Prognostic factors in cystosarcoma phyllodes. A clinicopathologic study of 77 patients

Abstract

The authors studied prognostic factors in 77 patients with primary cystosarcoma phyllodes (CSP) of the breast. Median patient age was 50 years of age, and the median follow‐up time was 8 years. Sixteen patients (21%) had distant metastases and subsequently died of CSP. Clinical variables such as age, symptom duration, clinical tumor size, and type of surgery were not of prognostic value. Local recurrence was more common among patients treated with breast‐conserving surgery than among those treated with mastectomy. However, there was no significant difference between these two subgroups in terms of distant metastasis‐free survival or overall survival. The prognostic significance of several histopathologic parameters was also assessed, e.g., stromal cellularity, stromal cellular atypism, mitotic activity, atypic mitoses, stromal overgrowth, tumor contour, tumor necrosis, and heterologous stromal elements. In a multivariate Cox analysis, the only features that were found to be independent prognostic factors were tumor necrosis (P < 0.05) and presence of stromal elements other than fibromyxoid tissue (P < 0.01). In summary, additional studies of prognostic factors in CSP are warranted because of the conflicting results in published reports.

p53 and c-kit (CD117) protein expression as prognostic indicators in breast phyllodes tumors: a tissue microarray study

“…[1][2][3][4][5] Histologic grade, [6][7][8] stromal overgrowth, 9,10 tumor necrosis and heterologous stromal elements, 11 as well as a combination of morphologic parameters, 12 have been traditionally used as predictors of clinical outcome. Nevertheless, specific parameters that can independently define recurrent likelihood are not universally agreed upon.…”

Phyllodes Tumor Presenting with a Rare Widespread Abdominal Metastases: A Case Report and Review of the Literature

“…The aetiology is unknown but risk factors like female gender, fourth and fifth decades of life, previous breast lesions have been reported [1]. It is a fairly large tumor which could be confused with giant fibroadenoma but massive sized phyllodes tumors like in our index case have been reported, also is bilateral occurence [1,7,8]. Our case involved the whole breast which was six times the size of the contralateral breast.…”

“…However, we were unable to link the protracted vomiting with the primary diagnosis in our patient initially because the abdomen is a rare site for metastasis and the patient did not show any sign of metastatic disease on the first presentation rather she showed progressive post-operative recovery up till the time of the initial discharge. Sometimes, distinguishing benign from malignant type is not always possible clinically [8] but the large size, nipple erosion and bleeding correlate positively with malignancy. Also, histopathology shows an unusual similarity among intra-canalicular fibroadenoma, benign phyllodes tumor and cystosarcoma and this could cause confusion even for the experienced pathologist [9].…”

“…Apart from the benign and malignant variants, there is also a borderline phyllodes tumor which may appear benign on histopathology but behaves like malignant variant [4] clinically. Generally, the histo-pathological pattern of phyllodes tumor does not correlate with the biological behavior and therefore it is of limited predictive value for metastasis [1,8]. Impliedly, a biopsy confirmed benign tumour could reoccur after excision and grow aggressively as if it is malignant.…”

“…This breast tumour fungated through the skin [3] and unlike adenocarcinoma that could also fungate through the skin, phyllodes tumor is usually free on the chest wall. Smaller lesions on the other hand, may cause clinical diagnostic difficulties because they have distinct borders just like fibro adenoma [9] but phyllodes tumor occur in adult females who are 15 years or more, older than the age for fibroadenoma [8].…”