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Open Access 01-12-2008 | Review

Giant breast tumors: Surgical management of phyllodes tumors, potential for reconstructive surgery and a review of literature

Authors: Margaret I Liang, Bhuvaneswari Ramaswamy, Cynthia C Patterson, Michael T McKelvey, Gayle Gordillo, Gerard J Nuovo, William E Carson III

Published in: World Journal of Surgical Oncology | Issue 1/2008

Abstract

Background

Phyllodes tumors are biphasic fibroepithelial neoplasms of the breast. While the surgical management of these relatively uncommon tumors has been addressed in the literature, few reports have commented on the surgical approach to tumors greater than ten centimeters in diameter – the giant phyllodes tumor.

Case presentation

We report two cases of giant breast tumors and discuss the techniques utilized for pre-operative diagnosis, tumor removal, and breast reconstruction. A review of the literature on the surgical management of phyllodes tumors was performed.

Conclusion

Management of the giant phyllodes tumor presents the surgeon with unique challenges. The majority of these tumors can be managed by simple mastectomy. Axillary lymph node metastasis is rare, and dissection should be limited to patients with pathologic evidence of tumor in the lymph nodes.

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Rowell MD, Perry RR, Jeng-Gwang H, Barranco SC: Phyllodes tumors. Am J Surg. 1993, 165: 376-79. 10.1016/S0002-9610(05)80849-9.CrossRefPubMed

Reinfuss M, Mitus J, Duda K, Stelmach A, Rys J, Smolak K: The treatment and prognosis of patients with phyllodes tumor of the breast: an analysis of 170 cases. Cancer. 1996, 77: 910-16. 10.1002/(SICI)1097-0142(19960301)77:5<910::AID-CNCR16>3.0.CO;2-6.CrossRefPubMed

Noguchi S, Motomura K, Inaji H, Imaoka S, Koyama H: Clonal analysis of fibroadenoma and phyllodes tumor of the breast. Cancer Res. 1993, 53: 4071-74.PubMed

Bernstein L, Deapen D, Ross RK: The descriptive epidemiology of malignant cystosarcoma phyllodes tumors of the breast. Cancer. 1993, 71: 3020-24. 10.1002/1097-0142(19930515)71:10<3020::AID-CNCR2820711022>3.0.CO;2-G.CrossRefPubMed

Salvadori B, Cusumano F, Del Bo R, Delledonne V, Grassi M, Rovini D: Surgical treatment of phyllodes tumors of the breast. Cancer. 1989, 63: 2532-36. 10.1002/1097-0142(19890615)63:12<2532::AID-CNCR2820631229>3.0.CO;2-Q.CrossRefPubMed

Stromberg BV, Golladay ES: Cystosarcoma phylloides in the adolescent female. J Pediatr Surg. 1978, 13: 423-25.CrossRefPubMed

Briggs RM, Walters M, Rosenthal D: Cystosarcoma phylloides in adolescent female patients. Am J Surg. 1983, 146: 712-14. 10.1016/0002-9610(83)90324-0.CrossRefPubMed

Chua CL, Thomas A, Ng BK: Cystosarcoma phyllodes: a review of surgical options. Surgery. 1989, 105: 141-47.PubMed

Cole-Beuglet C, Soriano R, Kurtz AB, Meyer JF, Kopans DB, Goldberg BB: Ultrasound, x-ray mammography, and histopathology of cystosarcoma phyllodes. Radiology. 1983, 146: 481-86.CrossRefPubMed

10.

Chao TC, Lo YF, Chen SC, Chen MF: Sonographic features of phyllodes tumors of the breast. Ultrasound Obstet Gynecol. 2002, 20: 64-71. 10.1046/j.1469-0705.2002.00736.x.CrossRefPubMed

11.

Chao T, Lo Y, Chen S, Chen M: Phyllodes tumors of the breast. Eur Radiol. 2003, 13: 88-93.PubMed

12.

