[Sarcoma of the breast]

Reports of 4 personal cases of breast sarcomas (3 cases of cystosarcoma phyllodes and 1 angiosarcoma), the authors review the literature concerning these rare tumors which account for less than 1% of malignant tumors of the breast. Whilst the usual clinical picture is that of a large tumor deforming the breast with pseudo-inflammatory signs, sarcomas 1 to 3 cm in diameter were discovered and treated with good chances of recovery. The natural history of breast sarcomas is marked above all by the risk of hematogenic metastatic spread (30% of cases) whilst very few (5%) local recurrences are seen following surgical treatment by mastectomy. Emphasis is placed upon problems of histological diagnosis of the variety of sarcoma and the demonstration of histoprognostic factors which can be used to predict the outcome (mitotic activity, grading) showing evidence of good correlation in the series analyzed. The various characteristics of cystosarcoma phyllodes are described emphasizing the conditions surrounding its development, relations with benign phyllodes tumors. The particular severity of this sarcomatous form in the very young woman is mentioned. Prevention lies in the sufficiently extensive excision of the phyllodes tumor. Mesenchymatous sarcomas of the breast are also accompanied by a fairly favorable prognosis (5 year actuarial survival of 50 to 80% according to series). By contrast, two special and rare histological varieties, angiosarcoma and lymphosarcoma, are characterized by a much more gloomy prognosis and require different treatment including radiotherapy and chemotherapy.