Treatment and Evolution of Women with Phyllodes Tumor and Breast Sarcoma: Analysis of 75 Cases

Abstract

INTRODUCTION: Phyllodes tumor is a rare neoplasia which is predominantly benign and almost exclusive to mammary tissue. Breast sarcomas, on the other hand, a heterogeneous group of non-epithelial tumors, represent less than 1% of all mammary neoplasias, and include primarily malign diseases of stromal elements and sarcomas of mesenchymal origin. MATERIALS AND METHODS: The authors have carried out a descriptive and retrospective study with 75 women treated at CAISM/UNICAMP, from September 1993 to December 2002, and from July 2008 to February 2012. The aim was to describe epidemiological, clinical and histopathological aspects, correlating them to the evolution of the disease. RESULTS: The age of the women analyzed in our service varied from 11 to 89 years old (average 41 years old). 43 out of the 75 cases (57.3%) were histologically benign phyllodes tumors, 9 (12%) were borderline, 12 (16%) malignant, and 11 (14.6%) were pure sarcomas. As far as size was concerned, tumors that were larger than 5cm: 41.86% of the benign phyllodes; 77.7% of the borderline; 83% of the malignant and 81.8% of the sarcomas. For the benign phyllodes, after surgical treatment, 18% of the women showed loco-regional re-incidence, always with a more serious histological lesion than the previous one. No patient, however, developed the disease non-loco-regionally. For the borderline phyllodes, only one woman was treated with wide resection; 4 (44.4%) showed loco-regional re-incidence for the histologically malignant type/sarcoma, one of which resulted in death due to metastasis in the lungs. For the malignant tumors, of all the women submitted to total or radical mastectomy, 4 (33.3%) presented re-incidence of the disease (loco-regionally or distant) and 3 of these (75%) evolved to death. 10 out of the 11 cases of sarcoma were treated with total or radical mastectomy. One of the cases evolved with bone metastasis and another with loco-regional re-incidence. DISCUSSION: Both groups include fast-growing tumors that can reach large dimensions. The disease is present in any age group but it is more common after the 50’s and very rare before the early 20’s. They normally evolve to benign tumors – only 15 to 30% of the cases are malignant. The phyllodes tumors have a high risk of local re-incidence, which is directly proportional to the histological malignity degree. Each re-incidence tends to be more aggressive than the previous lesion. Surgery must be the most careful possible regarding safety margins. CONCLUSION: Through the analysis of our sample, we can suppose that the risk of malignity is related to the patient’s age (>40 years of age) and the size of the lesion (>10cm). The clinical evolution of histologically benign was better and, although our sample demonstrates an incidence that is higher than the one described regarding young patients, we can conclude that these patients rarely develop the malignant form. Regarding tumors initially diagnosed as borderline phyllodes, our experience suggests treating them as malignant variants. As far as malignant phyllodes tumors and pure sarcomas are concerned, they have presented similar evolution and mastectomy has been the choice of treatment.