Kinoshita T, Fukutomi T, Kubochi K: Magnetic resonance imaging of benign pyllodes tumors of the breast. Breast J. 2004, 10: 232-236. 10.1111/j.1075-122X.2004.21316.x.CrossRefPubMed

13.

Cheung HS, Tse GMK, Ma TKF: Correspondence. Clin Radiol. 2002, 57: 230-31. 10.1053/crad.2000.0665.CrossRefPubMed

14.

Mangi AA, Smith BL, Gadd MS, Tanabe KK, Ott MJ, Souba WW: Surgical management of phyllodes tumors. Arch Surg. 1999, 134: 487-93. 10.1001/archsurg.134.5.487.CrossRefPubMed

15.

Veneti S, Manek S: Benign phyllodes tumour vs fibroadenoma: FNA cytological differentiation. Cytopathology. 2001, 12: 321-28. 10.1046/j.1365-2303.2001.00334.x.CrossRefPubMed

16.

Krishnamurthy S, Ashfaq R, Shin HJ, Sneige N: Distinction of phyllodes tumor from fibroadenoma: a reappraisal of an old problem. Cancer. 2000, 90: 342-49. 10.1002/1097-0142(20001225)90:6<342::AID-CNCR4>3.0.CO;2-I.CrossRefPubMed

17.

Sheen-Chen SM, Chou FF, Chen WJ: Cystosarcoma phylloides of the breast: a clinical, pathological and therapeutic option in 18 cases. Int Surg. 1991, 76: 101-04.PubMed

18.

Norris HJ, Taylor HB: Relationship of histologic features to behavior of cystosarcoma phyllodes – analysis of ninety-four cases. Cancer. 1967, 20: 2090-99. 10.1002/1097-0142(196712)20:12<2090::AID-CNCR2820201206>3.0.CO;2-L.CrossRefPubMed

19.

Treves N, Sunderland DA: Cystosarcoma phyllodes of the breast: a malignant and benign tumor. Cancer. 1951, 4: 1286-10.1002/1097-0142(195111)4:6<1286::AID-CNCR2820040614>3.0.CO;2-T.CrossRefPubMed

20.

Chaney AW, Pollack A, McNeese MD, Zager GK, Pisters PW, Pollock RE: Primary treatment of cystosarcoma phyllodes of the breast. Cancer. 2000, 89: 1502-11. 10.1002/1097-0142(20001001)89:7<1502::AID-CNCR13>3.0.CO;2-P.CrossRefPubMed

21.

Tan PH, Jayabaskar T, Chuah KL, Lee HY, Tan Y, Hilmy M: Phyllodes tumors of the breast: the role of pathologic parameters. Am J Clin Pathol. 2005, 123: 529-40. 10.1309/U6DVBFM81MLJC1FN.CrossRefPubMed

22.

Lenhard MS, Kalhert S, Himsl I, Ditsch N, Untch M, Bauerfeind I: Phyllodes tumour of the breast: Clinical follow up of 33 cases of this rare disease. Eur J Obstet Gynecol. 2007,

23.

Browder W, McQuitty JT, McDonald JC: Malignant cystosarcoma phylloides: treatment and prognosis. Am J Surg. 1978, 136: 239-41. 10.1016/0002-9610(78)90236-2.CrossRefPubMed

24.

Kessinger A, Foley JF, Lemon HM, Miller DM: Metastatic cystosarcoma phyllodes: a case report and review of the literature. J Surg Oncol. 1972, 4: 131-47. 10.1002/jso.2930040208.CrossRefPubMed

25.

Chaney AW, Pollack A, McNeese MD, Zagars GK: Adjuvant radiotherapy for phyllodes tumor of breast. Radiat Oncol Investig. 1998, 6: 289-90. 10.1002/(SICI)1520-6823(1998)6:6<264::AID-ROI3>3.0.CO;2-J.CrossRef

26.

