Malignant Phyllodes Tumor of the Breast With Multiple Cutaneous Metastasis Resembling Pleomorphic Rhabdomyosarcoma.

IF 1.1 4区 医学 Q4 DERMATOLOGY American Journal of Dermatopathology Pub Date : 2025-03-01 Epub Date: 2024-12-10 DOI:10.1097/DAD.0000000000002889
Denise Zieba, Susan Pories, Hima Bindu Thota, David I Suster
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Abstract

Abstract: Malignant phyllodes tumor (PT) of the breast is a rare fibroepithelial neoplasm that shows variegated histomorphology and an aggressive clinical course. Cutaneous metastases are rare. A 68 year old woman presented with a palpable left breast mass identified on a routine breast exam. Mammogram showed an oval circumscribed heterogeneous mass measuring 3.7 × 3.7 × 2.7 cm. Patient underwent core needle biopsy with subsequent excision and received a diagnosis of malignant phyllodes tumor with rhabdomyosarcomatous elements with negative margins. The patient suffered a local recurrence 5 months later and was scheduled for re- excision; however prior to that procedure the patient represented to clinic with several cutaneous and subcutaneous nodules located on the left flank, left arm, and bilateral buttocks; described as itchy but not painful. Biopsies of the left flank and the left arm were performed and pathologic examination of both biopsies demonstrated a high- grade rhabdomyoblastic neoplasm that closely resembled so-called pleomorphic rhabdomyosarcoma. The tumor cells in both biopsies marked for immunohistochemical markers of rhabdomyoblastic differentiation and re-review of the original resection specimen showed identical areas confirming the skin and subcutaneous nodules as metastatic malignant phyllodes tumor. We report an unusual case of malignant PT with cutaneous metastases that demonstrated a pure rhabdomyosarcoma phenotype with pleomorphic morphology. Awareness that malignant PT may rarely involve cutaneous sites and present with a pure rhabdomyosarcomatous morphology is important for proper recognition and diagnosis of these tumors, as out of context they may be confused with sarcomas.

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乳腺恶性叶状瘤合并多发性皮肤转移,形似多形性横纹肌肉瘤。
摘要:乳腺恶性叶状瘤(Malignant phyllodes tumor, PT)是一种罕见的纤维上皮肿瘤,其组织形态多样,临床病程具有侵袭性。皮肤转移很少见。一位68岁的女性在常规乳房检查中发现了一个可触及的左乳房肿块。乳房x光片示3.7 × 3.7 × 2.7 cm椭圆形围合不均质肿块。患者接受了核心穿刺活检和随后的切除,并被诊断为恶性叶状瘤伴阴性边缘横纹肌肉瘤。患者5个月后局部复发,计划再次切除;然而,在此手术之前,患者向诊所表示,在左侧、左臂和双侧臀部有几个皮肤和皮下结节;描述为发痒但不痛。对左侧和左臂进行了活组织检查,病理检查显示为高级别横纹肌母细胞瘤,与所谓的多形性横纹肌肉瘤非常相似。两次活检的肿瘤细胞免疫组织化学标记为横纹肌母细胞分化和重新检查原始切除标本显示相同的区域,证实皮肤和皮下结节为转移性恶性叶状瘤。我们报告一个不寻常的恶性PT与皮肤转移的情况下,表现出纯粹的横纹肌肉瘤表型与多形性形态。意识到恶性PT很少累及皮肤部位,表现为纯粹的横纹肌肉瘤形态,这对于正确识别和诊断这些肿瘤很重要,因为脱离上下文,它们可能与肉瘤混淆。
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来源期刊
CiteScore
1.80
自引率
9.10%
发文量
453
审稿时长
3 months
期刊介绍: The American Journal of Dermatopathology offers outstanding coverage of the latest diagnostic approaches and laboratory techniques, as well as insights into contemporary social, legal, and ethical concerns. Each issue features review articles on clinical, technical, and basic science advances and illuminating, detailed case reports. With the The American Journal of Dermatopathology you''ll be able to: -Incorporate step-by-step coverage of new or difficult-to-diagnose conditions from their earliest histopathologic signs to confirmatory immunohistochemical and molecular studies. -Apply the latest basic science findings and clinical approaches to your work right away. -Tap into the skills and expertise of your peers and colleagues the world over peer-reviewed original articles, "Extraordinary cases reports", coverage of practical guidelines, and graphic presentations. -Expand your horizons through the Journal''s idea-generating forum for debating controversial issues and learning from preeminent researchers and clinicians
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