Phyllodes tumor: Clinicopathologic review of 60 patients and flow cytometric analysis in 30 patients

doi:10.1016/0046-8177(92)90268-8

Human Pathology

Volume 23, Issue 9, September 1992, Pages 1048-1054

https://doi.org/10.1016/0046-8177(92)90268-8 Get rights and content

Abstract

We reviewed 66 phyllodes tumors of the breast from 60 patients. Our patients included 59 women and one man ranging in age from 16 to 72 years. Fifty patients presented for primary treatment of newly diagnosed breast masses, nine presented with recurrent tumors, and one presented with soft tissue metastases 9 years after bilateral subcutaneous mastectomies and multiple chest wall recurrences of phyllodes tumor. After 0.3 to 53.2 years (mean, 15.5 years) of follow-up, 26 (43.3%) patients are free of disease without recurrence, 26 (43.3%) patients are dead of other (17 patients) or unknown (nine patients) causes, four (6.7%) patients had locally recurrent tumor 0.7 to 2.9 years after lumpectomy and are free of disease 3 months to 12 years after re-excision or simple mastectomy, two (3.3%) patients are lost to follow-up, and two (3.3%) patients died with metastatic disease 1.8 and 7 years after diagnosis. Histologic features and flow cytometric analysis showed no correlation with outcome. Fifty-six breast tumors were biphasic and nine were purely stromal tumors. Twenty-six (47%) biphasic tumors showed stromal overgrowth. Tumor margins were pushing in 20 (39%) and infiltrative in 29 (61%) of 49 evaluable cases. Twenty-one tumors were highly cellular and 17 showed cytologic atypia. Necrosis was identified in 16 tumors. Mitotic rates ranged from $010$ high-power fields to $4810$ high-power fields. Twenty-four diploid, six aneuploid, three tetraploid, and one polyploid tumor were identified by flow cytometry. S-phase fractions tended to be higher in nondiploid tumors. Neither DNA content nor S-phase fraction correlated with outcome. Our results indicate that most mammary phyllodes tumors, including purely stromal tumors, behave as low-grade, nonmetastasizing neoplasms. Neither histologic evaluation nor DNA content provides reliable clues concerning the natural history of an individual tumor.

