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December 13, 2013, 1:17 am Cystosarcoma Phyllodes Cystosarcoma Phyllodes Composed of stromal and epithelial components like fibroadenomas. Graded as: Benign, Malignant, or Borderline Synonyms: Phyllodes Tumors Can undergo metastastic spread to lungs (most common), skeleton, heart, and liver. Phyllodes tumors account for less than 1 percent of all breast tumors. A racial predilection does not appear to exist for phyllodes tumors. Phyllodes tumors occur almost exclusively in females. Rare case reports have been described in males. Age Phyllodes tumors can occur in people of any age; however, the median age is the fifth decade of life. Some juvenile fibroadenomas in teenagers can look histologically like phyllodes tumors; however, they behave in a benign fashion similar to that of other fibroadenomas. Gross Morphology: A firm, mobile, well-circumscribed, nontender breast mass is appreciated. The tumor size ranges from 3-4 cm x 1-12 cm. The smaller tumors appear fibrous, gray-white in color and are well circumscribed. Larger tumor are often cystic and have polypoid masses dipping into serosanguinous filled cystic lesions. The larger tumors commonly have areas of degenerative change and necrosis and are hemorrhagic. Overlying skin may display a shiny appearance and be translucent enough to reveal underlying breast veins. Physical findings (ie, the occurrence of mobile masses with distinct borders) are similar to those of fibroadenoma. Phyllodes tumors generally manifest as larger masses and display rapid growth. Recurrent malignant tumors seem to be more aggressive than the original tumor. Histology: Phyllodes tumors, like fibroadenomas, are composed of a benign epithelial component and a cellular spindle cell stroma. The tumor is characterized by the formation of leaf-like processes protruding into cystic spaces. The stroma mainly may be composed of spindle-shaped fibroblastic and myofibroblastic, but may composed of osseous and chondroid components as well. The stroma is hypercellular, which distinguishes it from fibroadenoma. Atypical cells, increased mitotic activity, and stromal hypertrophy typify malignant forms of phyllodes tumors.

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Gross Appearance: Cystosarcoma phyllodes tumors are highly variable in the gross appearance, but the majority are fleshy, solid masses with cystic spaces and pockets of necrosis. Consistency can range from fleshy to mucoid. Radiology: Ultrasound and Mammography Mammographic findings (ie, the appearance of round densities with smooth borders) are also similar to those of fibroadenoma. Findings are ineffective at differentiating between benign tumors from malignant tumors or fibroadenomas. Prognosis and Treatment: Surgical excision is the usual treatment for phyllodes tumors. Complete mastectomies are indicated for recurrent tumor growth or evidence of malignancy. Chemotherapy and radiotherapy have not been proven to be effective. The prognosis for benign phyllodes tumors is good following surgical removal, although there is a 2035 percent chance of recurrence, particularly in patients over the age of 45. Recurrence is usually treated with further surgery, either another local excision or a complete mastectomy. The prognosis for patients diagnosed with borderline or malignant phyllodes tumors is more guarded. About 4 percent of borderline tumors will eventually metastasize. A Mayo Clinic study of 50 patients with malignant tumors found that 32 percent had a recurrence within two years after surgery; 26 percent developed metastases, and 32 percent of the group died from their malignancy. The most common sites for metastases from malignant phyllodes tumors are the lungs, bones, liver, and chest wall, although metastases to the lymph nodes have also been reported. Most patients with metastases from a malignant phyllodes tumor die within three years of their first treatment.

Tavassoli FA. Pathology of the Breast, Second Ed. 1999. McGraw-Hill Professional, NY. pg. 584-602. Cole-Beuglet C, Soriano R, Kurtz AB. Ultrasound, x-ray mammography, and histopathology of cystosarcoma phylloides. Radiology. Feb 1983;146(2):481-6. Papantoniou V, Koutsikos J, Sotiropoulou M, et al. Scintimammographic findings of Phyllodes tumor of the breast in a double-phase study with Tc-99m (V) DMSA and Tc-99m MIBI: a case report. Japanese Journal of Clinical Oncology 2004 34(7):429-431. Beers MH, Berkow R, ed. Cystosarcoma phyllodes. The Merck Manual of Diagnosis and Therapy. 2004. Section 18, Ch 242. Whitehouse Station, NJ; Merck Research Laboratories. Noguchi S, Aihara T, Motomura K, Inaji H, Imaoka S, et al. Phyllodes tumor of the breast: pathology, histogenesis, diagnosis, and treatment. Breast Cancer 3: 79-92, 1996.

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Contributor Peer Reviewer Record Number Created Modified Category: Location: Sublocation:

Lisa A Yamamoto (Unlisted Institution) Daniel Hawley (Naval Medical Center San Diego)

: 9181 2009-04-21 23:58:29-04 2009-06-06 23:01:17.509516-04 Neoplasm, malignant (NOS) Breast and Mammography None Selected

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