interesting case of cystosarcoma phyllodes
DESCRIPTION
An interesting case of Cystosarcoma Phyllodes.TRANSCRIPT
Breast Cancer Awareness Month
Breast Seminar
Seyed Morteza Mahmoodi
History 37 year old multiparous c/o growing mass in right breast since last 1 year Recently ulcerated, painful, bleeding, Rapidly grew before 6 month Previous breast US done in a private hospital Not currently lactating No previous breast disorders Review of systems normal No PMH 2 C-sections and no other PSH No FH of malignancies No significant social history
Examination 30 X 20 cm OQ right breast Overlaying skin Shinny, dilated veins, stretched skin Shallow 5 X 4 cm ulcer upper outer
quadrant Redness, swollen, pus in the ulcer base No nipple discharges
Palpation Non-tender, firm, well demarcated, Irregular, lobulated borders, freely mobile,
smooth surface Area around the ulcer warm Not fluctuant, not compressible, Normal contralateral breast No LN were palpable
Differential Diagnosis
Giant fibroadenoma Phylloides tumor Carcinoma
Phyllodes
Most common nonepithelial neoplasm of the breast
1% of tumors in the breast 85-90% benign Cyst-sarcoma-
phyllodes Phyllodes tumor
Benign Vs. Malignant Benign Tendency to grow aggressively Recurs locally Malignant Recurrent malignant tumors seem to be more aggressive Metastasis to lungs, skeleton, heart, and liver hemtogenously Metastasis to axillary lymph nodes occurred in only 2% Symptoms from metastasis seen as early as a few months to
as late as 12 years after the initial therapy 30% of patients with malignant phyllodes tumors die from the
disease Mostly within 3 years of the initial treatment
No cures for systemic metastases exist
Workup Imaging Studies Procedures Histologic Findings
Fibroadenoam Phyllodes
FibroadenomaPhyllodes tumour
Phylodes Vs. Fibroadenoma(Fibroepithelial Tumors) History Physical Examination Mammography US FNAC Core needle biopsy Histopathology Management
Surgical Treatment Wide local excision with adequate margin
of normal breast tissues regardless of histological type
Margins 2cm, 5cm Mass should not be ‘shelled out’ Quadranectomy Mastectomy LN involvement
Radiotherapy & Chemotherapy Role of radiotherapy remains unclear May be considered for high-risk phyllodes
tumors, including those >5cm, with stromal overgrowth, with >10 mitoses/high-power field, or with infiltrating margins
Doxorubicin and ifosfamide-based chemotherapies
Outcomes Locar recurrences of approximately 26% Stromal overgrowth, larger tumor size, and
involved margin were all significantly correlated with LR.
5-year survival rate malignant phyllodes tumour ranges from 54% to 82%
10-year ranges from 23% to 42%
Thank U