Malignant phyllodes tumours of the breast. A clinical and pathological analysis of 55 cases

doi:10.1016/0959-8049(93)90067-P

European Journal of Cancer

Volume 29, Issue 9, 1993, Pages 1252-1256

https://doi.org/10.1016/0959-8049(93)90067-P Get rights and content

Abstract

55 cases of malignant phyllodes tumours of the breast are described. 36 patients (i.e. 65.5%) of the studied group survived 5 years with no evidence of disease after surgery. It was proved that a simple mastectomy is sufficient therapy for patients with tumour limited to the breast. Metastases to the axillary lymphatic nodes are very rare. The main reason for treatment failure is distant metastases in the lungs. The only prognostic factor in the studied group was the grade of histological malignancy, determined by such criteria as the ratio between the malignant sarcomatous tissue and that typical for phyllodes tumour, the degree of cell polymorphism, mitotic activity, and possible multidirectional differentiation (towards malignant neoplasms of soft tissue and bones).

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Cited by (62)

Is there a survival benefit with adjuvant radiotherapy in margin negative malignant phyllodes tumor of the breast after mastectomy? A single institutional study
2021, Revista de Senologia y Patologia Mamaria
Citation Excerpt :
Core needle biopsy is preferable for preoperative diagnosis of phyllodes tumor as it is minimally invasive and has replaced excision biopsy for initial diagnosis.9–14 In those who undergo wide local excision the reported mean age at diagnosis was 45 years and mean size of the tumor was 4 cm.15–18 However despite most of the tumors presenting as large tumors, there is a low incidence of local recurrence and distant metastasis.
This study aims to analyze the benefit of adjuvant radiotherapy (RT) in malignant phyllodes tumor in terms of overall survival and control of local and systemic recurrence. Recently, there is an increasing trend toward the use of adjuvant RT.
Fifty-four patients with non-metastatic, malignant phyllodes tumor from January 2001 to December 2015 were included in the study. All patients had undergone margin negative surgical treatment either with a wide local excision [n = 6] or simple mastectomy [n = 48]. Patients who received adjuvant RT were stratified as Group 1 [n = 29] and those who did not receive adjuvant radiation as Group 2 [n = 25]. Survival probabilities were estimated by the Kaplan–Meier method.
The median follow-up was 76 months (2–150 months) with no statistically significant clinicopathologic or treatment factor associated with either local or systemic recurrence. There were seven [local 7.4% and systemic 5.6%] recurrences (3 in Group 1 and 4 in Group 2). The 5 and 10-year overall survival were 82% and 51% in Group 1 and 82% and 62% in Group 2, respectively (p = 0.989).
The role of adjuvant radiation in malignant phyllodes tumor in terms of overall survival is doubtful when margins are negative.
El objetivo de este estudio es analizar el beneficio de la radioterapia (RT) adyuvante en el tumor filodes maligno en términos de supervivencia general y control de la recidiva local y sistémica. Existe una tendencia reciente hacia el uso de RT adyuvante.
Se incluyó en el estudio a 54 pacientes con tumor filodes maligno no metastásico, de enero de 2001 a diciembre de 2015. Todas las pacientes habían sido sometidas a tratamiento quirúrgico de márgenes negativos, bien mediante extirpación local amplia [n = 6] o mastectomía simple [n = 48]. Las pacientes que recibieron RT adyuvante fueron estratificadas como Grupo 1 [n = 29], y aquellas que no recibieron radiación adyuvante como Grupo 2 [n = 25]. Las probabilidades de supervivencia fueron calculadas mediante el método de Kaplan-Meier.
El seguimiento medio fue de 76 meses (2-150 meses) sin factor clinicopatológico o terapéutico estadísticamente significativo asociado a la recidiva local o sistémica. Se produjeron siete recidivas [locales 7,4% y sistémicas 5,6%] (tres en el Grupo 1 y cuatro en el Grupo 2). La supervivencia general a cinco y 10 años fue de 82 y 51% en el Grupo 1, y de 82% y 62% en el Grupo 2, respectivamente (p = 0,989).
El rol de la radiación adyuvante en el tumor filodes maligno en términos de supervivencia general es dudoso cuando los márgenes son negativos.
Gaint phyllodes tumour with axillary & interpectoral lymph node metastasis; A rare presentation
2020, International Journal of Surgery Case Reports
Citation Excerpt :
Surgical therapy is aimed at complete excision of the tumor with at least 1-cm margins in the form of either lumpectomy or mastectomy, depending upon the tumor size to the breast ratio. Mastectomy has not shown a survival advantage over wide local excision [21]. The strongest independent predictor of local recurrence is a positive margin.
Phyllodes tumors are rare fibroepithelial neoplasms of the breast, account for less than 1 % of all breast neoplasms, lymph node metastasis is even rare and routine axillary dissection is not recommended. Approximately 20 % of patients with malignant phyllodes tumors develop distant metastasis.
A 45 years old premenopausal female, presented with a huge right breast mass for 3 years. Physical examination revealed a 40 × 46 cm, lobulated mass, fixed to the chest wall and multiple enlarged and mobile ipsilateral axillary lymphadenopathy. Core tissue biopsy revealed fibroepithelial & stromal proliferation suggestive of phyllodes tumor.
The CT scan of the chest and the abdomen revealed bilateral pulmonary metastasis.
