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.
Similar content being viewed by others
References
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
Muller J. Uber den feineran Bau und die Forman der krankhaften Geschwilste. G Reimer 1838
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;392:1–6
Treves N, Sunderland DA. Cystosarcoma phyllodes of the breast: a malignant and a benign tumor; a clinicopathological study of seventy-seven cases. Cancer 1951;4:1286–332
Lee B PG. Giant intracanalicular fibroadenomyxoma of the breast. Am J Cancer 1931;15
Rosen PP. Rosen’s Breast Pathology. Philadelphia: Lippincott Williams & Wilkins, 2001
Ward RM, Evans HL. Cystosarcoma phyllodes. A clinicopathologic study of 26 cases. Cancer 1986;58:2282–9
Rosen PP, Oberman HA. Tumors of the mammary gland. In: Atlas of Tumor Pathology. Washington DC: Armed Forces Institute of Pathology, 1992; 107–113
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
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;156:774–82
IVEW are (Imputation and Variance Estimation Software), University of Michigan, Ann Arbor, Michigan. 1998
Pietruszka M, Barnes L. Cystosarcoma phyllodes: a clinicopathologic analysis of 42 cases. Cancer 1978;41:1974–83
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
Zurrida S, Bartoli C, Galimberti V, et al. Which therapy for unexpected phyllode tumour of the breast? Eur J Cancer 1992;28:654–7
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;86:396–9
Barth RJ Jr. Histologic features predict local recurrence after breast conserving therapy of phyllodes tumors. Breast Cancer Res Treat 1999;57:291–5
Cheng SP, Chang YC, Liu TP, et al. Phyllodes tumor of the breast: the challenge persists. World J Surg 2006;30:1414–21
Tan PH, Jayabaskar T, Chuah KL, et al. Phyllodes tumors of the breast: the role of pathologic parameters. Am J Clin Pathol 2005;123:529–40
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
Rowell MD, Perry RR, Hsiu JG, Barranco SC. Phyllodes tumors. Am J Surg 1993;165:376–9
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;4:762–83
Ben Hassouna J, Damak T, Gamoudi A, et al. Phyllodes tumors of the breast: a case series of 106 patients. Am J Surg 2006;192:141–7
Blichert-Toft M, Hansen JP, Hansen OH, Schiodt T. Clinical course of cystosarcoma phyllodes related to histologic appearance. Surg Gynecol Obstet 1975;140:929–32
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;77:910–6
Chaney AW, Pollack A, McNeese MD, et al. Primary treatment of cystosarcoma phyllodes of the breast. Cancer 2000;89:1502–11
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;70:211–6
Inoshita S. Phyllodes tumor (cystosarcoma phyllodes) of the breast. A clinicopathologic study of 45 cases. Acta Pathol Jpn 1988;38:21–33
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Barrio, A.V., Clark, B.D., Goldberg, J.I. et al. Clinicopathologic Features and Long-Term Outcomes of 293 Phyllodes Tumors of the Breast. Ann Surg Oncol 14, 2961–2970 (2007). https://doi.org/10.1245/s10434-007-9439-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-007-9439-z