Document Type : Original Research
Authors
- Eva Ruvalcaba-Limón 1
- Josefina Jiménez-López 1
- Verónica Bautista-Piña 2
- Julio Ramírez-Bollas 1
- Flavia Morales-Vásquez 3
- Carlos Domínguez-Reyes 1
- Antonio Maffuz-Aziz 1
- Sergio Rodríguez-Cuevas 1
1 Dept. of Breast Surgical Oncology, Instituto de Enfermedades de la Mama y Fundación del Cáncer de Mama (IEM-FUCAM), Mexico City, Mexico
2 Dept. of Pathology, IEM-FUCAM, Mexico City, Mexico
3 Dept. of Medical Oncology, IEM-FUCAM, Mexico City, Mexico
Abstract
Background: Phyllodes tumor (PT) of the breast in Hispanic patients is more frequently reported with large tumors and with more borderline/malignant subtypes compared with other populations. The objective of this study was to describe characteristics of patients with PT and to identify differences among subtypes in a Mexican population.
Methods: A retrospective study was conducted on patients with PT. Sociodemographic, histopathologic, and treatment characteristics were compared among subtypes, including only surgically treated cases due the complete surgical-specimen study requirement for appropriate WHO classification.
Results: During 10 years, 346 PT were diagnosed; only 307 were included (305 patients), with a mean age of 41.7 yr. Self-detected lump took place in 91.8%, usually discovered 6 months previously, with median tumor size of 4.5 cm. Local wide excisions were done in 213 (69.8%) and mastectomies in 92 (30.1%). Immediate breast reconstruction took place in 38% and oncoplastic procedures in 23%. PT were classified as benign in 222 (72.3%) cases, borderline in 50 (16.2%), and malignant in 35 (11.4%), with pathological tumor size of 4.2, 5.4, and 8.7 cm, respectively (P<0.001). Patients with malignant PT were older (48 yr), with more diabetics (14.3%), less breastfeeding (37.1%), more smokers (17.1%), with more postmenopausal cases (42.9%), and older age at menopause (51.5 years) compared with the remaining subtypes (P<0.05). Relapse occurred in 8.2% of patients with follow-up.
Conclusion: In comparison with other Hispanic publications, these Mexican patients had similar age, with smaller tumors, modestly higher benign PT, fewer malignant PT, and lower documented relapse cases.
Keywords
Main Subjects
- Tse GMK, Tan PH, Lui PCW, Putti TC. Spindle cell lesions of the breast- the pathologic differential diagnosis. Breast Cancer Res Treat 2008; 109:199-207.
- Müller J. Ueber den feinen Bau und die Formen der Krankhaften geschwulste. Berlin, Germany, 1838. Reimer:54.
- Fiks A. Cystosarcoma phyllodes of the mammary gland- Müller’s tumor. For the 180th Birthday of Johannes Müller. Virchows Arch A Pathol Anat Histol 1981; 392(1):1-6.
- Pietruszka M, Barnes L. Cystosarcoma phyllodes: a clinicopathologic analysis of 42 cases. Cancer 1978; 41(5):1974-83.
- Azzopardi JG: Sarcoma in the breast. In: Benningron J, Editor. Problems in Breast Pathology. Vol. II. Major Problems in Pathology. Philadelphia, PA, USA: WB Saunders Co.; 1979; p. 355-9.
- Salvadori B, Cusumano F, Del Bo R, Delledonne V, Grassi M, Rovini D, et al. Surgical treatment of phyllodes tumors of the breast. Cancer 1989; 63(12):2532-6.
- WHO: Histological typing of breast tumors. Tumori 1982; 68:181-98.
- Komenaka IK, El-Tamer M, Pile-Spellman E, Hibshoosh H. Core needle biopsy as a diagnostic tool to differentiate phyllodes tumor from fibroadenoma. Arch Surg 2003; 138(9):987-90.
- Rodríguez A JC, Gómez A, Rennola A. Tumor filodes de la mama: revisión de 55 casos en el Hospital Oncológico “Padre Machado”. Rev Venez Oncol 2003; 15(1):28-37.
- Rodríguez A, Gutiérrez R. Tumor filodes. Experiencia quirúrgica del Instituto Nacional de Cancerología. Rev Colomb Cir 1994; 9(3):157-62.