Contarini O, Urdaneta LF, Hagan W, Stephenson SE: Cystosarcoma phylloides of the breast: a new therapeutic proposal. Am Surg. 1982, 48: 157-66.PubMed

27.

Hawkins RE, Schofield JB, Fisher C, Wiltshaw E, McKinna JA: The clinical and histologic criteria that predict metastases from cystosarcoma phyllodes. Cancer. 1992, 69: 141-47. 10.1002/1097-0142(19920101)69:1<141::AID-CNCR2820690125>3.0.CO;2-1.CrossRefPubMed

28.

Cohn-Cedermark G, Rutqvist LE, Rosendahl I, Silfversward C: Prognostic factors in cystosarcoma phyllodes: a clinicopathologic study of 77 patients. Cancer. 1991, 68: 2017-22. 10.1002/1097-0142(19911101)68:9<2017::AID-CNCR2820680929>3.0.CO;2-V.CrossRefPubMed

29.

Ward RM, Evans HL: Cystosarcoma phyllodes: a clinicopathologic study of 26 cases. Cancer. 1986, 58: 2282-89. 10.1002/1097-0142(19861115)58:10<2282::AID-CNCR2820581021>3.0.CO;2-2.CrossRefPubMed

30.

Hines JR, Murad TM, Beal JM: Prognostic indicators in cystosarcoma phylloides. Am J Surg. 1987, 153: 276-80. 10.1016/0002-9610(87)90601-5.CrossRefPubMed

31.

Khanna S, Gupta S, Khanna NN: Sarcomas of the breast: homogenous or heterogenous?. J Surg Oncol. 1981, 18: 119-28. 10.1002/jso.2930180203.CrossRefPubMed

32.

Moore MP, Kinne DW: Breast sarcoma. Surg Clin North Am. 1996, 76: 383-92. 10.1016/S0039-6109(05)70445-X.CrossRefPubMed

33.

Baker RR: Unusual lesions and their management. Surg Clin North Am. 1990, 70: 963-75.PubMed

34.

Rosenfeld JC, DeLaurentis DA, Lerner H: Cytosarcoma phyllodes. Diagnosis and management. Cancer Clin Trials. 1981, 4: 187-93.PubMed

35.

Singh G, Sharma RK: Immediate breast reconstruction for phyllodes tumors. The Breast. 2008, 17: 296-231. 10.1016/j.breast.2007.11.005.CrossRefPubMed

36.

Jonsson K, Libshitz HI: Arteriographic pattern in cystosarcoma phylloides. Br J Radiol. 1977, 50: 751-53.CrossRefPubMed

37.

Mendel MA, DePalma RG, Vogt C, Reagan JW: Cystosarcoma phyllodes: treatment by subcutaneous mastectomy with immediate prosthetic implantation. Am J Surg. 1972, 23: 718-21. 10.1016/0002-9610(72)90362-5.CrossRef

38.

Orenstein A, Tsur H: Cystosarcoma phylloides treated by excision and immediate reconstruction with silicon implant. Ann Plast Surg. 1987, 18: 520-23. 10.1097/00000637-198706000-00010.CrossRefPubMed

Title: Giant breast tumors: Surgical management of phyllodes tumors, potential for reconstructive surgery and a review of literature
Authors: Margaret I Liang
Bhuvaneswari Ramaswamy
Cynthia C Patterson
Michael T McKelvey
Gayle Gordillo
Gerard J Nuovo
William E Carson III
Publication date: 01-12-2008
Publisher: BioMed Central
Published in: World Journal of Surgical Oncology / Issue 1/2008
Electronic ISSN: 1477-7819
DOI: https://doi.org/10.1186/1477-7819-6-117

At a glance: The STEP trials

Springer Medicine

Giant breast tumors: Surgical management of phyllodes tumors, potential for reconstructive surgery and a review of literature

Abstract

Background

Case presentation

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Case presentation

Conclusion

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