Local Excision Of Tumor Research Articles

222P - Does tumor grade really improve the prognostic ability of the staging system for men with penile cancer: A SEER database analysis

BackgroundPenile cancer is now a rare condition and the low incidence of disease makes valid estimation of its prognosis difficult. In this study, we made an attempt and propose a nomogram to develop a prognostic rule that could predict the CSM free rates in patients with primary penile squamous cell carcinoma of penis (PPSCC). MethodsThis study included 1304 patients diagnosed with PPSCC between the years 2004 & 2011 and treated with penile tumor excision. Subjects were staged as per Surveillance, Epidemiology & End Results stage (SEER), American Joint Committee on Cancer (AJCC), TNM classification and the tumor grade (TG). CSM free rates were determined. Univariate and multivariate Cox regression model was used to test prediction of the CSM free rate. p-value was adjusted as per Bonferroni corrections. The predictive rule accuracy was created using receiver operating characteristic curve. ResultsThe clinic-pathological profile depicts a mean age of 64.66±14.38 yrs. The most common primary site involved was glans penis (n = 483, 37%) and the disease was localized in most patients (n = 777, 59.6%). Majority (n = 719, 55.1%) underwent partial penectomy followed by local tumor excision (n = 372, 28.5%). Most common pathological T stage was T1 (56.7%, n = 740), N stage was N0 (n = 1055, 80.9%) & M stage was M0 (n = 1269, 97.3%). Most commonly diagnosed AJCC was stage I (n = 670, 51.4%). The cumulative 5-year CSM free rates according to Fine & Gray, & Kaplan-Meier methods were 81.8% and 79.8%, respectively. The predictive accuracy as per SEER stage, AJCC stage, TNM stage alone were 68.8%, 70.3%, 72.3%, respectively. When TG was combined, the predictive accuracy increased to 72.8%, 73.1%, and 75.0%, respectively. TNM stage with TG was most accurate in predicting CSM free rate compared to other models. ConclusionsThis study concludes that though TNM stage with TG, and AJCC stage with TG appear to have comparable accuracy to predict the CSM free rate in patients with PPSCC, TNM stage with TG is the most accurate (75%) method to predict the CSM free rates. Addition of TG variable definitely improved the accuracy of these prognostic models. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Local recurrence after surgery of locally advanced rectal cancer treated with or without preoperative chemoradiotherapy

Introduction: The ?gold standard? for patients with locally advanced rectal cancer is neoadjuvant chemoradiotherapy followed by surgery. Aim: Evaluation of local recurrence after surgery for locally advanced rectal cancer. Methods and patients: Retrospective study included 189 patients, who were operated at Oncology Institute of Vojvodina from January 1st 2012 until December 31st 2017. Patients were divided into two groups. In the first group 73 patients who received chemoradiotherapy were included, while 116 patients without neoadjuvant treatment were in the second group. All patients were diagnosed with locally advanced rectal cancer. The existence of operable metastases in the liver and/or lungs did not exclude patients from the study. Patients who had undergone resection of the rectum by Miles, Hartmann or local tumor excision were excluded from the study. Results: The median follow-up period was 48 months (range 13-84). In total, 23 (12.2%) patients developed local recurrence. In the chemoradiotherapy group, 15.1% (11 of 73 patients) had a local recurrence, as compared with 10.3% (12 of 116 patients) in the group without neoadjuvant treatment. In both groups, there were no correlation between rate of local recurrence with other clinical and pathological parameters such as gender, tumor location, T and N stage, histological differentiation, or lymphovascular and perineural invasion (p>0.05). We confirmed significant association between circumferential resection margin with local recurrence in patients who were treated by preoperative chemoradiation (p=0.014). Conclusion: This study has not shown reduced risk of local recurrence after neoadjuvant therapy most likely due to small number of patients. Despite our results, neoadjuvant treatment followed by surgery remains the best treatment protocol for patients with locally advanced rectal cancer.

Histologic Evaluation of Malignant Polyps and Low-Stage Colorectal Carcinoma.

With widespread screening for colorectal cancer, the number of early-stage colorectal cancers is increasing. Local excision of pT1 tumors is associated with considerably less morbidity and mortality, but this must be weighed against risk of lymph node metastases. To understand histologic prognostic factors associated with adverse outcome in malignant polyps. Pertinent literature regarding histologic features of prognostic significance in malignant polyps and low-stage colorectal carcinomas is summarized and our institute's cases are used to highlight these histologic features. Poor prognostic factors for malignant polyps include high tumor grade, presence of lymphovascular invasion, tumor less than 1 mm from resection margin, submucosal invasion deeper than 1 mm, and high tumor budding. These features should be assessed by the pathologist and communicated to the clinical team in order to allow proper management.

