Parameters that influence the prognosis of Phyllodes tumour

OriginalArticlePARAMETERS THAT INFLUENCETHE PROGNOSIS OF PHYLLODES TUMOURSALIM AHMED SOOMRO, DEEN MOHAMMAD, RAFIQ AFRIDI, MUMTAZ MAHERDepartment of Surgery, Ward-2, Jinnah Postgraduate Medical Centre, KarachiABSTRACTObjective: To evaluate the factors that influence the prognosis of patients with Phyllodes tumour.Design & Duration: Interventional case series from April 2002 to April 2006.Setting: Department of Surgery, Surgical Ward-2, Jinnah Postgraduate Medical Centre, Karachi.Patients: Twenty two patients of Phyllodes tumour breast that were operated.Methodology: Detailed data of all the patients was collected. Diagnosis of Phyllodes tumour was made on goodclinical examination, ultrasonography, mammography and trucut biopsy. Primary treatment included wide localexcision in 19 cases and mastectomy in three cases.Results: All patients were females with a mean age of 31 years. Left breast was affected more (60%) than the rightand a painless lump was the commonest presentation. Patients were divided into three groups after final histopathologyreport. Ten patients were reported as benign phyllodes who showed no recurrence on follow-up and four patient asborderline phyllodes, who developed recurrence within 12-18 months; while eight patients were reported as malignantphyllodes.Conclusion: The key prognostic factors are status of margins, histological type and the size of the tumour. Trucutbiopsy has greater yield of diagnosis and surgery remains the mainstay of treatment for Cystosarcoma Phyllodes.KEY WORDS: Breast Tumours, Cystosarcoma PhyllodesINTRODUCTIONCystosarcoma Phyllodes (CSP) was first named anddescribed by Johannes Muller in 1838, based on a grosspathological description of a “bulky, cystic, fleshy andleafy tumour of the breast 1 ”. It is, a neoplasm of breastthat is characterized by the presence of both stromaland epithelial components. Cystosarcoma phyllodes israre and its incidence is estimated to be 0.3% to 0.5%of all breast tumours 2,3 .The WHO classification was proposed in 1982 to promoteuniformity in the recording and reporting of thebreast diseases, and to facilitate international compa-Correspondence:Dr. Salim Ahmed SoomroSenior Registrar, Surgical Ward-2,Jinnah Postgraduate Medical Centre, Karachi.Phones: 9201300, 0333-2271846.E-mail: salimsoomrobreastclinic@yahoo.comrisons 4 . According to it the Phyllodes tumours weredivided into benign, borderline and malignant. Theclassification criteria consisted of cellular atypia, stromalcellularity, sarcomatous differentiation, and mitoticindex 5 .Phyllodes tumor of breast may mimic the appearanceof fibroadenomas. However, unlike fibroadenomas theyhave the potential to recur after excision and tumorswith malignant grades may even metastasize 6 . Thisstudy was carried out to evaluate the factors that influencethe prognosis of Phyllodes tumour and to differentiateit from other benign breast conditions.PATIENTS & METHODSTwenty two patients with Phyllodes tumour of the breastwere operated in the Department of Surgery, Ward-2,Jinnah Postgraduate Medical Centre, Karachi fromApril 2002 to April 2006.All patients were females with a mean age of 31 years(range 18 to 45 years). Painless lump in the breast wasthe commonest presentation and the left breast was234Volume 23, Issue 4, 2007

Prognosis of Phyllodes Tumourthe optimal primary treatment is more controversial.Wide local excision was employed as the primary treatmentin the present series. When a borderline lesion recursafter primary surgery a simple mastectomy maybe required. Adjuvant radiotherapy for malignant CystosarcomaPhyllodes have shown encouraging results 15 .CONCLUSIONThe key prognostic factors are:Status of margins: The prognosis is good if the excisionmargin are clear for >1cm.Histological type: Hypercellular stroma, high nuclearpleomorphism, high mitotic rate, infiltrating margins,presence of necrosis and increased vascularity within the tumour, carries poor prognosis.Size of tumor: A size more than 5cms, carries poorprognosis.Trucut biopsy has greater yield of diagnosis.Surgery remains the primary treatment.Strict counseling for careful long-term follow-upis recommended.REFERENCES1. Muller J. Uberden feineran bau and die formen derKrankhaften Geschwulste. Berlin: Reimer, 1838:54-60.2. Kessinger A, Foley JF, Lordon HM, Miller DM.Metastatic Cystosarcoma Phyllodes: A case report.J Surg Oncol 1972; 4: 131-47.3. Vorherr H, Vorherr UF, Kutvirt DM, Key CR. CystosarcomaPhyllodes: Epidemiology, pathophysiology,pathobiology, diagnosis therapy and survival. ArchGynaecol 1985; 236: 173-81.4. The World Health Organization Histological typingof Breast Tumours, 2nd edition. Am J Clin Path1982; 78: 806-16.5. Rreves N, Sunderland DA. Cystosarcoma Phyllodesof the Breast: A malignant and a benign tumor. AS. A. Soomro, D. Mohammad, R. Afridi, M. Maherclinicopathologic study of 77 cases. Cancer 1951;4: 1286-1332.6. Kopans DB. Breast imaging. In: Breast Cancer, Aguide for fellows. Philadelphia, USA: J. B. LippincottCo.; 1989. p.173-74.7. Cohn-Cedermark G, Rutqvist LE, Rosendahl I, SilverswardC. Prognostic factors in CystosarcomaPhyllodes. A clinicopathologic study of 77 patients.Cancer 1991; 68: 2017-22.8. Salvadori B, Cusumano F, Del-Bo R. Surgical treatmentof Phyllodes tumors of the breast. Cancer1989; 63: 2532-6.9. Hawkins RE, Schfield JB, Fisher C. The clinicaland histologic criteria that predict metastases fromCystosarcoma Phyllodes. Cancer 1992; 69: 141-7.10. Ward RM, Evans HH. Cystosarcoma Phyllodes.A clinicopathologic study of 20 cases. Cancer 1986;68: 2286-9.11. Keish JM. Cystosarcoma Phyllodes in a 12 yearsold girl. Nigerian Cancer Med J 1974; 35: 295-6.12. McGregon GI, Knowling MA, Este FA. Sarcomaand Cystosarcoma Phyllodes tumors of the breast:A retrospective review of 58 cases. Am J Surg 1994;167: 447-80.13. Holthouse DJ, Smith PA, Naunton-Morgan R, MinchinD. Cystosarcoma Phyllodes; Western Australianexperience. Aust NZ J Surg 1999; 69: 635-8.14. Berg WA, Hruban RH, Kumar D. Lessons frommammographic – histologic correlation of largecoreneedle breast biopsy. Radiographics 1996; 16:1111-30.15. Chaney AW, Pollack A, McNeese MD, Zafar GK.Adjuvant radiotherapy for Phyllodes tumor of breast.Radiat Oncol Investig 1998; 6: 264-7.236Volume 23, Issue 4, 2007