Relationship of histologic features to behavior of cystosarcoma phyllodes.Analysis of ninety-four cases

Abstract

The clinical and pathologic findings in 94 patients with cystosarcoma phyllodes were studied to determine which pathologic characteristics were related to clinical behavior. The neoplasm recurred in 28 patients and 15 patients (17%) died of metastatic cystosarcoma. Most recurrences occurred within 2 years of initial surgery and all patients who died of cystosarcoma did so within 6 years. No tumor less than 4 cm in diameter or having fewer than 3 mitotic figures per 10 hpf in the areas of greatest mitotic activity proved fatal. Other microscopic features associated with a low risk of recurrence or of death were pushing margins (one death in 39 examples) and minimal cytologic atypism of the stromal cells (two deaths in 30 examples). No one feature was wholly reliable and a clearcut separation of benign from malignant tumors could not be made. Although axillary lymph nodes were enlarged in 17% of patients, metastasis to them occurred in not more than three instances (one histologically proved) and therefore radical mastectomy or routine axillary lymph node dissection is not worthwhile. Wide local excision for small cystosarcomas and simple mastectomy for larger ones is recommended. In addition, low axillary dissection should be considered in patients having clinically enlarged axillary lymph nodes and tumors larger than 4 cm if there is marked atypism of stromal cells or high mitotic activity, as determined by microscopic evaluation of the cystosarcoma.

Diagnostic performance of core needle biopsy in identifying breast phyllodes tumors

“…There are tremendous controversies regarding the nomenclature, classification (5)(6)(7)(8)(9)(10), and biological traits of PTB. There are over 60 terms for this type of tumor in the literature, including phyllodes tumor, pseudosarcoma adenoma, mucus gland tumor, breast mixed tumor, and pseudo-sarcoma.…”

Amplifications of the epidermal growth factor receptor gene (egfr) are common in phyllodes tumors of the breast and are associated with tumor progression

“…There are a number of histologic characteristics that have been shown to correlate with clinical outcome and thus can be helpful in grading of phyllodes tumors. [5][6][7][8][9][10] However, no morphological feature has been identified so far that exclusively allows for definitive determination of the tumor grade by itself.…”

Phyllodes tumor of the breast: Wolf inside the sheep’s skin!

“…Though clinical axillary lymph node involvement may be seen in 10-15% of patients, pathological involvement is seen in less than 1% of cases. [10][11][12][13] The clinical lymphadenopathy is due to reactive hyperplasia as a result of necrosis or secondary infection. [12] PTs recur locally irrespective of histological grade with higher incidence in borderline…”

“…Some authors have shown that up to 60% of patients with systemic metastasis develop prior LR, [25,[48][49][50] while some others refute this association. [10,11,23] LR or factors affecting LR may adversely affect survival for PT as well, similar to breast cancer. In a large study, Pezner et al demonstrated that survival is negatively affected by LR with a HR of 2.5 (p <0.05).…”