Role of CD10 Immunohistochemical Expression in Predicting Aggressive Behavior of Phylloides Tumors

  • Tariq, Muhammad Usman (Department of Pathology and Microbiology, Aga Khan University Hospital) ;
  • Haroon, Saroona (Department of Pathology and Microbiology, Aga Khan University Hospital) ;
  • Kayani, Naila (Department of Pathology and Microbiology, Aga Khan University Hospital)
  • Published : 2015.04.29


Background: Phylloides tumors are rare breast neoplasms with a variable clinical course depending on the tumor category. Along with histologic features, the role of immunohistochemical staining has been studied in predicting their behavior. Objectives: Our aim was to evaluate the role of CD 10 immunohistochemical staining in predicting survival, recurrence and metastasis in phylloides tumor. We also evaluated correlations of other clinicopathological features with overall and disease-free survival. Materials and Methods: CD10 expression was studied in 82 phylloides tumors divided into recurrent/metastatic and non-recurrent/non-metastatic cohorts. The Chi-square test was applied to determine the significance of differences in CD10 expression between outcome cohorts. Uni and multivariate survival analyses were also performed using log-rank test and Cox regression hazard models. Results: All 3 metastatic cases, 5 out of 6 (83.3%) recurrent cases and 37out of 73 (50.7%) non-recurrent and non-metastatic cases expressed significant (2+ or 3+) staining for CD10. This expression significantly varied between outcome cohorts (p<0.03). Tumor category and histological features including mitotic count and necrosis correlated significantly with recurrence and metastasis. A significant decrease in overall and disease free survival was seen with CD10 positivity, malignant category, increased mitoses and necrosis. Neither CD10 expression nor any other clinicopathologic feature proved to be an independent prognostic indicator in multivariate analysis. Conclusions: CD10 immunohistochemical staining can be used as a predictive tool for phylloides tumor but this expression should be interpreted in conjunction with tumor category.