A case of metastatic carcinoid tumor of the pancreas resected by laparoscopic distal pancreatectomy.

Background: Surgery for metastatic tumor of the pancreas has increased. However, rectal carcinoid tumor is considered to be quite uncommon as primary tumor. We reported a case that metastatic pancreatic tumor of rectal carcinoid tumor was successfully resected by laparoscopic distal pancreatectomy. Methods: The patient was a 70-year-old woman who underwent local excision of rectal submucosal tumor, which was pathologically diagnosed as a so-called carcinoid tumor, at another hospital in 2003. In 2009 and 2012, she received two times of hepatectomies for liver metastases of rectal carcinoid tumor at our hospital. In 2013, abdominal computed tomography revealed a 1 cm hypovascular tumor in the pancreatic body. We suspected the metastatic pancreatic tumor of rectal carcinoid and performed laparoscopic spleen-preserving distal pancreatectomy subsequently. Pathological examination of the resected specimen demonstrated that the tumor was metastatic carcinoid tumors of the pancreas. Results: Three years and 6 months have passed since pancreatic resection was performed and the patient is now still alive. Unfortunately, liver and bone metastases present, however, her quality of life has been very good under administration of octreotide once a month in the outpatient. Conclusion: We reported a rare case of metastatic carcinoid tumor of the pancreas. Laparoscopic distal pancreatectomy for metastatic tumor of the pancreas is thought to be feasible and acceptable.

A Case of Jejunal Mucosal Patch Repair for Local Excision of a Duodenal Gastrointestinal Stromal Tumor Associated with Neurofibromatosis Type 1

A Case of Jejunal Mucosal Patch Repair for Local Excision of a Duodenal Gastrointestinal Stromal Tumor Associated with Neurofibromatosis Type 1

A case of metastatic carcinoid tumor of the pancreas resected by laparoscopic distal pancreatectomy

Background: Surgery for metastatic tumor of the pancreas has increased. However, rectal carcinoid tumor is considered to be quite uncommon as primary tumor. We reported a case that metastatic pancreatic tumor of rectal carcinoid tumor was successfully resected by laparoscopic distal pancreatectomy. Methods: The patient was a 70-year-old woman who underwent local excision of rectal submucosal tumor, which was pathologically diagnosed as a so-called carcinoid tumor, at another hospital in 2003. In 2009 and 2012, she received two times of hepatectomies for liver metastases of rectal carcinoid tumor at our hospital. In 2013, abdominal computed tomography revealed a 1 cm hypovascular tumor in the pancreatic body. We suspected the metastatic pancreatic tumor of rectal carcinoid and performed laparoscopic spleen-preserving distal pancreatectomy subsequently. Pathological examination of the resected specimen demonstrated that the tumor was metastatic carcinoid tumors of the pancreas. Results: Three years and 6 months have passed since pancreatic resection was performed and the patient is now still alive. Unfortunately, liver and bone metastases present, however, her quality of life has been very good under administration of octreotide once a month in the outpatient. Conclusion: We reported a rare case of metastatic carcinoid tumor of the pancreas. Laparoscopic distal pancreatectomy for metastatic tumor of the pancreas is thought to be feasible and acceptable.

Patient-and observer-reported long-term scar quality of wide local excision scars in melanoma patients

Wide local excision of the primary tumour is the mainstay of treatment for melanoma patients. The aims of this study were to assess the patient- and observer-reported long-term scar quality after surgery using the patient and observer scar assessment scale (POSAS) in melanoma patients, to assess the reliability and validity of POSAS, and to identify factors influencing the scar assessment. This cross-sectional clinical study included 320 melanoma patients with primary tumours on the trunk and limbs. Data regarding patients, treatment, scar characteristics and functional outcomes was analysed. Internal consistency, inter-rater reliability, and convergent validity were examined. Factors influencing the patient- and observer-reported scar quality were tested using regression analyses. Results of the POSAS showed an overall good scar quality. The internal consistency of POSAS was good, and the convergent validity was strong. The inter-rater reliability was only moderate. The patients were influenced by the POSAS sub-items: colour, irregularity, thickness and pain. The observer was influenced by the POSAS sub-items: vascularity, surface area, thickness, relief and pliability. Both patient- and observer-reported scar qualities were influenced by age, location, type of superficial suture, keloids and widened scars. Moreover, the patients were influenced by the scar tightness while the observer was influenced by postoperative complications, hypertrophic scars, suture marks and dog ears. In conclusion POSAS is a reliable and valid scar assessment tool. The factors influencing patient- and observer-reported scar quality differed, and better understanding of this may improve treatment and hence patient-reported scar quality.

