Introduction. Phyllodes tumours are rare fibroepithelial lesions. Accurate preoperative pathological diagnosis allows correct surgical planning and avoidance of reoperation. Treatment can be either wide local excision or mastectomy to achieve histologically clear margins. Discussion. The exact aetiology of phyllodes tumour and its relationship with fibroadenoma are unclear. Women aged between 35 and 55 years are commonly involved. The median tumour size is 4？cm but can grow even larger having dilated veins and a blue discoloration over skin. Palpable axillary lymphadenopathy can be identified in up to 10–15% of patients but <1% had pathological positive nodes. Mammography and ultrasonography are main imaging modalities. Cytologically the presence of both epithelial and stromal elements supports the diagnosis. The value of FNAC in diagnosis of phyllodes tumour remains controversial, but core needle biopsy has high sensitivity and negative predictive value. Surgical management is the mainstay and local recurrence in phyllodes tumours has been associated with inadequate local excision. The role of adjuvant radiotherapy and chemotherapy remains uncertain and use of hormonal therapy has not been fully investigated. Conclusion. The preoperative diagnosis and proper management are crucial in phyllodes tumours because of their tendency to recur and malignant potential in some of these tumours. 1. Introduction Phyllodes tumors are rare fibroepithelial lesions. They make up 0.3 to 0.5% of female breast tumors [1] and have an incidence of about 2.1 per million, the peak of which occurs in women aged 45 to 49 years [2, 3]. The tumor is rarely found in adolescents and the elderly. They have been described as early as 1774, as a giant type of fibroadenoma [4]. Chelius [5] in 1827 first described this tumor. Johannes Muller (1838) was the first person to use the term cystosarcoma phyllodes. It was believed to be benign until 1943, when Cooper and Ackerman reported on the malignant biological potential of this tumor. In 1981 [6] the World Health Organization adopted the term phyllodes tumor and as described by Rosen [7] subclassified them histologically as benign, borderline, or malignant according to the features such as tumor margins, stromal overgrowth, tumor necrosis, cellular atypia, and number of mitosis per high power field. The majority of phyllodes tumors have been described as benign (35% to 64%), with the remainder divided between the borderline and malignant subtypes. The term phyllodes tumor represents a broad range of fibroepithelial diseases and presence
References
[1]
M. D. Rowell, R. R. Perry, J. G. Hsiu, and S. C. Barranco, “Phyllodes tumors,” The American Journal of Surgery, vol. 165, no. 3, pp. 376–379, 1993.
[2]
B. Salvadori, F. Cusumano, R. Del Bo et al., “Surgical treatment of phyllodes tumors of the breast,” Cancer, vol. 63, no. 12, pp. 2532–2536, 1989.
[3]
L. Bernstein, D. Deapen, and R. K. Ross, “The descriptive epidemiology of malignant cystosarcoma phyllodes tumors of the breast,” Cancer, vol. 71, no. 10, pp. 3020–3024, 1993.
[4]
A. Fiks, “Cystosarcoma phyllodes of the mammary gland—Muller's tumor,” Virchows Archiv, vol. 392, no. 1, pp. 1–6, 1981.
[5]
M. Chelius, Neue Jahrbucher Der Teutschen Medicin and Chirurgie, Naegele und Puchelt, Heidelberg, Germany, 1827.
[6]
World Health Organization, Histologic Typing of Breast Tumors, vol. 2, WHO, Geneva, Switzerland, 2nd edition, 1981.
[7]
P. P. Rosen, Rosen’s Breast Pathology, Lippincott William Wikins, New York, NY, USA, 2nd edition, 2001.
[8]
P. F. Ridgway, R. K. Jacklin, P. Ziprin et al., “Perioperative diagnosis of cystosarcoma phyllodes of the breast may be enhanced by MIB-1 index,” Journal of Surgical Research, vol. 122, no. 1, pp. 83–88, 2004.
[9]
A. K. El-Naggar, B. Mackay, N. Sneige, and J. G. Batsakis, “Stromal neoplasms of the breast: a comparative flow cytometric study,” Journal of Surgical Oncology, vol. 44, no. 3, pp. 151–156, 1990.
[10]
R. K. Jacklin, P. F. Ridgway, P. Ziprin, V. Healy, D. Hadjiminas, and A. Darzi, “Optimising preoperative diagnosis in phyllodes tumour of the breast,” Journal of Clinical Pathology, vol. 59, no. 5, pp. 454–459, 2006.
[11]
A. W. Chaney, A. Pollack, D. Marsha, et al., “Primary treatment of cystosarcoma phyllodes of the breast,” Cancer, vol. 89, pp. 1502–1510, 2000.
[12]
I. Kapiris, N. Nasiri, R. A'Hern, V. Healy, and G. P. H. Gui, “Outcome and predictive factors of local recurrence and distant metastases following primary surgical treatment of high-grade malignant phyllodes tumours of the breast,” European Journal of Surgical Oncology, vol. 27, no. 8, pp. 723–730, 2001.
