Incidence of phyllodes tumors of breast at a single centre in Allahabad, Uttar Pradesh, India
DOI:
https://doi.org/10.18203/2320-6012.ijrms20164227Keywords:
Breast, Phyllodes tumor, Treatment and prognosisAbstract
Background: Phyllodes tumor of breast is the rare fibro-epithelial tumor of breast constituting <1% of breast neoplasms. They are locally aggressive tumor and suddenly attain a big size. Fine needle aspiration cytology should have both stromal and epithelial component to make the diagnosis. Wide local excision of 1 to 2 cm margin of normal breast is the treatment of choice for tumour of <10 cm in size and simple mastectomy for tumor more than 10 cm. This study was conducted to evaluate the incidence and outcome after surgery for phyllodes tumor at our centre.
Methods: Data of 15 patients at our centre was retrieved retrospectively from January 2011 to April 2016.
Results: Out of these 15, 14 were female and 1 was male. 14 of them undergo wide local excision under general anesthesia while in one of the patients simple mastectomy was done. Based on tumor histology they are divided into 3 histotypes i. e. benign, borderline, and malignant. 12 patients were found to be benign, 3 borderline and none malignant. Out of 3 borderline disease patients 1 developed recurrence 8 months later to initial surgery. Wide local excision was done for total of 10 times and every time histopathology revealed borderline phyllodes but last report revealed sarcomatous changes. Patient also developed lung metastases and so was referred to oncology department and review histopathology revealed low grade spindle cell sarcoma. Full radiotherapy and complete course of MAID chemotherapy regimen was given but patient still developed local recurrence and metastasis to lungs. All patients in benign category were doing well and none of them developed recurrences in due course.
Conclusions: Phyllodes tumor is an interesting entity for both surgeons as well as pathologists because of its rare occurrence and varied histological features. Rapidly growing nature of this tumor does not necessarily indicate malignant disease. No correlation was found between tumor size and recurrence.
References
Dyer NH, Bridger JE, Taylor RS. Cystosarcoma phylloides. Br J Surg. 1966;53:450±5.
Popescu I, Serbanescu M, Ivaschescu C. Phyllodes tumours of the breast. Zentbl Chir. 1991;116:327-36.
Buchanan ED. Cystosarcoma phyllodes and its surgical management. Am Surg. 1995;61:350-5.
Müller J. Uber den feineren Ban und Die Formen der Krankaften Geschwulste. Berlin: G Reiner. 1838;1:54-7.
Oberman HA. Cystosarcoma phyllodes. A clinicopathologic study of hypercellular periductal stromal neoplasms of the breast. Cancer. 1965;18:697-710.
Amerson JR. Cystosarcoma in adolescent females. Ann Surg 1970;171:849-58.
Adachi Y, Matsushima T, Kido A. Phyllodes tumor in adolescents. Report of two cases and review of the literature. Breast Dis. 1993;6:285-93.
Nambiar R, Kutty MK. Giant ®bro-adenoma (cystosarcoma phyllodes) in adolescent females: a clinicopathological study. Br J Surg. 1974;61:113-7.
Shabb NS. Phyllodes tumor. Fine needle aspiration cytology of eight cases. Acta Cytol. 1997;41:321-6.
Azzopardi JG. Sarcoma in the breast. In: Benningron J, ed. Problems in breast pathology. Vol. II. Philadelphia: WB Saunders. 1979:355-9.
Salvadori B, Cusumano F, Del-Ro R. Surgical treatment of phyllodes tumors of the breast. Cancer. 1989;63:2532-6.
Aranda FI, Laforga JB, Lopez JL. Phyllodes tumor of the breast. An immunohistochemical study of 28 cases with special attention to the role of myo®broblast. Pathol Res Pract. 1994;190:474-81.
Treves N, Sutherland DJ. Cystosarcoma phyllodes of the breast: a clinicopathological study of 77 cases. Cancer. 1951;4:1286-332.
Patrascu A, Popescu CF, Plesea IE, Badulescu A, Tanase F, Mateescu G, Clinical and cytopathological aspects in phyllodes Tumors of the breast. Romanian J Morph Embryo. 2009;50(4):605-11.
Rowell MD, Perry RR, Hsiu JG, Barranco SC. Phyllodes tumors. Am J Surg. 1993;165(3):376-9.
Rosen Peter P. Unusual Clinical Presentations of Carcinoma. Rosen’s Breast Pathology, 3rd Edition, Chapter 33, Lippincott Williams & Wilkins. 2009.
Pietruszka M, Barnes L. Cystosarcoma phyllodes. A clinicopathological analysis of 42 cases. Cancer. 1978;41:1974-83.
Hawkins RE, Scho®eld JB, Fisher C. The clinical and histologic criteria that predict metastases from cystosarcoma phyllodes. Cancer. 1992;69:141-7.
de Roos WK, Kaye P, Dent DM. Factors leading to local recurrence or dearth after surgical resection of phyllodes tumours of the breast. Br J Surg. 1999;86:396-9.
Chaney AW, Pollack A, Mcneese MD, Zagars GK, Pisters PWT. Primary Treatment of Cystosarcoma Phyllodes of the Breast. June 15, 2000. Cancer. 2000;89:1502-11.
Mangi AA, Smith BL, Gadd MA, Tanabe KK, Ott MJ, Souba WW. Surgical management of phyllodes tumors. Arch Surg. 1999;134:487-92.
Zurrida S, Bartoli C, Galimberti V, Squicciarini P, Delledonne V, Veronesi P, et al. What therapy for unexpected phyllode tumour of the breast? Eur J Cancer. 1992;28:654-7.
Hopkins ML, McGowan TS, Rawlings G. Phylloides tumor of the breast: a report of 14 cases. J Surg Oncol 1994;56:108-12.
Stockade AD, Leader M. Phylloides tumour of the breast: response to radiotherapy. Clin Radiol. 1987;38:287-90.
Noms HJ, Taylor HB. Relationship of histologic features to behavior of cystosarcoma phyllodes: Analysis of ninety-four cases. Cancer. 1967;20:2090-9.
Brentani MM, Pacheco MM, Nagai MA, et al. Steroid receptors in cystosarcoma phylloides. Cancer Detect Prev. 1982;5:211-9.
Rao BR, Meyer JS, Fry CG. Most cystosarcoma phyllodes and ®broadenomas have progesterone receptors but lack oestrogen receptor: stromal localisation of the progesterone receptor. Cancer. 1981;47:2016-21.
