Surgical treatment of phyllodes tumors of the breast

Abstract

Eighty-one female patients with phyllodes tumors of the breast, surgically treated from 1974 to 1983, were studied. Their age ranged from 9 to 88 years. According to histology, the series was divided into three groups, of 28 (34.5%) benign tumors, 32 (39.5%) border-line tumors, and 21 (25.9%) malignant tumors. Because ten patients were lost to follow-up, only 71 women could be evaluated. All the patients had received surgical treatment: 51 women had been treated conservatively (11 enucleations, 40 wide resections), and 20 had undergone radical operations (13 underwent total and five underwent subcutaneous mastectomies, whereas one underwent modified and one underwent radical mastectomy). The mean follow-up, for the three groups, was 106 months for benign, 84 months for borderline, and 82 months for malignant tumors; in no case was radical surgery followed by local recurrence: of 51 women conservatively treated, 14 experienced local relapse, i.e., one of 24 women with benign, ten of 22 with borderline, and three of 8 with malignant lesions. Only two of 47 patients (4.2%) with borderline or malignant tumors developed distant metastasis and died from disease. No relationship between tumor size and risk of local recurrence could be demonstrated, and no difference could be identified between borderline and malignant lesions, in terms both of local and distant relapse. Local recurrences do not appear to affect survival: as a consequence, wide resection should be the primary treatment. Enucleation is to be proscribed. Total mastectomy has been indicated for very large tumors and for local recurrences of borderline and malignant lesions. Axillary dissection is not worthwhile.

Approaches to phyllodes tumour of the breast: a review article

“…According to Azzopardi and Salvadori, they had proposed a widely acceptable definitions for phyllodes tumour between benign, borderline and malignant type. 27,28 They have described on the tumour margins (pushing or infiltrative), stromal cellularity (low, moderate or high), mitotic rate (less than 5, between 5-9 or more than 10 per 10 high power field) and pleomorphism (mild, moderate or severe). World Health Organization added stromal atypia (mild, moderate or marked) and malignant heterologous elements in the criteria for diagnosis.…”

Proliferating activity in differential diagnosis of benign phyllodes tumor and cellular fibroadenomas: Is it helpful?

“…Clinically most PTs tend to behave in a benign fashion, but, unlike FA, they can recur locally (in 16-30%) 5 and can undergo malignant progression to sarcoma. 11,12 In many instances, differential diagnosis of FA and BPT poses no difficulty but in complicated cases such as FA with a slightly higher cellular stroma or with focal phyllodes structure differential diagnosis is problematic. 13 However, in general, the stromal cell cellularity in PT is higher than in FA, and the nuclear atypia of the former is more prominent than the latter.…”

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

“…The standard treatment for small phyllodes tumor 5cm or less is complete excision with a 1-2 cm cuff of normal tissue followed by histo-pathological confirmation and then long term follow up [15]. For large tumors or when cystosarcoma is confirmed, wide excision with 2 cm to 5 cm cuff of normal tissue is the treatment of choice [15][16][17]. When tumor load is massive or the whole breast is involved and the necessity for breast conservation is over-ridden like in our patient, simple mastectomy is indicated.…”