She underwent palliative Modified Radical Mastectomy. Pathology demonstrated malignant phyllodes with osseous and chondroid metaplasia, the resection margins were clear and 6 out of 25 nodes were positive.
Her post-operative recovery was uneventful and she received adjuvant chemo-radiotherapy. During 12 months follow up, no local recurrence was noted, but despite chemotherapy her pulmonary disease was increasing.
Only a few cases of cystosarcoma phyllodes with lymph node involvement have been reported in the literature. Treves, Norris and Taylor’s series have demonstrated the axillary node metastasis of less that 1 %. Since most sarcomas metastasize hematogenously, this finding explains why axillary metastasis is so rare. Hence most authors have concluded that removal of axillary lymph nodes is not warranted unless there are pathologically involved.
Management of Phyllodes tumor presents the surgeon with challenges. Core tissue biopsy is a reliable method for pre-operative diagnosis. Imaging like CT scan and MRI help to evaluate the primary lesion as well as distant metastasis. The majority of these cases can be managed by simple mastectomy. Axillary lymph node metastasis is rare and dissection should be limited to patients with pathological evidence of tumor in the lymph nodes.
Phyllodes tumors of the breast. The treatment results for 340 patients from a single cancer centre
2019, Breast
Citation Excerpt :
The role of adjuvant or palliative radio- or chemotherapy in PTB is currently debatable [1,5–7,9,10,12–14,16,17,20–22,24,25,29] and there is no place for a hormone therapy in these patients [12,14,21,22,30]. At present, two main problems regarding the treatment of PTB patients remain unclear: what is the appropriate width for a tumor-free margin and the role of adjuvant radiotherapy [1,2,7,10,13,15,16,20–22,24,26,28–33]. In our study we have tried to contribute to the debate on both these controversial issues.
The primary treatment of choice for patients with phyllodes tumor of the breast (PTB) is surgery. Two major problems regarding the treatment of such patients remain unclear: what is the appropriate surgical margin and what role is played by adjuvant radiotherapy (ART).
The study provides a retrospective review of all patients with PTB treated between 1952 and 2013 at a single institute. The histology slides were re-examined based on WHO criteria. The clinical characteristics and therapy outcomes were obtained. The five-year survival with no evidence of disease (NED) was used as the end point.
The study population comprised 340 women with PTB. Fifty-five percent of the patients were diagnosed with the benign, 11.8% with borderline and 33.2% with malignant PTB. All the patients received primary treatment with surgery (mastectomy–27.1%, and BCS– 72.9%). Local recurrence (LR) was found in 28 (9.1%) of these patients. Four patients with borderline and 8 with malignant PTB who were treated with BCS and had tumor-free margins < 1 cm received ART. None of these patients had LR and all survived 5 years NED. Of the 340 patients from our group, 294 (86.4%) survived five-years NED.
The prognosis for benign PTB is excellent and can be cured with surgery alone. A sufficient margin would be 0.1 cm (data from the literature) or 0.2–0.4 cm (our study). We recommend application of ART for such patients but the role of ART in patients with borderline and malignant PTB treated with BCS and with surgical margin < 1 cm remains uncertain.
Sarcomas of the Breast with a Spotlight on Angiosarcoma and Cystosarcoma Phyllodes
2016, Surgical Oncology Clinics of North America
Citation Excerpt :
Johannes Müller initially described phyllodes tumors as cystosarcoma phyllodes in 1838.40 The current World Health Organization (WHO) classification was established in 2003.41 They are composed of biphasic stromal and glandular elements.
Adrenal metastasis of a phyllodes tumor of the breast: Case report and review of the literature
2013, International Journal of Surgery Case Reports
A phyllodes tumor is a neoplasm of mixed mesenchymal and epithelial origin affecting the breast. It may pursue a benign or malignant evolution with distant metastases in the latter case. Sites most commonly affected by metastases are the lungs and bones. Simple mastectomy is the mainstay of treatment. This article presents the first described case of metastasis to the adrenal gland after sarcomatous transformation of a phyllodes tumor. A review of the literature is presented afterwards.
A 57-year old female patient presented with a voluminous breast mass which was completely resected. Unfortunately she presented with malignant recurrence in the breast which was also resected. A later recurrence within the lung presented and was completely resected but showed aspects of sarcomatous changes. Finally a recurrence was pathologically documented within the adrenal gland. Unfortunately, disease later progressed and the patient refused further treatment at that point.
While malignant transformation of breast phyllodes tumors and metastasis is relatively common, the prognosis for initially benign lesion that are completely excised is usually good. This case represents the first documented metastasis to the adrenal gland of a breast phyllodes tumor.
We presented the first case of adrenal metastasis of a phyllodes tumor after sarcomatous degeneration. This is an unusual presentation of a relatively uncommon but well-recognized disease of variable malignant potential.
Fibroepithelial Lesions
2022, A Comprehensive Guide to Core Needle Biopsies of the Breast, Second Edition

