Malignant Phyllodes Tumor With Liposarcomatous Differentiation
Bibliographic record
Abstract
A 47-year-old woman presented with a 1-year history of a palpable, asymptomatic breast mass. Her medical history was unremarkable. There was no family history of breast carcinoma. Her only medication consisted of oral contraceptives, and she was a nonsmoker. A solitary mass occupied most of the upper outer quadrant of the left breast. No axillary lymphadenopathy was identified. There were no palpable abnormalities of the right breast.The patient underwent ultrasound-guided core biopsies of the left breast, with the results suggestive of a malignant fibroepithelial neoplasm. A segmental mastectomy revealed a 5 × 5 × 5-cm, well-circumscribed, firm, and predominantly tan mass (Figure 1). This mass contained large clefts with leaflike projections, foci of tumor necrosis, and multiple areas that grossly resembled adipose tissue (arrow). Histologic examination of the tumor revealed a high-grade, malignant phyllodes tumor (PT) that was characterized by a pushing border and epithelial-lined clefts with hypercellular stromal overgrowth (Figure 2). The pleomorphic neoplastic stroma demonstrated a brisk mitotic rate and contained univacuolated and multivacuolated lipoblasts with hyperchromatic, pleomorphic, and scalloped nuclei (Figure 3). These areas resembled pleomorphic liposarcoma. No other sarcomatous elements were identified. The tumor was completely excised, and the patient remains well and disease free 16 months after surgery.Sarcomatous elements, including angiosarcoma, chondrosarcoma, leiomyosarcoma, osteosarcoma, and rhabdomyosarcoma, are rarely encountered in malignant PTs.1 Liposarcomas may also develop as stromal components of PTs. Liposarcomatous differentiation in PTs may consist of well-differentiated, myxoid, round cell, and pleomorphic liposarcomatous elements.23 Powell and Rosen3 described a series of 14 PTs with adipose differentiation that consisted of a single benign PT with lipomatous metaplasia (lipophyllodes tumor), 7 low-grade malignant PTs, and 6 high-grade malignant PTs. These tumors were all unilateral breast masses that developed in women with a mean age of 40 years. Mean tumor size was 4.0 cm. High-grade malignant PTs demonstrated large areas of stromal overgrowth that contained round cell and pleomorphic liposarcoma. No tumor recurrences were seen in the malignant PTs with adipose differentiation.3 The only tumor recurrence occurred when an incompletely excised lipophyllodes tumor recurred a year later as a high-grade malignant PT with pleomorphic liposarcomatous elements. In a series of 7 PTs with liposarcomatous elements, described by Austin and Dupree,2 only 1 patient experienced local tumor recurrence that developed 1 year after local excision.The clinical behavior of malignant PTs is difficult to predict. Liposarcomatous differentiation in malignant PTs, however, does not appear to equate with aggressive clinical behavior.23 Phyllodes tumors with liposarcomatous differentiation, like other PTs, require complete surgical excision to prevent local tumor recurrence.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".