Surgical treatment of patients with phylloides tumor of the breast
Gürhan Sakman, 1 Cem Kaan Parsak, 2 Ahmet Aslan, 1 Alper Akınoğlu, 1
1Çukurova Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı, ADANA
2Mustafa Kemal Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı, HATAY
Purpose: We aim to evaluate the diagnostic diffuculties and the surgical options and results for the phyllodes tumors, which are infrequent pathologies of breast tumors.
Background: The most recognised clinical problems seen in phyllodes tumors are preopreatively differential diagnosis and postoperatively freqeunt local recurrences. The recommented management option is resection of tumor within at least 2 cm of surgical margin. Recurrence rate is reported as 15-25% in various studies.
Materials and Methods: We evaluate the surgical procedures and results of 10 patients with phyllodes tumor retrospectively who admitted to General Surgery Department, School of Medicine, Cukurova University between 1997-2003. Physical examination, breast ultrasonography and mammography were used for preoperative diagnosis. Fine needle aspiration biopsy (FNA), incisional biopsy (IB), and frozen section were used for histopathological diagnosis. Four different surgical procedures were preferred for surgical treatment: 1) Wide mass excision with 2 cm of surgical margin, 2) Simple mastectomy, 3) Simple mastectomy with palpitated lymph node biopsy and 4) Modified radical mastectomy (MRM).
Phyllodes tumors should be taken in account in patients with breast mass and with possible diagnosis of fibroadenoma. Differential diagnosis of phyllodes tumor is really upmost importance as the surgical management performed in one seans. Preoperative FNA and core biopsy performed routinely may have an important role as the clinical experience increase. Local recurrence is an important clinical problem in phyllodes tumors.
Conclusion: Clinical and radiological evaluations are usually insufficient in the differential diagnosis of fibroadenoma and phyllodes tumours. Evaluation of lesions with frozen section in patients with phyllodes tumours may reduce the possiblity of recurrent surgical procedures. Clinically palpitated axillar lymph nodes in paitents with phyllodes tumors may not be important pathologically. Local recurrence of borderline phyllodes tumors underwent simple mastectomy for maintaining the proposed surgical margin may point out that prognostic criteria might be multi factorial.
Keywords: Phyllodes tumor, fibroepithelial tumors, breast.