Phyllodes tumours – a retrospective review of 83 clinical cases

Česká verze

Authors: P. Mužlayová ¹; O. Coufal ^2,3,4 ; P. Fabian ⁵; A. Svobodník ⁶; O. Zapletal ²
Authors place of work: Lékařská fakulta Masarykovy Univerzity, Brno ¹; Klinika operační onkologie, Masarykův onkologický ústav, Brno ²; Klinika operační onkologie lékařské fakulty Masarykovy univerzity, Brno ³; Regionální centrum aplikované molekulární onkologie (RECAMO), Brno ⁴; Oddělení onkologické patologie, Masarykův onkologický ústav, Brno ⁵; Mezinárodní centrum klinického výzkumu Fakultní nemocnice u sv. Anny v Brně ⁶
Published in the journal: Rozhl. Chir., 2019, roč. 98, č. 9, s. 362-369.
Category: Původní práce
doi: https://doi.org/10.33699/PIS.2019.98.9.362–369

Summary

Introduction: Phyllodes tumours are rare, accounting for 0.3–1.0% of all primary breast tumours. According to biological behaviour, they are divided into three categories: benign, borderline and malignant. Due to the rare incidence, the requirements for the radicality of surgical treatment are not well known. According to respected foreign recommendations, resection with a free margin of 10 mm or more is desirable.Methods: A retrospective review of patients, who underwent surgical treatment due to phyllodes tumour in the Masaryk Memorial Cancer lnstitute in 2003–2014.

Results: 83 patients were evaluated with a median follow-up of 68.0 months. Benign tumours accounted for 62.3%, borderline tumours accounted for 16.9% and malignant accounted for 20.8% of all tumours. Malignant phyllodes tumours reached a bigger average size (84.9 mm) than borderline (41.4 mm) and benign tumours (33.3 mm) and occurred in older patients (mean 56.4 years) than benign (mean 42.5 years). Results from preoperative core-cut biopsy were often inaccurate. In 70 cases, the primary resection was breast preserving, but the free margin above 1 mm was achieved only in 13 cases. The width of the resection edge never exceeded the recommended 10 mm. Nevertheless, there was a relapse in benign tumours in two cases and in the borderline tumours only in one case. Malignant tumours recurred more frequently, even after total mastectomy. Four patients with malignant tumours experienced distant metastases. There has never been a death caused by benign or borderline tumour.

Conclusion: The 10 mm resection margin is unachievable in our conditions. However, it seems that such radicality is not necessary in benign tumours, because they rarely recur even with close margins. Conversely, neither total mastectomy of the malignant phyllodes tumours will protect against local progression or distant metastasis.

Keywords:

surgery – recurrence – phyllodes tumour – margin of excision

Zdroje

1. Chelius M. Neue Jahrbucher Der Teutschen Medicin and Chirurgie. Naegele und Puchelt, Heidelberg 1827.

2. Mishra SP, Tiwary SK, Mishra M, et al. Phyllodes tumor of breast: a review article. ISRN Surg. 2013:361469. doi:10.1155/2013/361469.

3. Azzopardi JG, Chepick OF, Hartmann WH, et al. The World Health Organization Histological Typing of Breast Tumors. 2

^nd edition. American Journal of Clinical Pathology 1982;78:806–16.

4. Rosen PP. Rosen’s breast pathology. 2^ndedition. Lippincott William Wikins 2001.

5. Krishnamurthy S, Ashfaq R, Shin HJ, et al. Distinction of phyllodes tumor from fibroadenoma: a reappraisal of an old problem. Cancer 2000;90:342–9.

6. Rosen P, Overman H. Cystosarcoma phyllodes. Atlas of tumor pathology. Tumors of the mammary gland. 3^rd ed. Armed Forces Institute of Pathology, Washington DC 1993:107–14.

7. Lakhani S, Ellis I, Schnitt S, et al. WHO classification of tumours of the breast, 4^th ed. IARC Press, Lyon 2012:142–7.

8. Bella V, Bellová L. Fyloidný tumor. Onkológia 2011;6:278–80.

9. Nguyen BD. Imaging of pelvic bone metastasis from malignant phyllodes breast tumor. Radiology Case Reports 2006;1:82–4.

10. Yohe S, Yeh IT. “Missed“ diagnoses of phyllodes tumor on breast biopsy: pathologic clues to its recognition. Int J Surg Pathol. 2008;16:137–42. doi: 10.1177/1066896907311378.

11. Mazy S, Hustin J, Van Reepinghen P. Phyllodes tumor of the breast. JBR-BTR 1999;82:118.

12. Cole-Beuglet C, Soriano R, Kurtz AB. Ultrasound, x-ray mammography, and histopathology of cystosarcoma phylloides. Radiology 1983;146:481–6. doi: 10.1148/radiology.146.2.6294737

13. Wurdinger S, Herzog AB, Fischer DR, et al. Differentiation of phyllodes breast tumors from fibroadenomas on MRI. AJR 2005;185:1317–21. doi: 10.2214/AJR.04.1620

14. Chao TC, Lo YF, Chen SC, et al. Sonographic features of phyllodes tumors of the breast. Ultrasound Obstet Gynecol. 2002;20:64–71.