Current state of transanal minimally invasive surgery in the management of rectal cancer

Rectal cancer surgery has undergone a rapid change over the last few decades. We have come a long way from abdominoperineal resection to minimally invasive sphincter preserving techniques. Colorectal cancer screening programs made it possible to diagnose patients at earlier stages and this has led to question the necessity of radical surgery and the possibility of organ preservation. The platform most recently added to the surgical armamentarium is transanal minimally invasive surgery (TAMIS). It utilizes conventional laparoscopic tools to perform endoluminal surgery in rectum. Along with the conceptual changes in rectal cancer management, TAMIS is more frequently used for local excision of malignant rectal tumors. This review highlights the recent advances and current state of the role of TAMIS in the management of rectal cancer at various stages.

Management of a case of high-risk gastrointestinal stromal tumor in rectum by transanal minimal invasive surgery

BackgroundRectal gastrointestinal stromal tumor (GIST) is a very rare tumor of gastrointestinal tract. Surgical management of rectal GIST requires special attention for preserving of anal and urinary functions. Transanal minimal invasive surgery (TAMIS) is a well-developed minimally invasive technique for local excision of benign and early malignant rectal tumors; however, the application of TAMIS for rectal GIST is rarely and inadequately reported. We report the novel application of TAMIS for rectal GIST with considerations for anal and urinary functions.Case presentationA 67 years old female, who presented with history of per rectal bleeding, was diagnosed with submucosal GIST of 4.5 cm in diameter at right posterior wall of 7 cm from anal verge. Histology of biopsy showed abundant spindle-shaped cells arranged in bundles that were positive for CD34 and negative for C-Kit, desmin, smooth muscle actin (SMA), and S-100. The tumor was excised by TAMIS successfully. Final histopathology showed pT2 tumor with C-Kit positive and mitosis count 10 per 50 HPF. Postoperative period was uneventful, and she was discharged on adjuvant imatinib mesylate for 3 years.ConclusionTAMIS can be used safely in the management of rectal GIST after appropriate evaluation of tumor size, extent, location, and experience of operating surgeon.

Risk factors for upper tract urothelial recurrence following local excision of bladder cancer.

The mechanism of upper tract recurrence after local excision of bladder cancer remains unknown. This study was designed to identify risk factors for upper tract urothelial recurrence following local tumor excision of bladder cancer. To identify 76 597 bladder cancer patients, comprising 76 537 nonrecurrence and 60 recurrence patients, the Surveillance, Epidemiology, and End Results database was used. Kaplan‐Meier analysis and univariate and multivariate Cox proportional hazards regression models were used to determine the risk factors. Compared with the nonrecurrence group, the recurrence group was associated with older age, higher grade, high T stage, and higher proportional squamous cell carcinomas. Univariate Cox proportional hazards regression model showed that age, grades III and IV, T stage, and pathology were significantly associated with worse upper tract urothelial recurrence (UTUR) survival. However, after adjusting for prognostic factors, grade was no longer an independent prognostic factor in multivariate analysis. This study demonstrates that clinical prognosis of UTUR after local bladder tumor excision has significant independent risk factors that include age ≥60 years, T1 and T2 stage, and squamous cell carcinoma, and will require more careful consideration during follow‐up.

Transanal minimally invasive surgery for local excision of early rectal tumor.

Local excision (LE) is used in early rectal cancer and other pathologies for diagnostic purposes and curative treatment, as well as for palliative surgery in patients who are medically unfit for radical resection. Recently, transanal minimally invasive surgery (TAMIS) has been increasingly accepted as a means for performing LE. Here, we present a TAMIS technique for LE to which endoscopic submucosal dissection was applied. We used conventional laparoscopic instruments, including a 10-mm 30° camera. A GelPOINT Path® was introduced into the anal canal to maintain stable pneumorectum and valve-free access. After injecting MucoUp® (SI-4404) into the submucosal layer at the edge of the tumor, we marked dots on the mucosa with cautery using the point of the monopolar diathermy L-hook; we then performed circumferential mucosal incision and submucosal dissection. The remaining defects do not always have to be sutured. TAMIS for LE was performed for seven patients with no postoperative complication and mortality. One lesion required full-thickness resection, one lesion required partial full-thickness resection, and five lesions were dissected completely beneath the submucosal layer. Based on the pathological results, three patients underwent conventional radical resections. One patient had local recurrence at the 8-month follow-up and underwent endoscopic mucosal resection. TAMIS may be a promising option for LE that provides acceptable oncological outcomes and benefits to quality of life.

