Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2007

01-10-2007 | Breast Oncology

Clinicopathologic Features and Long-Term Outcomes of 293 Phyllodes Tumors of the Breast

Authors: Andrea V. Barrio, MD, Bradly D. Clark, MD, Jessica I. Goldberg, Laura W. Hoque, MD, Stephanie F. Bernik, MD, FACS, Laurie W. Flynn, MD, Barbara Susnik, MD, Dilip Giri, MD, Kristen Polo, Sujata Patil, MPH, PhD, Kimberly J. Van Zee, MS, MD, FACS

Published in: Annals of Surgical Oncology | Issue 10/2007

Login to get access

Abstract

Background

Phyllodes tumors (PT) are rare fibroepithelial neoplasms of the breast with unpredictable behavior. We reviewed our single institution experience with PT over 51 years to identify factors predictive of local recurrence (LR) and metastasis.

Methods

From 1954 to 2005, a total of 352 cases of PT were identified; 293 had follow-up. All available pathology slides (90%) were rereviewed for margins, borders, fibroproliferation in the surrounding breast tissue, stromal pattern, stromal cellularity, frequency of mitoses, and necrosis.

Results

All cases occurred in women, with a median age of 42, with 203 originally categorized as benign and 90 as malignant. Median follow-up was 7.9 years. A total of 35 patients developed LR at a median of 2 years. In univariate analyses, a higher actuarial LR rate was associated with positive margins (P = .04), fibroproliferation (P = .001), and necrosis (P = .006). PT classified as malignant did not have a higher risk of LR (P = .79). Five patients developed distant disease at a median of 1.2 years. These patients constituted 71% of the seven patients who had uniformly aggressive pathologic features, including large tumor size (≥7.0 cm), infiltrative borders, marked stromal overgrowth, marked stromal cellularity, high mitotic count, and necrosis.

