Phyllodes tumors of the breast: a case series of 106 patients

Institut Salah-Azaïz de Cancerologie, Tunis-Ville, Tūnis, Tunisia
The American Journal of Surgery (Impact Factor: 2.29). 09/2006; 192(2):141-7. DOI: 10.1016/j.amjsurg.2006.04.007
Source: PubMed


Phyllodes tumors (PTs) of the breast are rare, and their prognosis and treatment are still subject of discussion. The purpose of this study is to clarify therapeutic aspects and prognostic factors of this disease.
We retrospectively reviewed the medical records of 106 patients who had histologically confirmed PTs collected over a period of 10 years.
The mean age was 39.5 years (14-71 years). The mean tumoral size was 83 mm (15-250). According to criteria of Azzopardi and Salvadori, tumors were classified into 3 groups: benign (62 cases, 58.4%), borderline (16 cases, 15%), and malignant (28 cases, 26.4%). Eighty-two patients (77.4%) were treated conservatively (62 benign, 11 borderline, and 9 malignant) and 24 (22.6%) by radical surgery (5 borderline and 19 malignant). For malignant PTs treated by enucleation or local excision with or without reexcision of the tumor bed, the 5-year overall and disease-free survivals were 28.5% and 15.6% versus 72.7% and 73.6% when the surgery was radical (mastectomy with or without axillary dissection) (P = .12 and P = .0022). For the other histotypes, this difference disappeared. The rate of recurrence was 12.2% (13) after a mean follow-up of 39 months (5 benign, 2 borderline, and 5 malignant). The treatment of recurrences consisted of radical mastectomy (8 cases), simple mastectomy (2 cases), and local excision in 3 cases. Eight patients developed metastases, 2 of whom after recurrences. The 5-year overall and disease-free survivals were 86.54% and 78%, respectively. In univariate analysis, age and recurrences are not of prognostic value for survival, whereas tumor size, histotype, necrosis, cytonuclear atypia, tumor margins, and number of mitosis were significant prognostic factors for survival. In a multivariate study, only cytonuclear atypia remained an independent predictor for survival.
According to our results, we recommend for malignant PT a simple mastectomy, whereas for borderline and benign PT, treatment is based rather on wide excision passing in healthy tissue.

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    • "Phyllodes tumours of breast are rare (2.1 per million) and usually benign. They are more common in Latin American (Hispanic) women [7]. On histology they are fibro-epithelial tumours similar to fibroadenomas except for the hypocellular stroma with few mitoses and a true capsule present in fibroadenoma [3]. "
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    ABSTRACT: Background The controversy between breast conserving surgery and simple mastectomy for phyllodes tumours of the breast remains because of the unpredictable nature of the disease. Although some benign tumours may show an unusually aggressive behaviour, modified radical surgery for phyllodes tumours offers no survival advantage, and recently more conservative surgical approaches have been deployed. Case presentation A 30-year-old woman with a giant multifocal tumour of the breast underwent breast-conserving surgery that made use of the well- circumscribed feature of the tumour. The case demonstrates the safety, and cosmetic benefit of the breast-conserving approach for multifocal phyllodes tumours except for the high recurrence rate. Conclusions Large size, multifocality, and borderline or malignant histology are contraindications for breast-conserving surgery.
    Full-text · Article · Jul 2014 · World Journal of Surgical Oncology
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    • "The recurrence rate in benign tumors (5–15%) is lower than in malignant tumors (20–30%). Certain studies have shown that the overall five-year disease-free survival rate ranges from 78–91% and that the resection margin and size of the tumor may be key factors (13). "
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    ABSTRACT: Phyllodes tumors (PTs) of the breast are a rare type of tumor that account for <1% of breast tumors in females and usually present as a large lump of 3-5 cm in size. Surgery is the first line of treatment for PTs, and chemotherapy and irradiation may be useful in certain patients but not all. In the present study, the case of a 63-year-old female patient with a huge PT in the left breast is described. On physical examination, the patient presented with a huge mass of ∼45 cm in diameter, weighing ∼11 kg, and a composite of multiple chronic diseases. The breast and pectoris major and minor were excised. Post-operatively, the patient recovered well and to date there has been no evidence of local recurrence or distant metastasis.
    Full-text · Article · Jul 2013 · Oncology letters
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    ABSTRACT: RESUMEN Los tumores filoides, tumores fibroepiteliales de la glándula mamaria, representan menos de 1% de todos los tumores mamarios, se origi-nan en el estroma periductal o interlobular especializado y están constituidos por un componente mesenquimatoso, que forma estructuras foliáceas bordeadas por una capa doble de epitelio cilíndrico que se proyecta hacia una cavidad quística. Se clasifican en tres categorías: benigno, de baja malignidad o limítrofe y maligno. Pueden presentar componentes heterólogos. En este estudio se exponen los casos de dos adolescentes con tumores filoides malignos. Palabras clave: tumor filoides maligno, mastectomía simple, tinción de inmunoperoxidasa. ABSTRACT Phyllodes tumors, fibroepithelial tumors of the mammary gland, represent less than 1% of all breast tumors, they are originated in the spe-cialized mammary stroma and it is classified within the tumors with epithelial and stromal components. It has a mesenchymal component, which forms deciduous structures bordered by a double layer of epithelium projecting into a cystic cavity. They are classified into three categories: benign, low malignant or borderline and malignant. Heterologous stromal elements are rarely present. This study presents the cases of two adolescents with malignant phyllodes tumors.
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