Rare Gastric Submucosal Mass: Inflammatory Myoblastic Tumor

A 51-year-old man was admitted with a 1-month history of intermittent fever up to 37.8 °C. The fever was not alleviated by antibiotics or antivirus drug. He had no past history of serious illness, operation or hospitalization. Erythrocyte sedimentation rate and C-reactive protein were elevated at 120mm/hr and 106 mg/L, respectively. Other blood tests were within normal limits. Endoscopy revealed a protruding mass situated on the lesser curvature of distal gastric body, near the angular incisures. Endoscopic ultrasound showed an oval hypo echoic mass, 33mm×17mm in size, arising from the muscular is pretrial layer (Figure 1). Abdominal computed tomography scan demonstrated a strongly enhancing mass in the posterior wall of gastric body, approximately 3.4cm in the maximal diameter (Figure 2), which was associated with a sub mucosal lesion such as gastrointestinal stromal tumor, gastric glom us tumor and neuroendocrine tumor. The patient underwent local tumor excision. The cut surface of mass was grayish gelatinous texture (Figure 3). Microscopically, the tumor cells were characterized by proliferation of spindle-shaped atypical my fibroblastic cells and chronic inflammatory cells including plasma cells and lymphocytes (Supple-Figure). Inflammatory Myoblastic tumor (IMT) was further diagnosed by immunohistochemistry, which showed positive staining for desman and smooth muscle actin and was negative for CD117, CD34, and S-100. Lymph nodes tested negative for tumor. The preoperative fever disappeared and did not recur in the postoperative course.

Hospital of Diagnosis Influences the Probability of Receiving Curative Treatment for Esophageal Cancer.

The aim of this article was to study the influence of hospital of diagnosis on the probability of receiving curative treatment and its impact on survival among patients with esophageal cancer (EC). Although EC surgery is centralized in the Netherlands, the disease is often diagnosed in hospitals that do not perform this procedure. Patients with potentially curable esophageal or gastroesophageal junction tumors diagnosed between 2005 and 2013 who were potentially curable (cT1-3,X, any N, M0,X) were selected from the Netherlands Cancer Registry. Multilevel logistic regression was performed to examine the probability to undergo curative treatment (resection with or without neoadjuvant treatment, definitive chemoradiotherapy, or local tumor excision) according to hospital of diagnosis. Effects of variation in probability of undergoing curative treatment among these hospitals on survival were investigated by Cox regression. All 13,017 patients with potentially curable EC, diagnosed in 91 hospitals, were included. The proportion of patients receiving curative treatment ranged from 37% to 83% and from 45% to 86% in the periods 2005-2009 and 2010-2013, respectively, depending on hospital of diagnosis. After adjustment for patient- and hospital-related characteristics these proportions ranged from 41% to 77% and from 50% to 82%, respectively (both P < 0.001). Multivariable survival analyses showed that patients diagnosed in hospitals with a low probability of undergoing curative treatment had a worse overall survival (hazard ratio = 1.13, 95% confidence interval 1.06-1.20; hazard ratio = 1.15, 95% confidence interval 1.07-1.24). The variation in probability of undergoing potentially curative treatment for EC between hospitals of diagnosis and its impact on survival indicates that treatment decision making in EC may be improved.

Development and evaluation of a connective tissue phantom model for subsurface visualization of cancers requiring wide local excision.

