Phyllodes tumor of the breast-Pathological and surgical implications

The clinical and pathological findings of 22 patients with phyllodes tumor of the breast were retrospectively evaluated. The tumors were divided into benign, borderline, and malignant groups according to the following histological criteria: stromal atypia and cellularity, mitotic activity, and the character of the tumor margins (pushing vs. infiltrating). Fourteen (64%) of the tumors were defined as benign, 6 (27%) as borderline, and 2 (9%) as malignant. The mean age of the patients was 39.7 years (range 18-65). The mean size of the tumors was 5.3 cm (range 1-11 cm). All patients were treated surgically. In 20, the initial therapy was wide local excision, while in 2 simple mastectomy was performed. A third patient underwent mastectomy when the tumor recurred a second time as a malignant phyllodes tumor. The mean follow-up time was 10 years (range 6 months-30 years). Tumor recurred in 5 patients. In total, there were 6 tumor recurrences: 3 in the benign group (one patient had 2 recurrences), 1 in the borderline group, and 2 in the malignant group. Both patients with malignant phyllodes tumor died from lung metastases within 2 years after presentation. We found no correlation between the histological picture and the local recurrence in our small series of 22 patients. The separation of phyllodes tumor into benign, borderline, and malignant categories according to histopathological criteria did not give guidelines for extent of surgical treatment. We suggest that all patients presenting with primary or recurrent phyllodes tumor of the breast should be treated by wide local excision with a margin of healthy breast tissue (as in lumpectomy performed for carcinoma of the breast) with immediate re-excision for inadequately excised lesions, as judged by histological examination. Simple mastectomy should be reserved for cases in which a very large tumor occupies most of the breast tissue, thus making lumpectomy impossible.