Malignant Cystosarcoma Phyllodes: A Review of the Clinical Experience at King Faisal Specialist Hospital and Research Centre

Abstract

Twelve females with cystosarcoma phyllodes of the breast were referred to King Faisal Specialist Hospital and Research Centre (KFSH&RC) between 1980 and 1990, representing 0.8% of breast cancer patients seen during this period. Median age was 45 years (range 16 to 65 years). Seven patients (58%) were premenopausal. All patients presented with breast mass, which measured >10 cm in 58% of them. The median duration of symptoms was 15 months (range two to 174). Neither axillary lymph nodes nor distant metastases were seen at presentation. Surgery was the cornerstone of primary treatment (wide local excision in three and mastectomy in nine). Two patients received adjuvant chemotherapy and locoregional irradiation. All patients had malignant tumors histologically. Of the four tumors assayed for hormonal receptors, one was positive for estrogen and progesterone receptors. At a median follow-up of 17 months (range two to 77), four patients had relapsed; one died at 19 months and the projected five year survival is 83%. This limited data supports the observation that malignant cystosarcoma phyllodes is a distinctive clinicopathological entity of female breast cancer with a different natural history from carcinoma of the breast. Our survival results are similar to reported experience from the literature.

Malignant Phyllodes: Report of Three Cases and Review of the Literature

“…Throughout the years, the reported incidence of PT in all its forms remains to be <1%, with a mean age of occurrence ranging from 35-55 [1,2]. These tumors are more common to occur in women than men, with reported a correlation between multiparity and the incidence of PT [6,7], yet there are also reported cases in pediatric patients [8,9].…”

“…Due to the usually large size of PT, skin ulceration could occur; yet it does not pertain to being a sign of malignancy [13]. The same goes for axillary lymph node enlargement, which occurs due to the presence of infections and necrosis accompanying the mass [6].…”

“…Moreover, a clear surgical margin is more important in malignant phyllodes tumors as a recent meta-analysis included 9234 patients with positive margins, and concluded that the risk of local recurrence was significantly increased in the malignant type [23]. Axillary dissection is not required as the involvement of lymph nodes in phyllodes tumor are rare [23], but axillary lymph node sampling can be done in patients where suspicious lymph nodes were detected during evaluation [6]. In cases diagnosed as malignant PT, surgical excision remains the mainstay of treatment, where chemotherapy, hormonal manipulation and radiotherapy are used yet have not shown any significant effect on decreasing mortality or increasing life expectancy [19,24].…”

Retrospective Study Assessing Breast Cancer Occurrence and its Risk Factors among Females at Al Ahsa

“…The best predictor of the prognosis for BC depends on the histological grade that includes the morphological assessment of tumor biological characteristics [7,8]. In Riyadh, a study that took place between 1980 and 1990 reported that in 58% of cases the mass was greater than 10 cm, and there were no axillary lymph nodes or metastases found during examination [9]. Another study in the same period (1975 to 1991) reported that 64% of BC cases were diagnosed in advanced or metastatic stages (III & IV) [10].…”