Memenin Filloides Tümörleri: Tek Merkezden 35 Olgunun Klinikopatolojik Analizi

Amaç: Bu çalışma, filloid tümörlü (FT) hastaların demografik özelliklerini, tümörlerin klinik ve histopatolojik özelliklerini değerlendirmek ve merkezimizin deneyimlerinden yola çıkarak PT'lere tedavi yaklaşımlarını paylaşmak amacıyla yapılmıştır. Yöntem: Çalışmada İstanbul Üniversitesi Onkoloji Enstitüsü'nde 2006-2017 yılları arasında FT tanısı ile tedavi edilen hastaların demografik, klinikopatolojik özellikleri ve tedavi yaklaşımları hasta dosyaları ve patoloji kayıtları incelenerek retrospektif olarak değerlendirildi. Bulgular: Medyan yaş 39,7±11,1 yıl idi. Tanı için 6 hastaya eksizyonel biyopsi, 1 hastaya insizyonel biyopsi ve 27 hastaya kor biyopsi uygulandı. 27 hastaya meme koruyucu cerrahi (MKC), 8 hastaya mastektomi uygulandı. Bir lumpektomiye yeniden eksizyon eklendi ve MKC olan 2 olgu sınır pozitifliği nedeniyle mastektomiye çevrildi. Ortalama FT boyutu 55,3 mm (13 mm - 210 mm) idi. FT alt tipleri benign (n=15, %42,9), borderline (n=7, %20,0) ve malign (n=13, %37,1) olarak belirlendi. Malign FT'li hastalardan 3'üne mastektomi sonrası kemoterapi (KT) ve radyoterapi (RT), lumpektomili bir hastaya KT ve RT, 2 hastaya sadece RT uygulandı. FT'li hastalar ortalama 70 ay (12 ay-184 ay) takip edildi. Takipte 7 lokal nüks (LN) (2 benign FT, 1 borderline FT ve 4 malign FT), 1 tek uzak metastaz (malign FT) ve 1 LN artı uzak metastaz (malign FT) gözlendi. Sonuç: Negatif ≥1cm'lik cerrahi sınır, FT'lerin tedavisinde en önemli adımdır. Adjuvan KT veya RT'nin sağkalıma yararı tartışmalıdır ve daha fazla araştırmaya ihtiyaç vardır.

Anahtar Kelimeler:

Filloides tümör, Meme cerrahisi, Lokal nüks

Phyllodes Tumors of the Breast: Clinicopathological Analysis of 35 Single-Center Cases

Aim: This study was conducted with the aim of to evaluate demographics of patients with phyllodes tumor (PT), clinical and histopathologic characteristics of tumors, and to share treatment approach to PTs from the experience of our center. Method: In the study, the demographic, clinicopathological characteristics and treatment approaches of the patients who were treated between 2006 and 2017 at the Oncology Institute, Istanbul University with the diagnosis of PT were evaluated retrospectively by examining the patient files and pathology records. Results: The median age was 39.7±11.1 years. For diagnosis, 6 patients underwent excisional biopsies, 1 patient incisional biopsy, and 27 patients core biopsies. Twenty seven patients underwent breast-conserving surgery (BCS), whereas 8 patients had mastectomy. Re-excision was added to one lumpectomy, and 2 cases who had BCS were converted to mastectomy due to margin positivity. The mean PT size was 55.3 mm (13 mm - 210 mm). The PT subtypes were as follows: benign (n=15, 42.9%), borderline (n=7, 20.0%), and malignant (n=13, 37.1%). Among those with malignant PTs, 3 patients received chemotherapy (CT) and radiotherapy (RT) following mastectomy, one patient with lumpectomy had CT and RT, and 2 patients received only RT. Patients with PT were followed for an average of 70 months (12 months- 184 months). Seven local recurrences (LR) (2 benign PT, 1 borderline PT, and 4 malignant PT), 1 single distant metastasis (malignant PT), and 1 LR plus distant metastasis (malignant PT) were observed in follow-up. Conclusion: Negative surgical margin of ≥1cm is the most important step in the management of PTs. The survival benefit of adjuvant CT or RT are contraversial and need further investigation.

Keywords:

Phyllodes tumor, breast surgery, local recurrence,

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