[Rare presentations of cytosarcoma Phylloides]

Three cases of cystosarcoma phylloides of the breast are presented. The different microscopic presentations are discussed. The therapeutic and prognostic importance of the histologic differences are discussed. Even after excision of the tumour in what appears to be benign types, recurrence must be expected. The recurrent tumour often shows a higher degree of atypia. The same conclusion is reached in other cases in the literature. An excision of the tumor can only be considered to be sufficient treatment if the microscopic findings show a benign well incapsulated tumour with few cells and the excision has been done well in healthy tissue. This should only take place in young women. Since cystosarcoma phylloides can usually not be differentiated clinically or mammographically from fibro-adenomas not even by cytology all fibroadenomas of the breast must be removed and subjected to microscopic evaluation. A mistake in the microscopic evaluation may arise if not several areas of the tumours are examined. The treatment of choice in cystosarcoma phylloides is removal of the breast especially if there is a marked epithelial component to the carcinosarcoma, axillary lymphadenectomy and possibly postoperative radiation may be necessary.