PHYLLODES TUMOR OF THE BREAST: CLINICAL PRESENTATION, MANAGEMENT AND FOLLOW-UP

MEHMET YILDIRIM¹, ERDEM BARIŞ CARTI¹, AHMET DENIZ UÇAR¹, NAZIF ERKAN¹, ENVER VARDAR², SAVAŞ YAKAN¹, ÖZGÜR ESEN SIPAHI3¹, ZEHRA ADIBELLI³

¹İzmir Bozyaka Education and Research Hospital, General Surgery Department Izmir - ²İzmir Bozyaka Education and Research Hospital Pathology Department, ³İzmir Bozyaka Education and Research Hospital Radiology Department Izmir, Turkey

Introduction: Phyllodes tumor of the breast is a rare fibroepithelial breast tumor that usually ocur in adult females. They are composed of a benign epithelial component and a cellular, spindle cell stroma forming a leaf-like structure. No one morphologic finding is reliable in predicting the clinical behavior of the tumor. The rarity of phyllodes tumor and similarity to fibroadenoma necessitate studies and case series presentations delineating differential characteristics. We aimed to present our phylloides tumor experience to make contribution to the knowledge in the literature.

Materials and method: This retrospective study includes 414 patients (62 Phyllodes tumor and 352 fibroadenoma)that were diagnosed and treated at Izmir Bozyaka Education and Research Hospital between January 2005 and January 2013. Patients demographic findings, tumor characteristics, diagnostic and treatment modalities and also their follow-up results were examined. Multivariate regression analysis and ROC curve were structured in order to see the significance.

Results: The mean age was 42.5 (22-62) and mean tumor diameter was 4.4 (1,2-15) cm in phylloides tumor group. Breast preserving surgery was the preferred treatment of 52 and total mastectomy in 10 patients out of 62 phylloides tumor. The mean follow up time interval was 51 and 66 months for breast preserving and mastectomy patients respectively in phylloides tumor group. Recurrent cases in phylloides tumor group were respectively (12.5%) and 5 (12.5%) in breast preserving and mastectomy patients. Tumor size and patients age were found to be concordant with the type of histopathology (benign, borderline and malignant) of the phylloides tumor. Tumor size was found to be correlated with phylloides tumor diagnosis rather than fibroadenoma.

Conclusion: Histopathologically more aggressive phylloides tumor is more likely in bigger tumor size and older age. This is also true in differential diagnosis of fibroadenoma in suspicion of phylloides tumor.The lesions greater than 3 cm should always be surgically excised with clear surgical margins.