Radiopathological characteristics and outcomes of phyllodes tumor of the breast in Malaysian women

Abstract

Phyllodes tumor or cystosarcoma phyllodes is a rare fibroepithelial neoplasm which arises from the periductal stroma of the breast. They are classified as benign, borderline, and malignant based on the histologic features. However, all phyllodes tumor (PT) subtypes are regarded as having malignant potential and correct diagnosis is important for surgical management and optimal care. This study is a retrospective review of 76 women diagnosed as PT with highlights on the imaging characteristics, pathology, and surgical treatment over a 7-year period in a tertiary medical center of urban population in Malaysia. There were 45 benign, 16 borderline, and 15 malignant PT. The median age for benign PT was 43, borderline 48.5, and malignant 42 years. The Malay ethnic group constitute 52.6% of cases, with 27.6% and 18.4% in Chinese and Indian ethnic groups, respectively. On mammograms, most benign (64.3%) and 33.3% of malignant PT showed high-density lesions. Calcifications were only seen in 2 benign PT. On ultrasound, 86% of benign PT was well-circumscribed whilst 50.0% of malignant PT had irregular outline. Cystic spaces were seen in 40.0% of malignant and 9.5% of benign PT. 80% of malignant PT lesions were heterogenous. Malignant PT demonstrates tumor heterogeneity, cystic spaces, and posterior acoustic enhancement on ultrasound. Half of malignant PT showed regular borders on ultrasound and appear well circumscribed on mammogram. A total of 46 patients had wide local excision or excision biopsy whilst 30 underwent mastectomy as primary treatment. The majority of the borderline and malignant PTs in our study (75.0% and 85.7% respectively) and only 5 out of the 43 (11.6%) benign PT underwent mastectomy. There were 2 tumor recurrence in the benign PT group and 1 case in the borderline and malignant group respectively.

The treatment process of an extremely rare giant borderline phyllodes tumor of breast: case report and literature review

“…However, according to a review involving 5,530 patients, the overall recurrence rate of these patients is high, at 19.1% ( 14 ). According to a study in the National Cancer Database of the Cancer Council of the American College of Surgeons, involving 3120 patients, adjuvant radiotherapy for phyllodes tumors was used in 19.5% of cases between 2008 and 2009 ( 9 ). Data from this large retrospective study showed that radiotherapy can prolong the time of local recurrence and reduce the rate of local recurrence, but it has no significant effect on survival.…”

“…Due to the high recurrence rate, adjuvant radiotherapy as an improvement in local control has increased in the past few decades ( 8 , 9 ). In the only prospective study published so far, Mitus et al .…”

Recurrent borderline phyllodes tumor of the breast submitted to mastectomy and immediate reconstruction: Case report

“…PTs are rare breast neoplasms characterized by rapid growth [1,7,8]. They usually appear in women between 35 and 55 years of age, with an average presentation at 45 years, occurring ten to 20 years after FA peak incidence, by contrast with this case, in which the patient manifested the disease before 25 years of age [[9], [10], [11], [12]]. On physical examination, PTs are usually rigid, well delimited, mobile, non-adherent to the skin, with an average size of 4–7 cm, as described previously [2,3,13].…”

“…Local recurrence rates are 3.6–8% for benign PT, 14% for borderline and 30–42% for malignant [1,4,13]. Although our patient presented with benign and borderline PTs, she had several recurrences, probably associated with compromised surgical margins, considered the main risk factor for recurrence [9,13,17,19]. Metastatic potential is also closely related to malignancy, with greater hematogenous spread, mainly pulmonary and bone, justifying systemic staging.…”

“…Recent guidelines recommend that PT > 3 cm be resected with free margins ≥1 cm, with no need for axillary staging; lumpectomy may be indicated for small tumors, because it allows preservation and mammary function [3,4,17,20]. Some studies suggest that patients with benign and borderline PTs >5–10 cm or with other risk factors for recurrence and metastasis, malignant PTs, more than three recurrences or positive resection margin, or age above 50 years, should be subjected to mastectomy, preferably followed by immediate reconstruction [3,9,18]. Because our patient had progressive, borderline and more than three recurrent tumors, skin-reducing mastectomy on the right was chosen, removing all tumor mass, adjacent fibrotic tissue, and cutaneous scar tissue resulting from previous procedures, providing free and wide margins, as recommended [3,4,20].…”