Abstract
Purpose: We aim to evaluate the diagnostic diffuculties and the surgical options and results for the phyllodes tumors, which are infrequent pathologies of breast tumors.
Background: The most recognised clinical problems seen in phyllodes tumors are preopreatively differential diagnosis and postoperatively freqeunt local recurrences. The recommented management option is resection of tumor within at least 2 cm of surgical margin. Recurrence rate is reported as 15-25% in various studies.
Materials and Methods: We evaluate the surgical procedures and results of 10 patients with phyllodes tumor retrospectively who admitted to General Surgery Department, School of Medicine, Cukurova University between 1997-2003. Physical examination, breast ultrasonography and mammography were used for preoperative diagnosis. Fine needle aspiration biopsy (FNA), incisional biopsy (IB), and frozen section were used for histopathological diagnosis. Four different surgical procedures were preferred for surgical treatment: 1) Wide mass excision with 2 cm of surgical margin, 2) Simple mastectomy, 3) Simple mastectomy with palpitated lymph node biopsy and 4) Modified radical mastectomy (MRM).
Phyllodes tumors should be taken in account in patients with breast mass and with possible diagnosis of fibroadenoma. Differential diagnosis of phyllodes tumor is really upmost importance as the surgical management performed in one seans. Preoperative FNA and core biopsy performed routinely may have an important role as the clinical experience increase. Local recurrence is an important clinical problem in phyllodes tumors.
Conclusion: Clinical and radiological evaluations are usually insufficient in the differential diagnosis of fibroadenoma and phyllodes tumours. Evaluation of lesions with frozen section in patients with phyllodes tumours may reduce the possiblity of recurrent surgical procedures. Clinically palpitated axillar lymph nodes in paitents with phyllodes tumors may not be important pathologically. Local recurrence of borderline phyllodes tumors underwent simple mastectomy for maintaining the proposed surgical margin may point out that prognostic criteria might be multi factorial.
Keywords:
Phyllodes tumor, fibroepithelial tumors, breast.
References
1Guerrero MA, Ballard BR, Grau AM. Malignant phyllodes tumor of the breast: review of the literature and case report of stromal overgrowth. Surg Oncol 2003; 12(1):27-37.
2Rowell MD, Perry RR, Hsiu JG, Barranco Sc. Phyllodes tumors. American Journal of Surgery 1993; 165:376-79.
3Bernstein L, Deapen D, Ross RK. The descriptive epidemyology of malignant cystosarcoma phyllodes tumors of the breast. Cancer1993; 71(10):3020-3024.
4Chao TC, LO YF, Chen SC, Chen MF. Phyllodes tumors of the breast. Eur Radiol 2003; 13:88-93.
5Roos WK, Kaye P, Dent DM. Factors leading to lokal recurrence or death after surgical resection of phyllodes tumors of the breast. British Journal of Surgery 1999; 86:396-399.
6Norris HJ, Taylor HB. Relationship of histologic features to behavior of cystosarcoma phyllodes. Analysis of ninety-four cases. Cancer 1967; 20:2090-2099.
7Pietruszka M, Barnes L. Cystosarcoma phyllodes: a clinicopathologic analysis of 42 cases. Cancer 1978;41:1974-83.
8Mallebre B, Ebert A, Perez-Canto A, Hopp H, Opril F, Weitzel H. Cystosarkoma phyllodes of the breast. A retrospektive analysis of 12 cases. Geburtshilfe Fraunheilkd 1996;56(1):35-40.
9Salvadori B, Cusumano F, Del Bo R, Delladonne V, Grassi M, Rovini D, Saccozzi R, Andreola S, Clemente C. Surgical treatment of phyllodes tumors of the breast. Cancer 1989;15:63(12):2532-6.
10Stebbing JF, Nash AG. Diagnosis and management of phyllodes tumour of the breast: Experience of 33 cases at a specialist centre. Annr Coll. Surg. Engl. 1995;77(3):181-4
11Geisler DP, Boyler MJ, Malnar KF, McGee JM, Nolen MC, Fortner SM, Broughan TA. Phyllodes tumors of the breast: a review of 32 cases. Am Surg 2000;66(4):360-6.