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Phyllodes tumors are more common and may present at earlier age in Asian and Latina women.1,72 Rare reports in men are often associated with gynecomastia, suggesting a role for hormonal imbalance.73–75 Genetic risk factors are largely unknown, but phyllodes tumors have been described in Li-Fraumeni syndrome patients and in a mother and daughter pair.76–78
Fibroepithelial lesions of the breast comprise a morphologically and biologically heterogeneous group of biphasic tumors with epithelial and stromal components that demonstrate widely variable clinical behavior. Fibroadenomas are common benign tumors with a number of histologic variants, most of which pose no diagnostic challenge. Cellular and juvenile fibroadenomas can have overlapping features with phyllodes tumors and should be recognized. Phyllodes tumors constitute a spectrum of lesions with varying clinical behavior and are graded as benign, borderline or malignant based on a set of histologic features according to recommendations by the World Health Organization (WHO). Recent developments have significantly expanded our understanding of the pathogenesis of fibroepithelial lesions, highlighting fibroadenomas as true neoplasms and underscoring a commonality with phyllodes tumors in the form of recurrent MED12 exon 2 mutations. In addition, sequencing studies have elucidated pathways associated with phyllodes tumor progression. Accurate diagnosis and grading of phyllodes tumors are important for patient management and prognosis, as grade broadly correlates with increasing local recurrence risk, and essentially only malignant tumors metastasize. However, classification of fibroepithelial lesions in many cases remains challenging on both core biopsy and excision specimens. A commonly encountered problem at the benign end of the spectrum is the distinction of benign phyllodes tumor from cellular fibroadenoma, which is largely due to the subjective nature of histologic features used in diagnosis and histologic overlap between lesions. Grading is further complicated by the requirement to integrate multiple subjective and ill-defined parameters. On the opposite end of the histologic spectrum, malignant phyllodes tumors must be distinguished from more common metaplastic carcinomas and from primary or metastatic sarcomas, which can be especially difficult in core biopsies. Immunohistochemistry can be useful in the differential diagnosis but should be interpreted with attention to caveats. This review provides an overview and update on the spectrum of fibroepithelial lesions, with special emphasis on common problems and practical issues in diagnosis.
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Complete surgical resection is the standard treatment for localized breast phyllodes tumors. Post-surgical treatments are still a matter of debate. We carried out an overview of the literature to investigate the clinical outcome of patients with phyllodes tumor. A retrospective analysis of mono-institutional series has been included as well.
We reviewed all the retrospective series reported from 1951 until April 2012. We analyzed cases treated at our institution from 1999 to 2010.
Eighty-three articles (5530 patients; 1956 malignant tumors) were reviewed. Local recurrences were independent of histology. Distant recurrences were more frequent in the malignant tumors (22%). A total of 172 phyllodes tumors were included in the retrospective analysis.
Prognosis of phyllodes tumors is excellent. There are no convincing data to recommend any adjuvant treatment after surgery. Molecular characterization may well provide new clues to permit identification of active treatments for the rare poor prognosis cases.
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This is consistent with an occurrence rate of 0.3% to 1.0% of all breast neoplasms.152 In a review by Chaney and colleagues, of 101 patients diagnosed with a phylloides tumor, the age ranged from 10 to 86 years old with a median age of 45.153,154 Population-based studies have shown significantly higher incidence in younger Asian and Hispanic than non-Hispanic whites.
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It is important that these entities not be confused with phyllodes tumor, diagnostically and in communication with clinical colleagues. It is important to note that phyllodes tumors are uncommon lesions, accounting for approximately 0.3% to 1% of breast tumors in several series from tertiary referral centers (where the demographics are inherently skewed).8–13 The true incidence in community practice is difficult to accurately gauge but is almost certainly far lower.
Phyllodes tumors of the breast: Analysis of 53 patients
2009, Cancer/Radiotherapie
Les tumeurs phyllodes du sein sont des tumeurs fibroépithéliales similaires aux adénofibromes, mais avec une composante prédominante de tissu conjonctif. Ce sont des tumeurs rares qui représentent 0,3 à 0,9 % des tumeurs du sein chez la femme. L’objectif de ce travail était de revoir les stratégies diagnostiques et thérapeutiques actuelles des tumeurs phyllodes tout en présentant notre expérience à l’Institut national d’oncologie de 1998 à 2006.
Il s’agit d’une étude rétrospective des cas de tumeurs phyllodes colligés à l’Institut national d’oncologie de 1998 à 2006.
Cinquante-trois patientes ont été incluses dans notre étude, l’âge moyen au moment du diagnostic était de 37,2 ans (15–67), le délai moyen entre le premier signe et le diagnostic de 35 mois, la taille tumorale moyenne de 10,25 cm (1–30). Le diagnostic histologique était fondé dans la majorité des cas (78 %) sur une biopsie préopératoire et dans 22 % des cas sur l’examen extemporané peropératoire. Deux tumeurs étaient d’emblée métastatiques. Le traitement a consisté en une chirurgie suivie ou non d’une radiothérapie en fonction du grade des tumeurs. Dix tumeurs ont récidivé localement. Cinq patientes sont décédées.
Les tumeurs phyllodes sont de diagnostic essentiellement histologique, leur traitement est surtout chirurgical, 13,6 à 20 % récidivent localement, la radiothérapie occupe une place primordiale comme traitement adjuvant, elle permet de diminuer le taux de récidive locale, mais non celui de survie. La chimiothérapie semble avoir une place mal définie. Le pronostic est basé sur les caractères histologiques de la composante conjonctive tissulaire de ces tumeurs.
Phyllode tumors of the breast are fibroepithelial tumors similar to fibroadenomas but with a predominant conjunctive tissue component. These are composed of a connective tissue stroma and epithelial elements. They are rare with an incidence of 0.3–0.9% of all breast neoplasms. The present study demonstrates the recent experiences in diagnosis, therapeutical management and clinical follow-up of this disease.
This is a retrospective study of the experience of the Institut National d’Oncologie (INO, Rabat) from 1998 to 2006.
We included 53 patients. Median age was 37.2 years (15–67), tumor size was 1–30 cm (median 10.25 cm). The histological diagnosis was based on the biopsy in (7.8%) cases and extemporany in 22% cases, distant metastasis occurred in two patients; the treatment consisted of a surgery. The median follow-up was three years. Local recurrence occurred in ten patients. Distant metastasis occurred in two patients and five patients have died.
The confrontation of our results to the data of the international literature shows that the diagnosis of the phyllodes tumours is histological. The basis of the treatment is surgery. The adjuvant radiotherapy is very important in patients at high risk for local recurrence; chemotherapy has a badly defined place. The prognostic is based on the histological characters of the tissue conjunctive component of these tumours.
Fibroadenoma and related tumours
2009, Hughes, Mansel & Webster's Benign Disorders and Diseases of the Breast: Third Edition

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Original contributionPhyllodes tumor: Clinicopathologic review of 60 patients and flow cytometric analysis in 30 patients

Abstract

Am J Surg

Am J Surg

Clinical course of cystosarcoma phyllodes related to histological appearance

Surg Gynecol Obstet

Cystosarcoma phyllodes of the breast: A new therapeutic proposal

Am Surg

Metastatic cystosarcoma phyllodes: A case report and a review of the literature

J Surg Oncol

Relationship of histologic features to behavior of cystosarcoma phyllodes: Analysis of ninety-four cases

Cancer

Sarcoma of the breast. A study of 32 patients with reappraisal of classification and therapy

Ann Surg

Cystosarcoma phyllodes

Cancer

Practical aspects in the diagnosis and management of cystosarcoma phyllodes

Arch Surg

Cystosarcoma phyllodes

Johns Hopkins Med J

Cystosarcoma phyllodes of the breast: A malignant and a benign tumor. A clinicopathological study of seventy-seven cases

Cancer

Breast sarcoma—A retrospective study of twenty-five cases

Bull Cancer (Paris)

Original contribution
Phyllodes tumor: Clinicopathologic review of 60 patients and flow cytometric analysis in 30 patients