15. Stebbing JF, Nash AG. Diagnosis and management of phyllodes tumour of the breast: experience of 33 cases at a specialist centre. Ann R Coll Surg Engl. 1995;77:181–4.

16. The International Agency for Research on Cancer. World Health Organization Classification of Tumours. Pathology & genetics of tumours of the breast and female genital organs. IARC Press (Lyon) 2003.

17. NCCN guidelines for treatment of breast cancer [online]. NCCN: ® 2019 [cit. 14.3.2019]. Available from: https://www.nccn.org/

18. Zedníková I, Černá M, Hlaváčková M, et al. Fyloidní nádory prsu. Rozhledy v chirurgii 2015;94:4–7.

19. Lu Y, Chen Y, Zhu L, et al. Local recurrence of benign, borderline, and malignant phyllodes tumors of the breast: A systematic review and meta-analysis. Ann Surg Oncol. 2019; 26:1263–75. doi: 10.1245/s10434-018-07134-5.

20. Barrio AV, Clark BD, Goldberg JI, et al. Clinicopathologic features and long-term outcomes of 293 phyllodes tumors of the breast. Ann Surg Oncol. 2007;14:2961–70. doi: 10.1245/s10434-007-9439-z.

21. Kario K, Maeda S, Mizuno Y, et al. Phyllodes tumor of the breast: a clinicopathologic study of 34 cases. J Surg Oncol. 1990;45:46–51. doi: 10.1002/jso.2930450111.

22. Ward RM, Evans HL. Cystosarcoma phyllodes: a clinicopathologic study of 26 cases. Cancer 1986;58:2282–9. doi:0.1002/1097-0142(19861115)58:10<2282::aid-cncr2820581021>3.0.co;2-2.

23. Pietruszka M, Barnes L. Cystosarcoma phyllodes: a clinicopathologic analysis of 42 cases. Cancer 1978;41:1974–83. doi:10.1002/1097-0142(197805)41:5<1974::aid-cncr2820410543>3.0.co;2-c.

24. Co M, Chen C, Tsang JY, et al. Mammary phyllodes tumour: a 15-year multicentre clinical review. J Clin Pathol. 2018; 71:493–7. doi: 10.1136/jclinpath-2017-204827.

25. Matos AN, Neto J, Antonini M, et al. Phyllodes tumors of the breast: a retrospective evaluation of cases from the hospital do servidor pu´blico estadual de Sao Paulo. Mastology 2017;27:339–43.

26. Guillot E, Couturaud B, Reyal F, et al. Management of phyllodes breast tumors. Breast J. 2011;17:129–37. doi: 10.1111/j.1524-4741.2010.01045.x.

27. Kubala O, Prokop J et al. Radiací indukovaný (postiradiační) angiosarkom prsu – možnosti chirurgické léčby a přehled literatury. Rozhl Chir. 2017;96:353–8.

28. Tremblay-LeMay R, Hogue JC, Provencher L, et al. How wide should margins be for phyllodes tumors of the breast? Breast 2017;23:315–22. doi: 10.1111/tbj.12727.

29. Belkacemi Y, Bousquet G, Marsiglia H, et al. Phyllodes tumorof the breast. Int J Radiat Oncol Biol Phys. 2008;70:492–500. DOI: 10.1016/j.ijrobp.2007.06.059.

30. Zhou ZR, Wang CC, Sun XJ, et al. Prognostic factors in breast phyllodes tumors: a nomogram based on a retrospective cohort study of 404 patients. Cancer Med. 2018;7:1030–42. doi: 10.1002/cam4.1327.

31. Mitus JW, Blecharz P, Jakubowicz J, et al. Phyllodes tumors of the breast. The treatment results for 340 patientsfrom a single cancer centre. Breast 2019;43:85–90. doi: 10.1016/j.breast.2018.11.009.

32. Kim YJ, Kim K. Radiation therapy for malignant phyllodes tumor of the breast: an analysis of SEER data. Breast 2017;32:26–32. doi: 10.1245/s10434-009-0489-2.

33. Barth RJ Jr, Wells WA, Mitchell SE, et al. A prospective, multi-institutional study of adjuvant radiotherapy after resection of malignant phyllodes tumors. Ann Surg Oncol. 2009;16:2288–94. doi: 10.1245/s10434-009-0489-2.

34. Spitaleri G, Toesca A, Botteri E, et al. Breast phyllodes tumor: a review of literature and a single center retrospective series analysis. Crit Rev Oncol Hematol. 2013; 88427–36. . doi: 10.1016/j.critrevonc.2013.06.005.

35. Varghese SS, Sasidharan B, Manipadam MT, et al. Radiotherapy in phyllodes tumour. J Clin Diagn Res. 2017;11:XC01–XC03. doi: 10.7860/JCDR/2017/24591.9167.

36. Strode M, Khoury T, Mangieri C, et al. Update on the diagnosis and management of malignant phyllodes tumors of the breast. Breast 2017;33:91–6. doi: 10.1016/j.breast.2017.03.001

37. Turalba CI, el-Mahdi AM. Fatal metastatic cystosarcoma phylloides in anadolescent female: case report and review of treatment approaches, J Surg Oncol. 1986;33:176–81.

38. Roberts N, Runk D. Aggressive malignant phyllodes tumor. International Journal of Surgery 2015;8:161–5. doi: 10.1016/j.ijscr.2014.12.041.