Phyllodes Tumor

Findings: Mammogram shows a lobular hyper dense mass with partially circumscribed and partially obscured margins. No calcifications visible

Meaning : leaf-like in Greek, phyllodes tumors demonstrate papillary growth of epithelial lined stroma
Key point: Large rapidly growing circumscribed mass without calcifications
Mammography :Phyllodes tumors appear as a dense, round or oval masses with circumscribed or lobulated borders on mammography. Indistinct margins favor malignant transformation. Calcifications are rare but when present are coarse.
Ultrasonography: demonstrates an oval, round, or lobulated hypoechoic mass. Cystic spaces favor malignancy. Increased vascularity can be common .

T1W1/T2W1 :Phyllodes tumors appear heterogeneously hypointense on T1WI with slit like areas of increased T2WI representing fluid. Enhancement is typically rapid and suspicious kinetics can be observed in approximately 33% of cases.
Differential Diagnosis:
Typically occurring in younger women, fibroadenomas also appear as oval or lobulated mass but have dense, coarse calcifications, homogeneous echogenicity, and more moderate enhancement characteristics.
While there is some overlap with phyllodes tumors demonstrating malignant transformation, breast carcinoma is more likely to demonstrate indistinct margins. Pleomorphic calcifications also favor carcinoma.
Primary sarcoma of the breast is distinguished from phyllodes tumors by the absence of epithelial components. The clinical course of primary sarcoma of the breast is similar to malignant phyllodes tumors.

Ultrasound shows an irregularly shaped mass with heterogeneous echogenicity and ill-defined borders.

Treatment: is by surgical excision with greater than 1 cm margins. Mastectomy may be required for large tumors. Axillary node dissection is usually unnecessary. With respect to adjuvant therapy, radiation reduces local recurrence. Chemotherapy has demonstrated no benefit.

Cochrane Review Advises Chemo+RT For Early Hodgkin's

Chemotherapy followed by radiation therapy (RT) is the standard treatment for patients with early-stage Hodgkin's lymphoma, and it should remain so, according to a review published February 16 by the Cochrane Collaboration of Oxford, U.K.

A review of the outcomes of 1,245 patients who participated in five randomized clinical trials, published in the Cochrane Library, sought to answer the question of whether radiation therapy, with its risk of causing secondary cancers from radiation exposure, could be eliminated. The conclusion of the multi-institutional team from Denmark, Germany, and Switzerland was that from a short-term perspective, patients who received both treatments were less likely to die or have local recurrence compared to those who only received chemotherapy.

The clinical trials took place from the 1970s to 2004 and used a variety of chemotherapy agents, as well as diverse doses and types of radiation therapy. Initial responses by patients to treatments were equally effective in eliminating cancer in large part or entirely, according to lead author Christine Herbst, MD, of the department of internal medicine of the University Hospital of Cologne in Germany.
However, data from the meta-analysis identified differences in outcomes when patients were followed between two and 11.4 years. Patients who received the combined treatment were 40% as likely to die compared to those who had chemotherapy alone, and the hazard ratio for tumor control was similar, at 41%. Complete response rates were similar between the treatment groups.
Although adding radiation therapy increased five-year tumor control and overall survival, patients were exposed to radiation doses that could cause secondary cancers 10 to 30 years following treatment, the authors noted. The meta-analysis performed did not evaluate long-term risks.
by : Cynthia E. Keen