- Ben Hassouna J, Damak T, Gamoudi A, Chargui R, Khomsi F, Mahjoub S, et al. Phyllodes tumors of the breast: a case series of 106 patients. Am J Surg 2006; 192(2):141-7.
- Tan PH. 2005 Galloway Memorial Lecture: Breast Phyllodes Tumours – Morphology and Beyond. Ann Acad Med Singapore 2005; 34(11):671-7.
- Kapiris I, Nasiri N, A’Hern R, Healy V, Gui GP. Outcome and predictive factors of local recurrence and distant metastases following primary surgical treatment of high-grade malignant phyllodes tumours of the breast. Eur J Surg Oncol 2001; 27(8):723-30.
- Meneses A, Mohar A, De la Garza-Salazar J, Ramírez-Ugalde T. Prognostic factors on 45 cases of phyllodes tumors. J Exp Clin Cancer Res 2000; 19(1):69-73.
- Pimiento JM, Gadgil PV, Santillán AA, Lee MC, Esposito NN, Kiluk JV, et al. Phyllodes tumors: race-related differences. J Am Coll Surg 2011; 213:537-42.
- Barth RJ Jr. Histologic features predict local recurrence after breast conserving therapy of phyllodes tumors. Breast Cancer Res Treat 1999; 57(3):291-5.
- Lakhani SR EI, Schnitt SJ, Tan PH, van der Vijver MJ, editors: WHO Classification of Tumours of the Breast. Lyon, France: IARC; 2012; p. 22-3.
- Tavassoli FA, Devilee P. Pathology and genetics of tumours of the breast and female genital organs. In: World Health Organization Classification of Tumours. Lyon, France: IARC Press; 2003; p. 99-103.
- 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(10):2961-70.
- Tan PH, Thike AA, Tan WJ, Thu MM, Busmanis I, Li H, et al. Phyllodes Tumour Network Singapore. Predicting clinical behaviour of breast phyllodes tumours: a nomogram based on histological criteria and surgical margins. J Clin Pathol 2012; 65(1):69-76.
- Pérez PJA, Sánchez CG, Bohle OJ, Poblete SMT, Hernández HM, Massri ED. Tumor filodes de la mama. Caracterización clínica e histopatológica de 39 casos. Rev Chil Cir 2007; 59(3):185-90.
- Aranda FC, Olaya GEJ, Colín VA, Miguel PPS. Tumor phyllodes: experiencia institucional. Ginecol Obstet Mex 2009; 77(12):567-72.
- Ibáñez RG, Marambio GA, Jans BJ, Gamboa GJ, Adonis PP, Trewhela NR, et al. Tumor filoides de la mama. Rev Chil Cir 2010; 62(2):119-24.
- Velázquez-Dohorn M, Gamboa-Domínguez A, Medina-Franco H. Phyllodes tumor of the breast: clinicopathologic analysis of 22 cases. Rev Invest Clin 2013; 65(3):214-20.
- Reinfuss M, Mituś J, Duda K, Stelmach A, Ryś J, Smolak K. The treatment and prognosis of patients with phyllodes tumor of the breast: an analysis of 170 cases. Cancer 1996; 77(5):910-6.
- Lewitan G, Goldberg C, De Sousa Serro R, Cabaleiro C, Maris Espora S. Tumor phyllodes en una niña de 11 años. Comunicación de un caso. Arch Argent Pediatr 2010; 108(2):e41-3.
- 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(11):1011-7.
- Park HL, Kwon SH, Chang SY, Huh JY, Kim JY, Shim JY, et al. Long-term follow-up result of benign phyllodes tumor of the breast diagnosed and excised by ultrasound-guided vacuum-assisted breast biopsy. Breast Cancer 2012; 15(2):224-9.
- Jang JH, Choi MY, Lee SK, Kim S, Kim J, Lee J, et al. Clinicopathologic risk factors for the local recurrence of phyllodes tumors of the breast. Ann Surg Oncol 2012; 19(8):2612-7.
- Bernstein L, Deapen D, Ross RK. The descriptive epidemiology of malignant cystosarcoma phyllodes tumors of the breast. Cancer 1993; 71(10):3020-4.
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