12Chua CL, Thomas A. Cystosarcoma phyllodes: A review of surgical options. Surgery1989; 105:141-147.
13Tse GM, Cheung HS, Pang LM, Chu WC. Characterization of lesions of the breast with proton MR spectroscopy: comparison of carcinomas, benign lesions and phyllodes tumors. AJR Am J Roentgenol 2003;181(5):1267-72.
14Costantini M, Magistrelli A, Franceschini G. MRI in phyllodes tumor of thebreast. Case reports.Rays. 2002 Oct-Dec;27(4):313-8.
15Ogava Y, Nishioka A, Tsuboi N. Dynamic MR appearance of benign phyllodes tumor of the breast in a 20 years old woman. Radiat Med. 1997 Jul-Aug;15(4):247-50.
16Ohta H, Komibuchi T, Nishuo T. Technetium- 99m-sestamibi scintimammography of benign and malignant phyllodes tumors. Ann Nucl Med. 1997 Feb;11(1):37-9.
17Tse GM, Ma TK, Pang LM, Cheung H. Fine needle aspiration cytologic features of mammary phyllodes tumors. Acta Cytol. 2002 Sep- Oct;46(5):855-63.
18Jayaram G, Sthaneshwar P.Fine-needle aspiration cytology of phyllodes tumors. Diagn. Cytopathol. 2002 Apr;26(4):222-7.
19Komenaka IK, El-Tamer M, Pile-Spellman E, Hibshoosh H. Core needle biopsy as a diagnostic tool to differentiate phyllodes tumor from fibroadenoma. Arch Surg. 2003 Sep;138(9):987-90.
20Chaney AW, Pollack A, Mcneese MD. Primary treatment of cystosarcoma phyllodes of the breast. Cancer 2000; 89:1502-1510.
21Klausner JM, Lelcuk S, Ilia B, Inbar M, Hammer B, Skornik Y, Rozin RR. Breast carcinoma originating in cystosarcoma phyllodes. Clin Oncol.1983 Mar;9(1):71-4.
22Mangi AA, Smith BL, Gadd MA. Surgical management of phyllodes tumors. Arch Surg 1999; 134:487-491.
23Buchanan EB. Cystosarcoma phyllodes and its surgical management. Ann Surgeon 1995 Apr;61(4):350-355.
24Eich PD, Diederich S, Eich HT, Micke O, Wagner W. Diagnostic radiation oncology: malignant cystosarcoma phylloides. Strahlenther Onkol. 2000 Apr;176(4):192-5.
25Dacic S, Kounelis S, Kouri E, Jones MW. İmmunohistochemical profile of cystosarcoma phyllodes of the breast: A study of 23 cases. The Breast Journal 2002; 8(6):376-381.
26Moffat CJC, Pinder SE, Dixon AR. Phyllodes tumor of the breast: A clinicopathological review of 32 cases. Histopathology 1995; 27:205-218.
27Hart J, Layfield LJ, Trumbull WE. Practical aspects in the diagnosis and management of cystosarcoma phyllodes. Arch Surg 1988; 123:1079-1083.
28Parker SJ, Harries SA. Phyllodes tumours. Postgrad Med J. 2001;77(909):428-35.
29Kario K, Maeda S, Mizuno Y, Makino Y, Tankawa S, Kitazawa H. Phyllodes tumor of the breast: a clinicopathologic study of 34 cases. Journal of Surgical Oncology 1990; 45:46-51.
30Soumarova R, Seneklova Z, Horova H, Vojkovska H, Horova I, Budikova M, Ruzickova J, Jezkova B. Retrospective analysis of 25 woman with malignant cystosarcoma phyllodes treatmenent results. Arch Gynecol Obstet. 2004;269(4):278-81.
31Kok KY, Telesinnghe PU, Yapp SK. Treatment and outcome of cystosarcoma phyllodes in Brunei: a13 year experience. J.R.Coll.Surg Edinb. 2001;46(4):198-201.
