Phyllodes Tumors of the Breast: A Review of 32 Cases

Abstract

Most general surgeons involved in breast cancer care have limited experience with phyllodes tumors. We analyzed a comprehensive database incorporating 8567 breast cancer cases treated surgically in the Tulsa, Oklahoma, region between 1969 and 1993. This yielded 32 cases of phyllodes tumors (0.37%) in 31 patients. The median age was 57 years (range, 18–91). There were 9 low-grade (28%), 2 intermediate-grade (6%), and 21 high-grade (66%) lesions. Size distribution consisted of 23 (72%) lesions 5 cm or less and 9 (28%) greater than 5 cm (mean, 3; range, 1.2–17.5 cm). Of 137 resected nodes in 13 patients, none were positive for metastatic disease. Surgical management consisted of wide excision or mastectomy. No patients received adjuvant chemoradiation therapy. The disease-free, locoregional disease-free, and overall mean survival rates were 80, 81, and 97 months, respectively. Ten-year disease-free survival (DFS), locoregional disease-free survival (LRDFS), and overall survival (OS) rates were 66, 72, and 55 per cent, respectively. Although there was a tendency toward a higher rate of locoregional recurrences and metastases with high-grade lesions, this was not statistically significant and did not affect DFS, LRDFS, or OS rates. Similarly, size of lesion did not affect DFS, LRDFS, or OS rates. Three patients (9.6%) had metastatic disease at presentation, and a further two (6.4%) developed metastases during follow-up. Overall, nine (28.1%) recurrences developed in eight patients, seven locoregional and two distant. Four patients (12.9%) died with evidence of disease. These findings indicate prolonged survival in this patient population with cystosarcoma phyllodes. Wide local excision of primary and recurrent lesions remains the mainstay of therapy. Neither regional lymph node dissection nor adjuvant chemoradiation adds significant benefit.

Malignant phyllodes tumor of the breast with heterologous osteosarcoma and chondrosarcomatous differentiation: A rare case report with imaging findings

“…Phyllodes tumors are fibroepithelial neoplasms with characteristic architectural features composed of an epithelial component and a cellular stromal component [5 , 9] . The World Health Organization has subcategorized phyllodes tumors into benign, borderline, and malignant categories on the basis of 5 histological parameters: stromal cellularity, stromal atypia, tumor margins, mitotic activity, and stromal overgrowth [10] .…”

“…Phyllodes tumor of the breast is a rare biphasic neoplasm with epithelial and stromal components, and accounts for 2.5% of all fibroepithelial neoplasms [ [1] , [2] , [3] , [4] ]. They occur predominantly in women with a median age of 42-45 years [5] , and are generally characterized by a rapidly growing large palpable mass. They are classified into benign, borderline, and malignant classes on the basis of histological features such as stromal cellularity and atypia, stromal overgrowth, mitotic rate, and tumor borders [6] .…”

Dermatofibrosarcoma Protruberans of the Breast Skin Simulating Mammary Carcinoma

“…Primary mesenchymal tumors of the breast are rare where sarcomas arising in the breast parenchyma account for 0.2 to 1.0% of all breast malignancies [3]. The reported incidence of DFSP is approximately five cases per one million individuals per year [1].…”

Surgical Management and System Therapy of the Most Giant Known Malignant Metastatic Breast Phyllodes Tumor: A Case Report and Review of the Literature

“…Phyllodes tumors belong to uncommon fibroepithelial breast tumors with a range of biological behaviors. Phyllodes tumors are responsible for less than 1% of all neoplasms of the breast [1]. They can behave like benign fibroadenomas or as in the case described in this work, as malignant tumors that can metastasize distantly.…”