Supported by : Aga Khan University Hospital


  1. Asif HM, Sultana S, Akhtar N, Rehman JU, Rehman RU (2014). Prevalence, risk factors and disease knowledge of breast cancer in Pakistan. Asian Pac J Cancer Prev, 15, 4411-6.
  2. Asoglu O, Ugurlu MM, Blanchard K, et al (2004). Risk factors for recurrence and death after primary surgical treatment of malignant phyllodes tumors. Ann Surg Oncol, 11, 1011-7.
  3. Al-Masri M, Darwazeh G, Sawalhi S, et al (2012). Phyllodes Tumor of the Breast: Role of CD10 in predicting metastasis. Ann Surg Oncol, 19, 1181-4.
  4. Barth RJ Jr (1999). Histologic features predict local recurrence after breast conserving therapy of phyllodes tumors. Breast Cancer Res Treat, 57, 291-5.
  5. Barth RJ Jr, Wells WA, Mitchell SE, Cole BF (2009). A prospective, multi-institutional study of adjuvant radiotherapy after resection of malignant phyllodes tumors. Ann Surg Oncol, 16, 2288-94.
  6. Burton GV, Hart LL, Leight GS, et al (1989). Cystosarcoma phyllodes. Effective therapy with cisplatin and etoposide chemotherapy. Cancer, 63, 2088-92.<2088::AID-CNCR2820631103>3.0.CO;2-C
  7. Chen CM, Chen CJ, Chang CL, et al (2000). CD34, CD117 and actin expression in phyllodes tumor of the breast. J Surg Res, 94, 84-91.
  8. Chu P, Arber DA (2000). Paraffin section detection of CD10 in 505 non hematopoietic neoplasms. Am J Clin Pathol, 113, 374-82.
  9. Chu PG, Arber DA, Weiss LM, Chang KL (2001). Utility of CD10 in distinguishing between endometrial stromal sarcoma and uterine smooth muscle tumours: an immunohistochemical comparison of 34 cases. Mod Pathol, 14, 465-471.
  10. Gillette CE, Bobrow LG, Millis RR (1990) S100 protein in human mammary tissue: Immunoreactivity in breast carcinoma, including Paget's disease of the nipple and value as a marker of myoepithelial cells. J Pathol, 160, 19-24.
  11. Gregory CD, Tursz T, Edwards CF, et al (1987). Identification of a subset of normal B cells with a Burkitt's lymphoma (BL)-like phenotype. J Immunol, 139, 313-8.
  12. Guelstein VI, Tchypysheva TA, Ermilova VD, Ljubimov AV (1993) Myoepithelial and basement membrane antigen and malignant human breast tumors. Int J Cancer, 53, 269-77.
  13. Hawkins RE, Schofield JB, Wiltshaw E, et al (1992). Ifosfamide is an active drug for chemotherapy of metastatic cystosarcoma phyllodes. Cancer, 69, 2271-5.<2271::AID-CNCR2820690911>3.0.CO;2-7
  14. Hussin H, Pailoor J, Cheng PS (2013). The role of CD10 immunohistochemistry in the grading of phyllodes tumor of the breast. J Interdiscipl Histopathol, 1, 195-203.
  15. Khosravi-Shahi P (2011). Management of non-metastatic phyllodes tumors of the breast: review of the literature. Surg Oncol, 20, 143-8.
  16. Khurshid A, Kayani N, Bhurgri Y (2006). Phylloides tumors in adolescent girls and young women in Pakistan. Asian Pac J Cancer Prev, 7, 563-6.
  17. Khurshid A, Faridi N, Arif AM, Naqvi H, Tahir M (2013). Breast lesions in adolescents and young women in Pakistan-a 5 year study of significance of early recognition. Asian Pac J Cancer Prev, 14, 3465-7.
  18. Millar EK, Beretov J, Marr P, et al (1999). Malignant phyllodes tumours of the breast display increased stromal p53 protein expression. Histopathology, 34, 491-6.
  19. Moore MA, AriyaratneY, Badar F, et al (2009). Cancer epidemiology in South Asia past, present and future. Asian Pac J Cancer Prev, 10, 49-67.
  20. Moritani S, Kushima R, Sugihara H, et al (2002). Availability of CD10 immunohistochemistry as a marker of breast myoepithelial cells on paraffin sections. Mod Pathol, 15, 397-405.
  21. Noguchi S, Motomura S, Inaji H, Imaoka S, Koyama H (1993). Clonal analysis of fibroadenoma and phyllodes tumor of the breast. Cancer Res, 53, 4071-4.
  22. Ortega E, Aranda FI, Chulia MT, et al (2001). Phyllodes tumor of the breast with actin inclusions in stromal cells: diagnosis by fine-needle aspiration cytology. Diagn Cytopathol, 25, 115-7.
  23. Rowell MD, Perry RR, Hsiu JG, Barranco SC (1993). Phyllodes tumors. Am J Surg, 165, 376-9.
  24. Shaukat U, Ismail M, Mehmood N (2013). Epidemiology, major risk factors and genetic predisposition for breast cancer in the Pakistani population. Asian Pac J Cancer Prev, 14, 625-9.
  25. Stein H, Lennert K, Feller AC, Mason DY (1984). Immunohistological analysis of human lymphoma: correlation of histological and immunological categories. Adv Cancer Res, 42, 67-147.
  26. Tan PH, Jayabaskar T, Chuah KL, et al (2005). Phyllodes tumors of the breast: the role of pathologic parameters. Am J Clin Pathol, 123, 529-40.
  27. Tan PH, Jayabaskar T, Yip G, et al (2005). P53 and c-kit (CD117) protein expression as prognostic indicators in breast phyllodes tumors: a tissue microarray study. Mod Pathol, 18, 1527-34.
  28. Tan PH, Tse GM, Lee A (2013). WHO classification of Tumors of the Breast (4th edn). IARC Press, Lyon, France pp 142-7.
  29. Tsai WC, Jin JS, Yu JC, Sheu LF (2006). CD10, actin, and vimentin expression in breast phyllodes tumors correlates with tumor grades of the WHO grading system. Int J Surg Pathol, 14, 127-31.
  30. Tse GM, Lui PC, Scolyer RA, et al (2003). Tumour angiogenesis and p53 protein expression in mammary phyllodes tumours. Mod Pathol, 16, 1007-13.
  31. Tse GMK, Lui PCW, Lee CS, et al (2004). Stromal expression of vascular endoethelial growth factor correlates with tumor grade and microvessel density in mammary phyllodes tumors: a multicenter study of 185 cases. Hum Pathol, 35, 1053-7.
  32. Tse GM, Tan PH (2005). Recent advances in the pathology of fibroepithelial tumors of the breast. Curr Diagn Pathol, 11, 426-34.
  33. Tse GM, Tsang AK, Putti TC, et al (2005). Stromal CD10 expression in mammary fibroadenomas and phyllodes tumours. J Clin Pathol, 58, 185-9.
  34. Tse GMK, Lui PC, Vong JS, et al (2009). Increased epidermal growth factor receptor (EGFR) expression in malignant mammary phyllodes tumors. Breast Cancer Res Treat, 114, 441-8.
  35. Yang X, Kandil D, Cosar EF, Khan A (2014). Fibroepithelial tumors of the breast: pathologic and immunohistochemical features and molecular mechanisms. Arch Pathol Lab Med, 138, 25-36.

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