Conclusions

Positive margins, fibroproliferation in the surrounding breast tissue, and necrosis are associated with a marked increase in LR rates. Efforts should be made to achieve negative surgical margins to reduce risk of LR. Death from PT is rare (2%), and only PT that demonstrate uniformly aggressive pathologic features seem to be associated with mortality.
Literature
1.
Tavassoli FA DP. Pathology and genetics of tumours of the breast and female genital organs. In: World Health Organization Classification of Tumours. Lyon: IARC Press, 2003; 99–103
2.
Muller J. Uber den feineran Bau und die Forman der krankhaften Geschwilste. G Reimer 1838
3.
Fiks A. Cystosarcoma phyllodes of the mammary gland—Muller’s tumor. For the 180th birthday of Johannes Muller. Virchows Arch A Pathol Anat Histol 1981;392:1–6PubMedCrossRef
4.
Treves N, Sunderland DA. Cystosarcoma phyllodes of the breast: a malignant and a benign tumor; a clinicopathological study of seventy-seven cases. Cancer 1951;4:1286–332PubMedCrossRef
5.
Lee B PG. Giant intracanalicular fibroadenomyxoma of the breast. Am J Cancer 1931;15
6.
Rosen PP. Rosen’s Breast Pathology. Philadelphia: Lippincott Williams & Wilkins, 2001
7.
Ward RM, Evans HL. Cystosarcoma phyllodes. A clinicopathologic study of 26 cases. Cancer 1986;58:2282–9PubMedCrossRef
8.
Rosen PP, Oberman HA. Tumors of the mammary gland. In: Atlas of Tumor Pathology. Washington DC: Armed Forces Institute of Pathology, 1992; 107–113
9.
Raghunathan TE, Lepkowski JM, Van Hoewyk J. A multivariate technique for multiply imputing missing values using a sequence of regression models. Survey Method 2001;27:85–95
10.
Taylor JM, Cooper KL, Wei JT, et al. Use of multiple imputation to correct for nonresponse bias in a survey of urologic symptoms among African-American men. Am J Epidemiol 2002;156:774–82PubMedCrossRef
11.
IVEW are (Imputation and Variance Estimation Software), University of Michigan, Ann Arbor, Michigan. 1998
12.
Pietruszka M, Barnes L. Cystosarcoma phyllodes: a clinicopathologic analysis of 42 cases. Cancer 1978;41:1974–83PubMedCrossRef
13.
Kario K, Maeda S, Mizuno Y, et al. Phyllodes tumor of the breast: a clinicopathologic study of 34 cases. J Surg Oncol 1990;45:46–51PubMedCrossRef
14.
Zurrida S, Bartoli C, Galimberti V, et al. Which therapy for unexpected phyllode tumour of the breast? Eur J Cancer 1992;28:654–7PubMedCrossRef
15.
de Roos WK, Kaye P, Dent DM. Factors leading to local recurrence or death after surgical resection of phyllodes tumours of the breast. Br J Surg 1999;86:396–9PubMedCrossRef
16.
Barth RJ Jr. Histologic features predict local recurrence after breast conserving therapy of phyllodes tumors. Breast Cancer Res Treat 1999;57:291–5PubMedCrossRef
17.
Cheng SP, Chang YC, Liu TP, et al. Phyllodes tumor of the breast: the challenge persists. World J Surg 2006;30:1414–21PubMedCrossRef
18.
Tan PH, Jayabaskar T, Chuah KL, et al. Phyllodes tumors of the breast: the role of pathologic parameters. Am J Clin Pathol 2005;123:529–40PubMedCrossRef
19.
Cohn-Cedermark G, Rutqvist LE, Rosendahl I, Silfversward C. Prognostic factors in cystosarcoma phyllodes. A clinicopathologic study of 77 patients. Cancer 1991;68:2017–22PubMedCrossRef
20.
21.
Frantz VK, Pickren JW, Melcher GW, Auchincloss H Jr. Indicence of chronic cystic disease in so-called “normal breasts”: a study based on 225 postmortem examinations. Cancer 1951;4:762–83PubMedCrossRef
22.
Ben Hassouna J, Damak T, Gamoudi A, et al. Phyllodes tumors of the breast: a case series of 106 patients. Am J Surg 2006;192:141–7PubMedCrossRef
23.
Blichert-Toft M, Hansen JP, Hansen OH, Schiodt T. Clinical course of cystosarcoma phyllodes related to histologic appearance. Surg Gynecol Obstet 1975;140:929–32PubMed
24.
Reinfuss M, Mitus J, Duda K, et al. The treatment and prognosis of patients with phyllodes tumor of the breast: an analysis of 170 cases. Cancer 1996;77:910–6PubMedCrossRef
25.
Chaney AW, Pollack A, McNeese MD, et al. Primary treatment of cystosarcoma phyllodes of the breast. Cancer 2000;89:1502–11PubMedCrossRef
26.
Hart WR, Bauer RC, Oberman HA. Cystosarcoma phyllodes. A clinicopathologic study of twenty-six hypercellular periductal stromal tumors of the breast. Am J Clin Pathol 1978;70:211–6PubMed
27.
Inoshita S. Phyllodes tumor (cystosarcoma phyllodes) of the breast. A clinicopathologic study of 45 cases. Acta Pathol Jpn 1988;38:21–33PubMed
Metadata
Title
Clinicopathologic Features and Long-Term Outcomes of 293 Phyllodes Tumors of the Breast
Authors
Andrea V. Barrio, MD
Bradly D. Clark, MD
Jessica I. Goldberg
Laura W. Hoque, MD
Stephanie F. Bernik, MD, FACS
Laurie W. Flynn, MD
Barbara Susnik, MD
Dilip Giri, MD
Kristen Polo
Sujata Patil, MPH, PhD
Kimberly J. Van Zee, MS, MD, FACS
Publication date
01-10-2007
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 10/2007
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-007-9439-z

Other articles of this Issue 10/2007

Annals of Surgical Oncology 10/2007 Go to the issue

Melanomas

Stage-IV Melanoma and Pulmonary Metastases: Factors Predictive of Survival

Gastrointestinal Oncology

Expression of Human Leukocyte Antigen G (HLA-G) Correlates with Poor Prognosis in Gastric Carcinoma

Controversies in Oncology

Talc Pleurodesis for Malignant Effusions Is Preferred Over the PleurX Catheter (Pro Position)

Gastrointestinal Oncology

Preoperative Chemoradiotherapy with Capecitabine and Oxaliplatin in Locally Advanced Rectal Cancer. A Phase I–II Multicenter Study of the Dutch Colorectal Cancer Group

Endocrine Tumors

Anaplastic Carcinoma of the Thyroid Arising More Often from Follicular Carcinoma than Papillary Carcinoma

Laboratory Research

Targeting of Insulin-like Growth Factor-I Receptor with a Monoclonal Antibody Inhibits Growth of Hepatic Metastases from Human Colon Carcinoma in Mice