[13]
S. Noguchi, K. Motomura, H. Inaji, S. Imaoka, and H. Koyama, “Clonal analysis of fibroadenoma and phyllodes tumor of the breast,” Cancer Research, vol. 53, no. 17, pp. 4071–4074, 1993.
[14]
J. G. Azzopardi, A. Ahmed, and R. R. Millis, “Problems in breast pathology,” Major Problems in Pathology, vol. 11, pp. 346–364, 1979.
[15]
M. Reinfuss, J. Mitus, K. Duda, A. Stelmach, J. Rys, and K. Smolak, “The treatment and prognosis of patients with phyllodes tumor of the breast: an analysis of 170 cases,” Cancer, vol. 77, pp. 910–916, 1996.
[16]
C. L. Chua, A. Thomas, and B. K. Ng, “Cystosarcoma phyllodes: a review of surgical options,” Surgery, vol. 105, no. 2 I, pp. 141–147, 1989.
[17]
S. Wurdinger, A. B. Herzog, D. R. Fischer et al., “Differentiation of phyllodes breast tumors from fibroadenomas on MRI,” American Journal of Roentgenology, vol. 185, no. 5, pp. 1317–1321, 2005.
[18]
J. M. Feder, E. S. de Paredes, J. P. Hogge, and J. J. Wilken, “Unusual breast lesions: radiologic-pathologic correlation,” Radiographics, vol. 19, pp. S11–S26, 1999.
[19]
C. Cole Beuglet, R. Soriano, and A. B. Kurtz, “Ultrasound, X-ray mammography, and histopathology of cystosarcoma phylloides,” Radiology, vol. 146, no. 2, pp. 481–486, 1983.
[20]
A. Jorge Blanco, B. Vargas Serrano, R. Rodriguez Romero, et al., “Phyllodes tumors of the breast,” European Radiology, vol. 9, pp. 356–360, 1999.
[21]
P. Cosmacini, P. Veronesi, S. Zurrida, C. Bartoli, C. Ferranti, and G. Coopmans De Yoldi, “Mammography in the diagnosis of phyllodes tumors of the breast. Analysis of 99 cases,” Radiologia Medica, vol. 82, no. 1-2, pp. 52–55, 1991.
[22]
T. Kinoshita, T. Fukutomi, and K. Kubochi, “Magnetic resonance imaging of benign phyllodes tumors of the breast,” Breast Journal, vol. 10, no. 3, pp. 232–236, 2004.
[23]
G. M. K. Tse, H. S. Cheung, L. M. Pang et al., “Characterization of lesions of the breast with proton MR spectroscopy: comparison of carcinomas, benign lesions, and phyllodes tumors,” American Journal of Roentgenology, vol. 181, no. 5, pp. 1267–1272, 2003.
[24]
N. Katayama, Y. Inoue, T. Ichikawa et al., “Increased activity in benign phyllodes tumor on Tc-99m MDP scintimammography,” Clinical Nuclear Medicine, vol. 25, no. 7, pp. 551–552, 2000.
[25]
H. Ohta, T. Komibuchi, T. Nishio et al., “Technetium-99m-sestamibi scintimammography of benign and malignant phyllodes tumors,” Annals of Nuclear Medicine, vol. 11, no. 1, pp. 37–39, 1997.
[26]
J. E. Page and J. E. Williams, “The radiological features of phylloides tumour of the breast with clinico-pathological correlation,” Clinical Radiology, vol. 44, no. 1, pp. 8–12, 1991.
[27]
W. Buchberger, K. Strasser, K. Heim, E. Muller, and H. Schrocksnadel, “Phylloides tumor: findings on mammography, sonography, and aspiration cytology in 10 cases,” American Journal of Roentgenology, vol. 157, no. 4, pp. 715–719, 1991.
[28]
L. Liberman, E. Bonaccio, D. Hamele-Bena, A. F. Abramson, M. A. Cohen, and D. D. Dershaw, “Benign and malignant phyllodes tumors: mammographic and sonographic findings,” Radiology, vol. 198, no. 1, pp. 121–124, 1996.
[29]
D. C. Chhieng, J. F. Cangiarella, J. Waisman, et al., “Fine-needle aspiration cytology of spindle cell lesions of the breast,” Cancer, vol. 87, pp. 359–371, 1999.
[30]
U. Simi, D. Moretti, P. Iacconi et al., “Fine needle aspiration cytopathology of phyllodes tumor. Differential diagnosis with fibroadenoma,” Acta Cytologica, vol. 32, no. 1, pp. 63–66, 1988.
[31]
I. K. Komenaka, M. El-Tamer, E. Pile-Spellman, and H. Hibshoosh, “Core needle biopsy as a diagnostic tool to differentiate phyllodes tumor from fibroadenoma,” Archives of Surgery, vol. 138, no. 9, pp. 987–990, 2003.