Wide local excision (WLE) of tumors with negative margins remains a challenge because surgeons cannot directly visualize the mass. Fluorescence-guided surgery (FGS) may improve surgical accuracy; however, conventional methods with direct surface tumor visualization are not immediately applicable, and properties of tissues surrounding the cancer must be considered. We developed a phantom model for sarcoma resection with the near-infrared fluorophore IRDye 800CW and used it to iteratively define the properties of connective tissues that typically surround sarcoma tumors. We then tested the ability of a blinded surgeon to resect fluorescent tumor-simulating inclusions with ∼1-cm margins using predetermined target fluorescence intensities and a Solaris open-air fluorescence imaging system. In connective tissue-simulating phantoms, fluorescence intensity decreased with increasing blood concentration and increased with increasing intralipid concentrations. Fluorescent inclusions could be resolved at ≥1-cm depth in all inclusion concentrations and sizes tested. When inclusion depth was held constant, fluorescence intensity decreased with decreasing volume. Using targeted fluorescence intensities, a blinded surgeon was able to successfully excise inclusions with ∼1-cm margins from fat- and muscle-simulating phantoms with inclusion-to-background contrast ratios as low as 2∶1. Indirect, subsurface FGS is a promising tool for surgical resection of cancers requiring WLE.

TRANSANAL ENDOSCOPIC MICROSURGERY IN THE MANAGEMENT OF RECTAL CARCINOID.

AIMS: Carcinoid tumors, a type of neuro-endocrine tumors (NETs), comprise a heterogeneous group of neoplasms arising from cells of the neuro-endocrine system. Rectal carcinoid tumors are relatively uncommon, representing 1,1% to 1,3% of all rectal neoplasms. Their incidence is dramatically increasing. The aim of this study was to review our department`s experience and assess the efficacy of transanal endoscopic microsurgery (TEM) in the management of rectal carcinoid tumor. METHODS: Between 2013 and 2015, four patients with rectal carcinoid underwent TEM, and their clinical data were reviewed retrospectively. RESULTS: Two patients (50%) were identified as high-risk patients and underwent TEM, full-thickness excision and two ones (50%) were identified as low-risk patients and underwent TEM, submucosal resection. One patient from the high-risk group was referred to us by gastroenterologist from another hospital for complete surgery after endoscopic polypectomy with microscopically tumor positive resection margin. Tumor size was bigger in high-risk patients than in low-risk ones (14 and 20 mm versus 7 and 9 mm). There was no lymphovascular invasion in both groups. The operation time was longer in the full-thickness excision than in the submucosal resection group (45 and 55 min versus 27 and 33 min). One patient with full-thickness excision was complicated with acute urinary retention. There was neither local recurrence, nor distant metastasis in our patients during the follow-up period. CONCLUSIONS: Our data suggest that TEM is a safe, minimally invasive approach for local excision of rectal carcinoid tumors and, generally, leads to good oncological and surgical outcomes. Furthermore, for patients with microscopically positive margins after endoscopic polypectomy, TEM can be an effective surgical option for complete residual tumor removal.

Short course hypofractionated whole breast irradiation after conservative surgery: a single institution phase II study

BackgroundTo assess the oncologic outcomes of hypofractionated whole breast irradiation (Hypo-WBI).MethodsEligible patients had undergone breast conservative surgery for early breast cancer (pTis-2) and none/limited nodal involvement. Hypo-WBI consisted of 34 Gy in 10 daily fractions over 2 weeks to the whole breast three-dimensional conformal radiotherapy (3DCRT), followed by a single fraction of 8 Gy to the tumor bed after 1 week (electrons). Primary endpoint is freedom from ipsilateral breast tumor recurrence (IBTR). Minimum follow up for living & event-free patients is 3 yrs.; median follow up time of the whole analyzed patient population is 5.4 yrs. (range: 1.8–11.4 yrs).ResultsTwo hundred fifty-one patients were accrued from 2004 to 2013. All patients underwent local excision of the primary tumor to negative margins. Four patients failed in the ipsilateral breast after a median time of 3.2 years (range: 1.7–5.7 yrs) for a 5-year IBTR-free survival of 98.7% (95%CI: 97.3%–100%). IBTR-free survival was significantly higher for patients with invasive cancer than for patients with intraductal carcinoma (p = 0.036). Within patients with invasive tumors, no clear trends or associations were detected between IBTR and age, grading, molecular subtype, pT or pN stage. At 5 years, the actuarial rates of GR2 fibrosis and GR2+ teleangectasia are 2.4% (95%CI: 0–6.5%) and 7.1% (95%CI: 0.4–13.7%), respectively. Cosmesis was scored as excellent/good by ≈95% of patients and ≈60% of clinicians.ConclusionsHypo-WBI in 3 weeks allows excellent oncologic outcomes for invasive breast cancer after conservative surgery. Patients with intraductal carcinoma should be treated with Hypo-WBI only within a controlled study.Trial registrationIRE-IFO Ethical and Scientific Committee (cod. RS61/04).

