Management Of phyllodes tumor of the breast at the NCI : A retrospective study / Mohammed Gamal Ahmed Awad ; Supervised Sherif Fouad Naguib , Mostafa Abdeltawab Hussein Sakkary , Maher Hassan Ibraheem Hassan

Thesis (M.Sc.) - Cairo University - National Cancer Institute - Department of Oncology (Surgical)

Objective Phyllodes tumor (PT) are rare fibroepithelial lesions that comprise 0.3{u2013}0.5% of all breast tumors. The aim of this study was to evaluate the clinicopathologic features, diagnostic tools, therapeutic outcomes and risk factors associated with recurrence and distant metastasis in patients with PT. Patients and Methods A total of 127 patients were reviewed and analyzed who were pathologically proved to be PT of the breast and treated in National Cancer Institute in Egypt in the period from January 2011 to January 2016. Patient characteristics, clinicopathologic features of tumors, diagnostic findings, surgical outcomes, adjuvant therapies, and follow-up findings were retrospectively evaluated. Results The mean age of patients was 39 years with slightly older age presentation for malignant PT. Non-tender, sharply demarcated, and mobile breast lump is the most common clinical finding. The most frequent site for the tumor was the upper outer quadrant (45.6 %). Total excision with at least 1 cm macroscopic clear margins was the most frequently performed initial surgery (44.9%). Sixty patients presented with benign PTs (47.2%), 34 had borderline PTs (26.8%) and 33 had malignant PTs (26%). During the mean follow-up period of approximately 36 months, Local recurrence occurred in 34 patients, 9 benign cases (14.5%), 11 borderline (32.4%) and 14 malignant PTs (42.4 %). Mastectomy was the most commonly used surgery in recurrent cases (61.4%). Distant metastasis occurred in 12 patients. 4 with borderline PTs and 8 with malignant PTs .Most common site for metastasis was the lungs. No significant difference in other clinical, diagnostic, and pathologic characteristics was found between the groups. Conclusion PT has non-specific clinical and radiologic findings, and can easily be confused with other similar breast masses, particularly FA. Total excision with adequate clear margins is of great importance to reduce the risk of local recurrence. However, it should be always kept in mind that local recurrence can develop even after appropriate surgery for all histologic subtypes of PT. Therefore, these patients should be closely followed up at regular intervals after surgery

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