[32]
S. A. Deen, G. T. McKee, and M. W. Kissin, “Differential cytologic features of fibroepithelial lesions of the breast,” Diagnostic Cytopathology, vol. 20, pp. 53–56, 1999.
[33]
G. Jayaram and P. Sthaneshwar, “Fine-needle aspiration cytology of phyllodes tumors,” Diagnostic Cytopathology, vol. 26, no. 4, pp. 222–227, 2002.
[34]
T. W. Jacobs, Y. Y. Chen, D. G. Guinee et al., “Fibroepithelial lesions with cellular stroma on breast core needle biopsy: are there predictors of outcome on surgical excision?” American Journal of Clinical Pathology, vol. 124, no. 3, pp. 342–354, 2005.
[35]
G. Cohn-Cedermark, L. E. Rutqvist, I. Rosendahl, and C. Silfversward, “Prognostic factors in cystosarcoma phyllodes: a clinicopathologic study of 77 patients,” Cancer, vol. 68, no. 9, pp. 2017–2022, 1991.
[36]
H. J. Norris and H. B. Taylor, “Relationship of histologic features to behavior of cystosarcoma phyllodes. Analysis of ninety-four cases,” Cancer, vol. 20, no. 12, pp. 2090–2099, 1967.
[37]
O. Contarini, L. F. Urdaneta, W. Hagan, and S. E. Stephenson, “Cystosarcoma phylloides of the breast: a new therapeutic proposal,” American Surgeon, vol. 48, no. 4, pp. 157–166, 1982.
[38]
R. R. Baker, “Unusual lesions and their management,” Surgical Clinics of North America, vol. 70, no. 4, pp. 963–975, 1990.
[39]
G. Singh and R. K. Sharma, “Immediate breast reconstruction for phyllodes tumors,” Breast, vol. 17, no. 3, pp. 296–301, 2008.
[40]
K. Jonsson and H. I. Libshitz, “Arteriographic pattern in cystosarcoma phylloides,” British Journal of Radiology, vol. 50, no. 598, pp. 751–753, 1977.
[41]
M. I. Liang, B. Ramaswamy, C. C. Patterson et al., “Giant breast tumors: surgical management of phyllodes tumors, potential for reconstructive surgery and a review of literature,” World Journal of Surgical Oncology, vol. 6, article 117, 2008.
[42]
A. A. Mangi, B. L. Smith, M. A. Gadd, K. K. Tanabe, M. J. Ott, and W. W. Souba, “Surgical management of phyllodes tumors,” Archives of Surgery, vol. 134, no. 5, pp. 487–493, 1999.
[43]
M. A. Mendel, R. G. DePalma, C. Vogt, and J. W. Reagan, “Cystosarcoma phyllodes: treatment by subcutaneous mastectomy with immediate prosthetic implantation,” The American Journal of Surgery, vol. 23, pp. 718–721, 1972.
[44]
A. Orenstein and H. Tsur, “Cystosarcoma phylloides treated by excision and immediate reconstruction with silicon implant,” Annals of Plastic Surgery, vol. 18, no. 6, pp. 520–523, 1987.
[45]
S. Khanna, S. Gupta, and N. N. Khanna, “Sarcomas of the breast: homogenous or heterogenous?” Journal of Surgical Oncology, vol. 18, no. 2, pp. 119–128, 1981.
[46]
S. C. Carabell and R. L. Goodman, “Radiation therapy for soft tissue sarcoma,” Seminars in Oncology, vol. 8, no. 2, pp. 201–206, 1981.
[47]
R. E. Hawkins, J. B. Schofield, E. Wiltshaw, C. Fisher, and J. A. McKinna, “Ifosfamide is an active drug for chemotherapy of metastatic cystosarcoma phyllodes,” Cancer, vol. 69, no. 9, pp. 2271–2275, 1992.
[48]
G. V. Burton, L. L. Hart, G. S. Leight, J. D. Iglehart, K. S. McCarty, and E. B. Cox, “Cystosarcoma phyllodes. Effective therapy with cisplatin and etoposide chemotherapy,” Cancer, vol. 63, no. 11, pp. 2088–2092, 1989.
[49]
S. C. Joshi, D. N. Sharma, A. K. Bahadur, R. Maurya, S. Kumar, and N. Khurana, “Cystosarcoma phyllodes: our institutional experience,” Australasian Radiology, vol. 47, no. 4, pp. 434–437, 2003.
[50]
T. Palshof, M. Blickert-Taft, and L. Daehnfelt, “Estradiol binding protein in cystosarcoma phylloides of the breast,” European Journal of Cancer, vol. 16, pp. 591–593, 1980.
[51]
A. W. Chaney, A. Pollack, M. D. McNeese, and G. K. Zagars, “Adjuvant radiotherapy for phyllodes tumor of breast,” Radiation Oncology Investigations, vol. 6, no. 6, pp. 264–267, 1998.
