Memenin filloides tümörlerinin klinik özellikleri ve süreci

Amaç: Primer meme neoplazilerinin %0,3-1’ini oluşturan nadir görülen fibroepitelyal meme tümörü ’dür. Klinik, radyolojik ve histopatolojik olarak fibroadenomlar ile karışırlar. Bu yazıda, filloides meme tümörü nedeni ile tedavi edilen hastalarımızın demografik özellikleri, klinikopatolojik bulguları, takip sonuçları ve uygulanan tedavi yöntemlerinin incelenmesi amaçlanmıştır. Gereç ve Yöntem: Ocak 2010-Temmuz 2019 tarihleri arasında tedavi edilen 24 filloides tümör hastasının verileri retrospektif olarak incelendi. Bulgular: Yaş ortalaması 44,1 (20-64) yıl idi. En sık başvuru semptomu hızlı büyüyen kitle idi. Hastalık 12 hastada sağ memede, 2 hastada bilateral idi. Biyopsi yöntemi olarak, 10 hastada tru-cut biyopsi, 13 hastada eksiyonel, 1 hastada insizyonel biyopsi kullanıldı. Eksizyonel biyopsi (n:6), segmental mastektomi(n:11) ve mastektomi (n:7) uygulanan cerrahi prosedürler idi. Ortalama tümör boyutu 64,6 mm(20-220) olarak saptandı. Histopatolojik olarak, 9 benign, 6 borderline ve 9 malign filloides tümör tanısı konuldu. Ortalama takip süresi 18 (6-82)ay idi. Takipte, malign filloides tümörlü 4 hastada lokal nüks, 1 hastada uzak metastaz tespit edildi. 3 hasta kemoterapi ve 2 hasta radyoterapi tedavisi aldı. Sonuç: Filloid tümörler nadir görülen, miks tip meme tümörleridir. Klinik, radyolojik ve histopatolojik olarak meme fibroadenomları ile karışabilmektedir. Uygun cerrahi tedavinin yapılabilmesi için tru-cut biyopsi ile ameliyat öncesi tanının konulması önemlidir. Aksi taktirde re-operasyon ve lokal nüks oranları artmaktadır.

Clinical features and course of Phyllodes tumors of breast

Purpose: Phyllodes tumoris a rare fibroepithelial breast tumor that constitutes 0.3-1% of primary breast neoplasms. They are confused with fibroadenomas, clinically, radiologically and histopathologically. In this article, it is aimed to examine the demographic characteristics, clinicopathological findings, follow-up results and treatment methods of our patients treated due tophyllodes tumor. Materials and Methods: The data of 24 phyllodes tumor patients treated between January 2010 and July 2019 were analyzed retrospectively. Results: The average age was 44.1 (20-64) years. The most common symptom was the fast growing mass. The disease was on the right breast in 12 patients and bilateral in 2 patients. As a biopsy method, true-cut biopsy was used in 10 patients, excisional biopsy in 13 patients, and incisional biopsy in 1 patient. Excisional biopsy (n: 6), segmental mastectomy (n: 11) and masectomy (n: 7) were surgical procedures applied. The mean tumor size was determined as 64.6 mm (20-220). Histopathologically, 9 benign, 6 borderline and 9 malignant phyllodes tumors were diagnosed. The mean follow-up was 18 (6-82) months. During follow-up, local recurrence was detected in 4 patients and distant metastasis in 1 patient. 3 patients received chemotherapy and 2 patients received radiotherapy. Conclusion: Phyllodes tumors are rare, mixed-type breast tumors. It can be mixed clinically, radiologically and histopathologically with breast fibroadenomas. It is important to make a preoperative diagnosis with tru-cut biopsy for proper surgical treatment. Otherwise, re-operation and local recurrence rates increase.

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  • 1. Anderson BO, Lawton TJ, Lehman CD, Moe RE. Phyllodes tumors. In: Disease of the Breast. 3rd ed (Eds JR Harris, ME Lippman, M Morrow, CK Osborne):991-1006. Philadelphia, Lippincott Williams & Wilkins,. 2004.