Should the rectal defect be closed following transanal local excision of rectal tumors? A systematic review and meta-analysis.

Transanal local excision (TLE) has become the treatment of choice for benign and early-stage selected malignant tumors. However, closure of the rectal wall defect remains a controversial point and the available literature still remains unclear. Our aim was to determine through a systematic review of the literature and a meta-analysis of relevant studies whether or not the wall defect following TLE of rectal tumors should be closed. Medline and the Cochrane Trials Register were searched for trials published up to December 2016 comparing open versus closed management of the surgical rectal defect after TLE of rectal tumors. Meta-analysis was performed using Review Manager 5.0. Four studies were analyzed, yielding 489 patients (317 in the closed group and 182 in the open group). Meta-analysis showed no significant difference between the closed and open groups regarding the overall morbidity rate (OR 1.26; 95% CI 0.32-4.91; p=0.74), postoperative local infection rate (OR 0.62; 95% CI 0.23-1.62; p=0.33), postoperative bleeding rate (OR 0.83; 95% CI 0.29-1.77; p=0.63), and postoperative reintervention rate (OR 2.21; 95% CI 0.52-9.47; p=0.29). This review and meta-analysis suggest that there is no difference between closure or non-closure of wall defects after TLE.

Internal Mammary Artery Perforator Flap for Immediate Volume Replacement Following Wide Local Excision of Breast Cancer.

BackgroundBreast-conserving therapy is defined as a breast-conserving wide local excision (WLE) of a mammary tumour combined with postoperative radiotherapy. Immediate restoration of the mammary shape by use of breast reduction techniques (volume displacement) or tissue replacement techniques (volume replacement) is gaining popularity to prevent breast malformation.MethodsTo date, using the internal mammary artery perforator (IMAP) flap has been suggested for immediate volume replacement after WLE, but has never been evaluated in a published study.ResultsWe applied this flap in 12 women (mean age, 56.1 years) after WLE (mean specimen weight, 46.5 g) of the medial aspect of the breast. Over a median follow-up of 35.3 months (standard deviation, 1.2 months), 4 women needed repeated surgery for dog-ear correction of the donor site.ConclusionsIn our experience, the use of an IMAP flap was a reliable technique with good cosmetic outcomes after oncoplastic reconstruction. In this series, donor site revision often proved necessary initially, but we showed that this may easily be prevented.

A CASE OF WELL-DIFFERENTIATED LIPOSARCOMA IN THE RIGHT SCROTUM, DIAGNOSED AFTER LOCAL TUMOR EXCISION

A 71-year-old male was referred to our hospital with right scrotal swelling. The ultrasonography and magnetic resonance imaging revealed a 6.5 cm mass adjacent to the right testicle. Under the preoperative diagnosis of benign intrascrotal lipoma, local tumor excision through scrotal skin incision was performed. The histopathological examination revealed atypical lipomatous tumor/well-differentiated liposarcoma. With the evidence of malignancy, two-stage surgery was mandatory. Thus, radical orchiectomy with high cord ligation and wide excision of surrounding soft tissue structures through inguinal skin incision was performed. However, there were no tumor cells remaining in the resected samples. Neither adjuvant radiation therapy nor chemotherapy has been performed since contrast computed tomography showed no evidence of metastasis. He is free of disease at 1 year postoperatively.

BILATERAL BREAST SARCOMA IN WOMEN WITH MACROMASTIA

Bilateral breast sarcomas are rare malignancies of unknown etiology. Most common histological subtypes of breast sarcoma are angiosarcoma, fibrosarcoma and malignant fibrous histiocytoma. Phyllodes tumors have a predisposition to transform into sarcoma. The present clinical case describes bilateral breast fibrosarcomas in a 39 years-old female with macromastia. This peculiarity gave possibilities to do wide local excision of both tumors within 3.0 cmresection margins and preserve both breasts. Histological and immunohistochemical (ERG, CK-AE1/AE3) examination confirmed fibrosarcomas in both breast (in right – stage IIB, in left – stage IIA). Patient carried on postoperative treatment with radiation therapy (36.1 Gy for both breasts) and four cycles of adjuvant chemotherapy (doxorubicin, cisplatin, cyclophosphamide). For the first year patient had clinical and ultrasound examination every three months, then every 6 months. CT scan of chest and abdomen was every year. In seven post-op years there was no evidence of disease recurrence. Thus, macromastia gives an exceptional chance to carry out organ-sparing radical surgery in women with advanced breast malignancies.