:1-8.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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