Phyllodes tumors- A retrospective review of 83 clinical cases

Abstract

Introduction: Phyllodes tumours are rare, accounting for 0.3–1.0% of all primary breast tumours. According to biological behaviour, they are divided
into three categories: benign, borderline and malignant. Due to the rare incidence, the requirements for the radicality of surgical treatment are not
well known. According to respected foreign recommendations, resection with a free margin of 10 mm or more is desirable.
Methods: A retrospective review of patients, who underwent surgical treatment due to phyllodes tumour in the Masaryk Memorial Cancer lnstitute
in 2003–2014.
Results: 83 patients were evaluated with a median follow-up of 68.0 months. Benign tumours accounted for 62.3%, borderline tumours accounted
for 16.9% and malignant accounted for 20.8% of all tumours. Malignant phyllodes tumours reached a bigger average size (84.9 mm) than borderline
(41.4 mm) and benign tumours (33.3 mm) and occurred in older patients (mean 56.4 years) than benign (mean 42.5 years). Results from
preoperative core-cut biopsy were often inaccurate. In 70 cases, the primary resection was breast preserving, but the free margin above 1 mm was
achieved only in 13 cases. The width of the resection edge never exceeded the recommended 10 mm. Nevertheless, there was a relapse in benign
tumours in two cases and in the borderline tumours only in one case. Malignant tumours recurred more frequently, even after total mastectomy.
Four patients with malignant tumours experienced distant metastases. There has never been a death caused by benign or borderline tumour.
Conclusion: The 10 mm resection margin is unachievable in our conditions. However, it seems that such radicality is not necessary in benign
tumours, because they rarely recur even with close margins. Conversely, neither total mastectomy of the malignant phyllodes tumours will protect
against local progression or distant metastasis.