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Prognostic indicators in cystosarcoma phylloides.

J R Hines, T M Murad, J M Beal

    American Journal of Surgery
    |March 1, 1987
    PubMed
    Summary
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    Cystosarcoma phylloides is a rare breast tumor with unpredictable behavior. Aggressive features like skin ulceration and high-grade histology indicate malignancy, necessitating mastectomy for malignant or large benign lesions.

    Area of Science:

    • Oncology
    • Pathology
    • Surgical Oncology

    Background:

    • Cystosarcoma phylloides (now often referred to as phyllodes tumor) is a rare breast neoplasm.
    • Its clinical course is frequently unpredictable, making diagnosis and treatment challenging.

    Purpose of the Study:

    • To retrospectively evaluate indicators of aggressive behavior in cystosarcoma phylloides.
    • To assess the incidence of associated breast cancer and patient outcomes.

    Main Methods:

    • Retrospective review of 25 patients diagnosed with cystosarcoma phylloides.
    • Analysis of clinical, pathological, and treatment data to identify prognostic factors.

    Main Results:

    • Older age, nulliparity, rapid growth, pain, and large tumor size were suggestive but not definitive indicators of malignancy.

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  • Ominous characteristics included skin ulceration, tumor necrosis, and infiltrating margins.
  • High-grade tumors and mixed mesenchymal components were associated with aggressive behavior.
  • A 24% incidence of associated breast cancer was observed.
  • 40% of lesions were malignant, 40% recurred, and 16% died from the disease.
  • Local excision was inadequate, while quadrantectomy was effective for benign peripheral lesions with clear margins.

    • Conclusions:

    • Mastectomy is indicated for malignant cystosarcoma phylloides and large benign lesions.
    • Close patient follow-up is crucial due to unpredictable recurrence and metastasis potential.
    • Early identification of aggressive features is vital for appropriate management.