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PaperMalignant phyllodes tumours of the breast. A clinical and pathological analysis of 55 cases

Abstract

Am J Surg

Am J Surg

Am J Surg

Am Surg

Ultrasound, X-ray mammography, and histopathology of cystosarcoma phylloides

Radiology

Cystosarcoma phylloides. A steroid receptor and ultrastructure analysis

Ann Surg

Liposarcoma arising within a cystosarcoma phyllodes

J Surg Oncol

Développement d'une tumeur phyllode agressive après traitement conservateur d'un adénocarcinome mammaire

Bull Cancer (Paris)

Sarcoma of the breast

Malignant cystosarcoma phyllodes in a man treated with polyestradiolphosphate. Case report

Acta Chir Scand

Cystosarcoma phylloides of the breast. A new therapeutic proposal

Ann Surg

Sarcomas of the breast. Homogenous or heterogenous?

J Surg Oncol

Cystosarcoma phyllodes

Ann Surg

Fatal metastatic cystosarcoma phyllodes in an adolescent female: case report and review of treatment approaches

J Surg Oncol

Cystosarcoma phyllodes in adolescent females. A report of seven patients

Ann Surg

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

Cancer

Radical treatment of recurrent cystosarcoma phylloides

Ann Surg

Paper
Malignant phyllodes tumours of the breast. A clinical and pathological analysis of 55 cases