Phyllodes tumors: A retrospective study of 22 cases in the department of gyneco obstetrics 2 of the Hassan II university hospital

Abstract

Introduction: Phyllodes tumors (PTs) of the breast are rare fibro-epithelial tumors, which represent 1% of all primary breast tumors with an incidence of 0.3% to 0.9%, and they represent 2% to 3% of fibroepithelial neoplasms. Their diagnosis is based on histology. Our work aims to determine the epidemiological, clinical, histological and therapeutic aspects of PTs. Materials and methods: This is a retrospective study conducted in the gyneco-obstetric II department at the hospital center Hassan II, between January 1st 2015, and December 31st 2020 of, on 22 patients histologically proved cases of phyllodes tumors. Results: The study was conducted on 22 women, for whom the average diagnosis age was 35.6years old from 19 to 63years. 63.6% of the patients were nulliparous. The main clinical manifestation was a unilateral breast nodule measuring between 1 and 15.5cm (5cm on average). Mammographic exploration in the majority of cases revealed hyperdense opacity, roughly oval, well limited, often with regular outlines. The histological type was benign in 68.18% of cases, borderline in 18.18% and phyllodes sarcoma in 13.63%. The treatment was conservative in 86.37% of cases (lumpectomy), and radical in 13.63% of cases (mastectomy). After surgical treatment, 2 patients had insufficient resection limits and subsequently benefited from tumor bed revision. After follow-up, two tumors locally recurred with a huge mass that took up the entire breast. The two patients who had undergone a mastectomy and whose development was marked by the appearance of a second recurrence on the mastectomy scar, one of which was operable and the second had pulmonary metastases hence the indication of chemotherapy. Conclusion: Out of this study, we noticed that Phyllodes tumors of the breast mainly affect young women. The diagnostic confirmation necessarily requires histological proof which is not often easy by only biopsy. The best management of this tumor remains adequate surgical resection with healthy margins, while emphasizing the need for monitoring because the risk of recurrence is always present. The prognosis is based on the histological characteristics of the tumor and the quality of tumor excision.