phyllodes tumors of the breast final

7/28/2019 Phyllodes Tumors of the Breast FINAL

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BACK GROUND Cystosarcoma phyllodes (CP) is an extremely rare form of

breast lesion with an unpredictable clinical course.

This accounts for 0.30.9% of all breast neoplasms and

approximately 2%-3% of all fibro-epithelial lesions of the

breast.

Given their rarity, epidemiologic data are scant.

Study-Los Angeles county -17 yr period

Average annual incidence rate was 2.1 per million women,

Higher incidence in Latina whites, as compared to non-Latina whites, Asians,

and African American women


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BACK GROUND This neoplasm is manifested in women of all ages, including

adolescent and elderly.

Median age at presentation is 42 to 45 (10 to 82 yrs)

Data - Tumor grade increases with mean age at diagnosis

Some case reports describe these tumors in men, usually in

association with gynecomastia


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BACK GROUND No etiologic or predisposing factors - exception of Li-Fraumeni

syndrome,

Rare autosomal dominant condition - development of multipletumors

They tend to be large, very fast-growing breast tumors that

evolve in a 'leaf-shaped' growth pattern.

Hence the diagnosis should be considered in all rapidly

growing breast nodules.


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BACKGROUND- GROSS HISTOLOGY Round to oval multinodular masses with a grayish white

appearance that resemble the head of a cauliflower

May be indistinguishable from fibroadenomas.

Grow radially creating a pseudocapsule through which tongues

of stroma may protrude and grow into adjacent breast tissue

Necrosis and hemorrhage can occur in larger tumors.


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BACKGROUND- MICROSCOPIC

APPEARENCE Range of appearances covers the spectrum from resembling a

benign fibroadenoma to a high-grade sarcoma.

Characteristic leaf-like architecture consists of elongated cleft-

like spaces that contain papillary projections of epithelial-lined

stroma with varying degrees of hyperplasia and atypia.

The stromal elements are a key component in the

differentiation of phyllodes tumors from fibroadenomas and in

distinguishing a benign from a malignant phyllodes tumor


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BACK GROUND

Histologically, phyllodes tumors are classified as benign,

borderline or malignant.

The most commonly accepted criteria used for classification of

benign versus malignant tumors are as follows.

The degree of stromal cellular atypia

Mitotic activity

Infiltrative as compared to circumscribed tumor margins.

Presence or absence of stromal overgrowth (ie, presence of pure stroma

devoid of epithelium).


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BACK GROUND

Benign -increased stromal cellularity with mild to moderate cellular atypia,

circumscribed tumor margins and low mitotic rate (less than 4 mitoses per

10 high power fields) and lack of stromal overgrowth.

Borderline -greater degree of stromal cellularity and atypia, a mitotic rate

from 4 to 9 mitosis per 10 high power fields , microscopic infiltrative

borders and lack of stromal overgrowth.

Malignant - marked stromal cellularity and atypia, infiltrative margins, highmitotic rate (more than 10 mitosis per 10 high power fields examined), and

by the presence of stromal overgrowth.


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BACK GROUND In most large series, more than 50 percent - benign

Approximately 25 percent of phyllodes tumors are malignant,

The histological classification of these neoplasms into benign,

borderline and malignant has not proven to be successful,

because

Benign form of cystosarcoma phyllodes could manifest metastases.

Malignant variant of cystosarcoma resulted in an excellent prognosis.


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AIMS AND OBJECTIVES

This study aims to report the experience of the during

a 2-year period and also to review the spectrum ofhistopathological findings in our subset of population.


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MATERIALS AND METHODS

The data of Pathological specimens of patients with

primary breast neoplasms, who were evaluated and

treated in Osmania General Hospital from August

2009 to September 2011 were analyzed.


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RESULTS Total number of breast tumours evaluated over a period of

2 years126 cases

Total diagnosed as Phyllodes tumour- 11(8.7%)

All diagnosed were Females.

Mean age at presentation 47.18 (Range 30-74 Years)


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AGE DISTRIBUTION

AGE GROUP NUMBER (%)

30-49 YEARS 5 (45.45%)

50-70 YEARS 5 (45.45%)

>70 YEARS 1(9.1%)

TOTAL 11(100%)


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Malignant vs Benign

Phyllodes tumour Number (%)

Benign 6(54.5%)

Malignant 5(45.5%)

Total 11(100%)


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Malignant vs BenignNo. Of Cases Mean Age at

presentation

Range

Benign 6(54.5%) 44.67 14.16 Yrs 30-68 Yrs

Malignant 5(45.5%) 50.2 18.06 Yrs 30-74 Yrs

Total 11(100%) 47.18 15.46 Yrs 30-74 Yrs


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Patterns of MalignancyPatterns of Malignancy Number (%)

Necrosis and increased mitotic activity, 3 cases (60%)

Stromal pleomorphism with stromal

outgrowth

1 case (20%)

Infiltrating margin and necrosis. 1 case (20%)


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Circumscribed border of tumour


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Benign Phyllodes


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Spindle cells with plump nuclei (arrow). Mitosis (double arrows)


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Distribution of LesionsPresent Study S Abdelkrim etal 1

M. S. Lenhard

et al 2

Stamatkos et al

3

Benign 6 (54.5%) 13 (50%) 12 (40% 15 (68%)

Borderline 0 (0%) 7 (27%) 8 (27%) 2 (9%)

Malignant 5 (45.5%) 6 (23%) 10 (33%) 5 (23%)

Total 11 (100%) 26 (100%) 30 (100%) 22 (100%

1. Soumaya Ben Abdelkrim et al. World Journal of Oncology 2010,

2. M. S. Lenhard et al.Journal of Clinical Oncology, 2006 ASCO Annual Meeting Proceedings

Part I. Vol 24, No. 18S (June 20 Supplement), 2006.

3. Michael Stamatakos et al.International Seminars in Surgical Oncology 2009, 6:6


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Age at Presentation- Comparison

Present Study S Abdelkrim et al M. S. Lenhard et al

No. of Cases 11 26 30

Mean age at

Presentation

47.18 15.46 Yrs 40 Yrs 47 Years

Range 30-74 Yrs 19-66 Yrs -


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Population Characteristics By GradePresent Study

Mean Age (Range In Yrs)

S Abdelkrim et al

Mean Age (Range In Yrs)

Benign 44.67 (30 - 68) 35.8 (19 - 55)

Borderline - 44.7 (34 - 52)

Malignant 50.2 (30 - 74) 45.2 (29 - 66)

Total 47.18 (30 - 74) 40 (19 - 66)


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phyllodes tumors of the breast final

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