Benign Phyllodes Tumor With Cystic Squamous Metaplasia: A Cytohistological Correlation of a Rare Case

Document Type: Case Reports

Authors

1 Dept. of Pathology, North Bengal Medical College, The West Bengal University of Health Sciences, Siliguri, Darjeeling, West Bengal, India

2 Anadaloke Sonoscan Centre, Siliguri, Darjeeling, West Bengal, India

Abstract

Background: Phyllodes tumors (PTs) are uncommon biphasic fibroepithelial neoplasms of the breast occurring in elderly females with a peak incidence between 45 and 49 years. Depending on various histological criteria, they are subdivided into benign, borderline, and malignant forms. Metaplastic changes occur, but are quite infrequent and cystic squamous metaplasia is very rare among the observed metaplastic changes in PT.
Case: The current paper presents the case of a 41-year-old female with a progressively enlarging swelling in the left breast. Subsequent histopathological examination revealed benign PT with cystic squamous metaplasia. The previously done fine needle aspiration smears were also reviewed, which showed important diagnostic clues to this rare entity, but were ignored due to the rarity of the lesion.
Conclusion: The case was presented because of its unique cytological and histopathological morphology and also to determine the role of aspiration cytology to diagnose such a rare occurrence.

Highlights

  • Benign phyllodes tumor with cystic squamous metaplasia
  • Cytology and histology of such a rare lesion
  • Important differentials to be considered

Keywords


1. Bellocq JP, Magro G. Fibroepithelial tumours. In: Tavassoli FA, Devilee P, editors. World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Breast and Female Genital Tract. Lyon: IARC Press; 2003. pp. 99–103.

2. Bernstein L, Deapen D, Ross RK. The descriptive epidemiology of malignant cystosarcoma phyllodes tumors of the breast. Cancer 1993 May;71(10):3020–4.

3. Chua CL, Thomas A, Ng BK. Cystosarcoma phyllodes—Asian variations. Aust N Z J Surg 1988 Apr;58(4):301–5.

4. Rosen PP. Rosen’s Breast Pathology. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2001.

5. Sugie T, Takeuchi E, Kunishima F, Yotsumoto F, Kono Y. A case of ductal carcinoma with squamous differentiation in malignant phyllodes tumor. Breast Cancer 2007;14(3):327–32.

6. Grimes MM. Cystosarcoma phyllodes of the breast: histologic features, flow cytometric analysis, and clinical correlations. Mod Pathol 1992 May;5(3):232–9.

7. Norris HJ, Taylor HB. Relationship of histologic features to behavior of cystosarcoma phyllodes. Analysis of ninety-four cases. Cancer 1967 Dec;20(12):2090–9.

8. Quinlan-Davidson S, Hodgson N, Elavathil L, Shangguo T. Borderline phyllodes tumor with an incidental invasive tubular carcinoma and lobular carcinoma in situ component: a case report. J Breast Cancer 2011 Sep;14(3):237–40.

9. Salvadori B, Cusumano F, Del Bo R, Delledonne V, Grassi M, Rovini D et al. Surgical treatment of phyllodes tumors of the breast. Cancer 1989 Jun;63(12):2532–6.

10. Bernstein L, Deapen D, Ross RK. The descriptive epidemiology of malignant cystosarcoma phyllodes tumors of the breast. Cancer 1993 May;71(10):3020–4.

11. Rajan PB, Cranor ML, Rosen PP. Cystosarcoma phyllodes in adolescent girls and young women: a study of 45 patients. Am J Surg Pathol 1998 Jan;22(1):64–9.

12. Mishra SP, Tiwary SK, Mishra M, Khanna AK. Phyllodes Tumor of Breast: A Review Article. ISRN Surgery 2013;2013:1-8. https://doi.org/10.1155/2013/361469.

13. Kumar H, Iqbal MB, Buch A, Panicker N. Extensive squamous metaplasia in a benign phyllodes tumor: A rare case report. Med J DY Patil Univ 2015;8(3):404–6.

14. Gottfried MR. Extensive squamous metaplasia in gynecomastia. Arch Pathol Lab Med 1986 Oct;110(10):971–3.

15. Söderstrom KO, Toikkanen S. Extensive squamous metaplasia simulating squamous cell carcinoma in benign breast papillomatosis. Hum Pathol 1983 Dec;14(12):1081–2.

16. Rosen PP. Fibroepithelial Neoplasms. In: Pine JW, editor. Rosen’s Breast Pathology, 3rd.

17. Philadelphia. Lippincott Williams & Wilkins; 2009. pp. 202–26.