Memede Kollizyon Tümörü: Heterolog Komponentli Malign Filloides Tümör ve İnvaziv Meme Karsinomu, Spesifiye Edilemeyen Tip

Öz

Memenin filloides tümörleri nadir tümörler olup malign formu çok daha nadirdir. Malign formları da dahil tüm filloides tümörlerde intratümöral karsinom gelişimi olabilir. Ancak kollizyon tümörünün bir parçası olarak malign filloides tümör ve eşlik eden invaziv duktal karsinom ise çok nadir bir klinik antitedir. Malign filloides tümörün spesifik radyolojik bulgusu olmadığı için tanı histopatolojik değerlendirme ile yapılır. Eşlik eden tümörün saptanması da çok dikkatli makroskobik ve mikroskobik değerlendirmeler ile mümkündür. Biz bu sunumda 44 yaşında kadın hastada aynı memede heterolog komponentli malign filloides tümör ve arada geçiş zonu bulunmayan invaziv duktal karsinom olgusunu bildiriyoruz. Preoperatif dönemde radyolojik olarak veya cerrahi sırasında saptanmamış kollizyon tümörünün tanısında tümörden kapsamlı patolojik örneklemeler ile çok dikkatli makroskobik değerlendirme önemlidir. Malign filloides tümör hematojen yayılım gösterir, bu nedenle de aksiller lenf nodu diseksiyonuna gerek yoktur. Ancak karsinom ile birliktelik durumunda, tedavi şeklini ve prognozu karsinom evresi belirler.

Anahtar Kelimeler

• Kollizyon tümörü
• malign filloides tümör
• invaziv meme karsinomu

Collision Tumor in the Breast: Malignant Phyllodes Tumor with Heterologous Component and Invasive Breast Carcinoma, No Special Type

Öz

Phyllodes tumors of the breast are rare tumors, and the malignant form is much rarer. Intratumoral carcinoma may develop in all phyllodes tumors, including their malignant forms. However, malignant phyllodes tumor as a part of collision tumor and accompanying invasive ductal carcinoma is a very rare clinical entity. Since malignant phyllodes tumor does not have specific radiological findings, the diagnosis is made by histopathological evaluation. Detection of the accompanying tumor is also possible with very careful macroscopic and microscopic evaluations. In this report, we report a case of malignant phyllodes tumor with heterologous component and invasive ductal carcinoma with no transition zone in the same breast of a 44-year-old female patient. Intense sampling and very careful macroscopic evaluation are important in the diagnosis of a collision tumor that was not detected radiologically or during surgery in the preoperative period. Malignant phyllodes tumor spreads hematogenously, so axillary lymph node dissection is not required. However, in the case of association with carcinoma, the type of treatment and prognosis are determined by the carcinoma stage.

Anahtar Kelimeler

• Collision tumor
• malignant phyllodes tumor
• invasive breast carcinoma

Kaynakça

1. 1. Miles EF, Jacimore LL: Synchronous bilateral breast carcinoma and axillary non-hodgkin lymphoma: a case report and review of the literature. Case Rep Oncol Med. 2012:685919.
2. 2. Siddiqui FA, Maheshwari V, Alam K, Jain A: Coexistent non-Hodgkins lymphoma and ductal carcinoma breast: diagnosis on fine needle aspiration cytology. Diagn Cytopathol. 2011;39:767-9.
3. 3. Bernstein L, Deapen D, Ross RK. The descriptive epidemiology of malignant cystosarcoma phyllodes tumors of the breast. Cancer. 1993;71(10):3020-4.
4. 4. Bozkurt H, Karakaya IB, Aktas E, Irkorucu O. Coexistence of phylloides tumour and invasive ductal cancer in the breast. Niger J Clin Pract. 2019 ;22(8):1169-1171.
5. 5. Panko N, Jebran AA, Gomberawalla A, Connolly M. Invasive Ductal Carcinoma within a Benign Phyllodes Tumor. Am J Case Rep. 2017;18:813-816.
6. 6. Tan BY, Acs G, Apple SK, Badve S, Bleiweiss IJ, Brogi E, Calvo JP, Dabbs DJ, Ellis IO, Eusebi V, Farshid G, Fox SB, Ichihara S, Lakhani SR, Rakha EA, Reis-Filho JS, Richardson AL, Sahin A, Schmitt FC, Schnitt SJ, Siziopikou KP, Soares FA, Tse GM, Vincent-Salomon A, Tan PH. Phyllodes tumours of the breast: a consensus review. Histopathology. 2016;68(1):5-21.
7. 7. Ramdass MJ, Dindyal S: Phyllodes breast tumour showing invasive squamous-cell carcinoma with invasive ductal, clear-cell, secretory, and squamous components. Lancet Oncol. 2006;7:880.
8. 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;14:237-40.

9. 9. Parfitt JR, Armstrong C, O'Malley F, Ross J, Tuck AB: In-situ and invasive carcinoma within a phyllodes tumor associated with lymph node metastases. World J Surg Oncol. 2004;2:46.
10. 10. Macher-Goeppinger S, Marme F, Goeppert B, Penzel R, Schirmacher P, Sinn HP, Aulmann S: Invasive ductal breast cancer within a malignant phyllodes tumor: case report and assessment of clonality. Hum Pathol. 2010;41:293-6.
11. 11. Kefeli M, Yildiz L, Akpolat I, Balci P, Ozen N: The coexistence of invasive ductal carcinoma and malignant phyllodes tumor with liposarcomatous and chondrosarcomatous differentiation in the same breast in a post-osteosarcoma case. Pathol Res Pract. 2008; 204:919-23
12. 12. Muthusamy RK, Mehta SS. Synchronous malignant phyllodes tumor with skin ulceration and invasive carcinoma as collision tumor. Indian J Med Paediatr Oncol. 2017;38:78‑80
13. 13. Pai UK, Kavalakat AJ, Thomas N. Synchronous collision tumor of malignant phyllodes and invasive ductal carcinoma. Oncol J India. 2022;6:78-81.
14. 14. Abdullah N, Rizuana IH, Goh JHL, Lee QZ, Md Isa N, Md Pauzi SH. Bilateral metachronous breast malignancies: Malignant phylloides and invasive breast carcinoma-a case report. Front Oncol. 2023;24;13:1034556.
15. 15. Tan PH, Thike AA, Tan WJ, Thu MM, Busmanis I, Li H, Chay WY, Tan MH; Phyllodes Tumour Network Singapore. Predicting clinical behaviour of breast phyllodes tumours: a nomogram based on histological criteria and surgical margins. J Clin Pathol. 2012;65(1):69-76.
16. 16. Wang F, Fang Wang , Yan Jia , Zhongsheng Tong. Comparison of the clinical and prognostic features of primary breast sarcomas and malignant phyllodes tumor. Jpn J Clin Oncol. 2015;45(2):146-52.
17. 17. Ostapenko E, Burneckis A, Ostapenko A, Skaisgirytė A, Ostapenko V. Malignant phyllodes tumor of the breast with metastases to the lungs: A case report and literature review. Radiol Case Rep. 2022; 18;17(10):4006-12.
18. 18. Liu, HP, Chang, WY, Hsu, CW. et al. A giant malignant phyllodes tumor of breast post mastectomy with metastasis to stomach manifesting as anemia: a case report and review of literature. BMC Surg. 2020;20:187
19. 19. Koh VCY, Thike AA, Nasir NDM, Yip GWC, Bay BH, Tan PH. Size and heterologous elements predict metastases in malignant phyllodes tumours of the breast. Virchows Arch. 2018;472(4):615-21.