  • 2. Lee AHS. Recent developments in the histological diagnosis of spindle cell carcinoma, fibromatosis and phyllodes tumour of the breast: spindle cell and fibroepithelial lesions. Histopathology. 2007;52:45– 57.
  • 3. Lee AHS, Hodi Z, Ellis IO, Elston CW. Histological features useful in the distinction of phyllodes tumour and fibroadenoma on needle core biopsy of the breast. Histopathology. 2007;51:336-44.
  • 4. McDivitt RW, Urban JA, Farrow JH. Cystosarcoma phyllodes. Johns Hopkins Med J. 1967;120:33–45.
  • 5. Bernstein L, Deapen D, Ross RK. The descriptive epidemiology of malignant cystosarcoma phyllodes tumors of the breast. Cancer. 1993;71:3020–4.
  • 6. Parker SJ, Harries SA. Phyllodes tumours. Postgrad Med J. 2001;77:428–35.
  • 7. Abdalla HM, Sakr MA. Predictive factors of local recurrence and survival following primary surgical treatment of phyllodes tumors of the breast. J Egypt Natl Cancer Inst. 2006;18:125–33.
  • 8. Barrio AV, Clark BD, Goldberg JI, Hoque LW, Bernik SF, Flynn LW et al. Clinicopathologic features and long-term outcomes of 293 phyllodes tumors of the breast. Ann Surg Oncol. 2007;14:2961–70.
  • 9. Guillot E, Couturaud B, Reyal F, Curnier A, Ravinet J, Lae M et al. Management of phyllodes breast tumors. Breast J. 2011;17:129–37.
  • 10. National Comprehensive Cancer Network. Phyllodes Tumor (Version 1.2016). Available at: http://www.nccn.org/professionals/physician_gls/p df/breast.pdf. Accessed 25 Jan 2016.
  • 11. Feakins RM, Mulcahy HE, Nickols CD, Wells CA. p53 expression in phyllodes tumours is associated with histological features of malignancy but does not predict outcome. Histopathology. 1999;35:162-9.
  • 12. Kuijper A, Buerger H, Simon R, Schaefer KL, Croonen A, Boecker W et al. Analysis of the progression of fibroepithelial tumours of the breast by PCRbased clonality assay. J Pathol. 2002;197:575-81.
  • 13. Testori A, Meroni S, Errico V, Travaglini R, Voulaz E, Alloisio M. Huge malignant phyllodes breast tumor:a real entity in a new era of early breast cancer, World J Surg Oncol. 2015;13.1:81–4.
  • 14. Yabuuchi H, Soeda H, Matsuo Y, Okafuji T, Eguchi T, Sakai S et al. Phylloides tumor of the breast: correlation between MR findings and histologic grade. Radiology. 2006;241:702e9.
  • 15. Strode M, Khoury T, Mangieri C, Takabe K. Update on the diagnosis and management of malignant phyllodes tumors of the breast. Breast. 2017;33:91-6.
  • 16. Foxcroft LM, Evans EB, Porter AJ. Difficulties in the pre-operative diagnosis of phyllodes tumours of the breast: a study of 84 cases. Breast. 2007;16:27–37.
  • 17. Dillon MF, Quinn CM, McDermott EW, O’Doherty A, O’Higgins N, Hill ADK. Needle core biopsy in the diagnosis of phyllodes neoplasm. Surgery. 2006;140:779–84.
  • 18. Bode MK, Rissanen T, Apaja-Sarkkinen M. Ultrasonography and core needle biopsy in the differential diagnosis of fibroadenoma and tumor phyllodes. Acta Radiol. 2007;48:708‐13.
  • 19. Vega Bolı´var A, Alonso-Bartolome´ P, Ortega Garcı´a E, Garijo Ayensa F. Ultrasound-guided core needle biopsy of non-palpable breast lesions: a prospective analysis in 204 cases. Acta Radiol. 2005;46:690–5.
  • 20. Kim S, Kim JY, Kim DH, Jung WH, Koo JS. Analysis of phyllodes tumor recurrence according to the histologic grade. Breast Cancer Res Treat. 2013;141:353–63.
