Fatal metastatic cystosarcoma phyllodes in an adolescent female: Case report and review of treatment approaches

Abstract

The third reported case of fatal malignant cystosarcoma phyllodes in an adolescent female is described. The patterns of local recurrence and distant spread in this case, including the response to treatment, were similar to those reported in the first reported case in this age group. A review of the treatment recommendations for cystosarcoma phyllodes revealed that the surgical procedure of choice for the malignant variant has remained controversial, and the conclusions regarding the ineffectiveness of radiation and chemotherapy have been based on insufficient data handed down through the years. Our observations in this case and the information we have obtained from the literature have prompted us to recommend a multidisciplinary approach for malignant cystosarcoma phyllodes, particularly in young women, and we are calling for a multi-institutional study group to further investigate this disease.

Primary treatment of cystosarcoma phyllodes of the breast

“…Local failure rates for benign tumors range between 5-15% 1,4,9,15 and 20 -30% for malignant tumors. 9,10,15,27,28,29 In the current series, the 10-year actuarial local failure rate was 8%. Local failure occurred in 3 of 71 patients (4%) with benign or indeterminate tumors.…”

Cystosarcoma phyllodes. Effective therapy with cisplatin and etoposide chemotherapy

“…',3,'6, 27 We, however, observed excellent tumor responses to radiation therapy in all three of our patients. Others also reported control of metastatic disease with radiation…”

Fibroadenoma in an operated case of malignant phyllodes tumour: a rare case report

“…Local failure rates for benign tumors range between 5-15% and 20-30% for malignant tumors. 15,19,22,23,26,[31][32][33] Margins of 1-2 cm have been recommended, and enucleation alone is insufficient. 19,21,22,25,26 de-Roos et al found positive margins in all patients who sustained a local recurrence after local excision.…”

“…24 The reported rates of distant metastasis for patients with malignant tumors range from 25-40%. 9,19,25,31 The role of adjuvant radiotherapy is not well established. August et al suggested radiotherapy after wide local excision for high risk lesions (tumour >5 cms, presence of stromal overgrowth, >10 mitoses/10hpf, infiltrative margins), for local recurrence would likely be avoided in 90% or more of these patients.…”