  • 21. Asoglu O, Ugurlu MM, Blanchard K, Grant CS, Reynolds C, Cha SS et al. Risk factors for recurrence and death after primary surgical treatment of malignant phyllodes tumors. Ann Surg Oncol. 2004;11:1011–7.
  • 22. Borhani-Khomani K, Talman ML, Kroman N, Tvedskov TF. Risk of local recurrence of benign and borderline phyllodes tumors: a Danish populationbased retrospective study. Ann Surg Oncol. 2016;23:1543–8.
  • 23. Cowan ML, Argani P, Cimino-Mathews A. Benign and low-grade fibroepithelial neoplasms of the breast have low recurrence rate after positive surgical margins. Mod Pathol. 2016;29:259–65.
  • 24. Macdonald OK, Lee CM, Tward JD, Chappel CD, Gaffney DK. Malignant phyllodes tumor of the female breast: association of primary therapy with cause-specific survival from the surveillance, epidemiology, and end results (SEER) program. Cancer. 2006;107:2127–33.
  • 25. Rodrigues MF, Truong PT, McKevitt EC, Weir LM, Knowling MA, Wai ES. Phyllodes tumors of the breast: The British Columbia Cancer Agency experience. Cancer Radiother. 2018;22:112‐9.
  • 26. Valdes EK, Boolbol SK, Cohen J-M, Feldman SM. Malignant transformation of a breast fibroadenoma to cystsarcoma phyllodes: case report and review of the literature. Am Surg. 2005;71:348–53.
  • 27. Abe M, Miyata S, Nishimura S, Lijima K, Makita M, Akiyama F, et al. Malignant transformation of breast fibroadenoma to malignant phyllodes tumor: longterm outcome of 36 malignant phyllodes tumors. Breast Cancer. 2011;18:268‐72.
  • 28. Vargas HI, Vargas MP, Gonzalez K, Burla M, Khalkhali I. Percutaneous excisional biopsy of palpable breast masses under ultrasound visualization. Breast J. 2006;12:218-22.
  • 29. Contarini O, Urdaneta LF, Hagan W, Stephenson SE Jr. Cystosarcoma phylloides of the breast: a new therapeutic proposal. Am Surg. 1982;48:157‐66.
  • 30. Zhang Y, KLEER CG. Phyllodes tumor of the breast: histopathologic features, differential diagnosis, and molecular/genetic updates. Arch Pathol Lab Med. 2016;140:665-71.
  • 31. Hopkins ML, McGowan TS, Rawlings G, Liu FF, Fyles AW, Yeoh JL et al. Phylloides tumor of the breast: a report of 14 cases. J Surg Oncol. 1994;56.2:108-12.
  • 32. Barth RJ. Histologic features predict local recurrence after breast-conserving therapy of phyllodes tumors. Breast Cancer Res Treat. 1999;57:291–5.
  • 33. Kleer CG, Giordano TJ, Braun T, Oberman HA. Pathologic, immunohistochemical, and molecular features of benign and malignant phyllodes tumors of the breast. Mod Pathol. 2001;14:185-90.
  • 34. Reinfuss M, Mitus J, Duda K, Stelmach A, Rys J, Smolak K. The treatment and prognosis of patients with phyllodes tumor of the breast: an analysis of 170 cases. Cancer. 1996;77:910–6.
  • 35. Kapiris I, Nasiri N, A’Hern R, Healy V, Gui GP. Outcome and predictive factorsof local recurrence and distant metastases following primary surgical treatment of high-grade malignant phyllodes tumours of the breast. Eur J Surg Oncol. 2001;27:723–30.
  • 36. Chaney AW, Pollack A, McNeese MD, Zagars GK, Pisters PW, Pollock RE et al. Primary treatment of cystosarcoma phyllodes of the breast. Cancer. 2000;89:1502–11
  • 37. Varghese SS, Sasidharan B, Manipadam MT, Paul MJ, Backianathan S. Radiotherapy in Phyllodes tTumour. J Clin Diagn Res. 2017;11:XC01
Cukurova Medical Journal-Cover
  • ISSN: 2602-3032
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 1976
  • Yayıncı: Çukurova Üniversitesi Tıp Fakültesi
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