Recurrent Phyllodes Tumor of the Breast: Defining the Role for Skin-Sparing Mastectomy and Autologous Reconstruction

Mohamed Anwar Atalla; Warren Matthew Rozen; Damien Grinsell; Anthony Hyett; Saurabh Prakash; Alvin Cham

doi:10.1055/s-0031-1275493

Journal of Reconstructive Microsurgery, Inhaltsverzeichnis

J Reconstr Microsurg 2011; 27(4): 267-272
DOI: 10.1055/s-0031-1275493

Recurrent Phyllodes Tumor of the Breast: Defining the Role for Skin-Sparing Mastectomy and Autologous Reconstruction

Mohamed Anwar Atalla¹ , Warren Matthew Rozen¹ , Damien Grinsell¹ , Anthony Hyett¹ , Saurabh Prakash¹ , Alvin Cham¹

¹Department of Surgery, Western Hospital, Footscray, Victoria, Australia

Abstract

ABSTRACT

Phyllodes tumors (PTs) are uncommon fibroepithelial tumors of the breast, noteworthy for their difficult excisions and high recurrence rates. In the setting of recurrence, there is no consensus in the literature as to the extent of excision or the impact on reconstructive options. Breast-conserving surgery and simple mastectomy have each been described with mixed reports. Despite a shift toward the selective use of skin-sparing mastectomy and nipple-areola complex–sparing mastectomy in breast carcinoma, neither the role for these techniques nor the role for breast reconstruction in recurrent PT has been described. A case report is presented demonstrating the utility of skin-sparing mastectomy and autologous breast reconstruction for locally recurrent PT of the breast, with a literature review of management options in this setting presented. The case presented highlights an appropriate setting for autologous microsurgical reconstruction of the breast in recurrent PT. The literature review highlights a lack of any published management consensus, with only the role for mastectomy suggested for recurrent high-grade or malignant lesions. A potential management algorithm is thus presented. Skin-sparing mastectomy, particularly for intermediate-grade lesions, may allow wider resections while enabling aesthetically pleasing reconstructive options without affecting recurrence rates.

KEYWORDS

Phyllodes tumor - cystosarcoma - breast - skin sparing mastectomy - reconstruction

Volltext

Referenzen

REFERENCES

1 Rowell M D, Perry R R, Hsiu J G, Barranco S C. Phyllodes tumors. Am J Surg. 1993; 165 376-379
2 Barrio A V, Clark B D, Goldberg J I et al.. Clinicopathologic features and long-term outcomes of 293 phyllodes tumors of the breast. Ann Surg Oncol. 2007; 14 2961-2970
3 WHO . Histological typing of breast tumors. Tumor. 1982; 68 181-198
4 Palmer M L, De Risi D C, Pelikan A et al.. Treatment options and recurrence potential for cystosarcoma phyllodes. Surg Gynecol Obstet. 1990; 170 193-196
5 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; 77 910-916
6 Lindquist K D, van Heerden J A, Weiland L H, Martin Jr J K. Recurrent and metastatic cystosarcoma phyllodes. Am J Surg. 1982; 144 341-343
7 Chua C L, Thomas A, Ng B K. Cystosarcoma phyllodes: a review of surgical options. Surgery. 1989; 105(2 Pt 1) 141-147
8 Barth Jr R J. Histologic features predict local recurrence after breast conserving therapy of phyllodes tumors. Breast Cancer Res Treat. 1999; 57 291-295
9 de Roos W K, Kaye P, Dent D M. Factors leading to local recurrence or death after surgical resection of phyllodes tumours of the breast. Br J Surg. 1999; 86 396-399
10 Azzopardi J G. Sarcoma in the breast. In: Azzopardi J G, ed. Problems in Breast Pathology. Philadelphia: W.B. Saunders; 1979: 346-65
11 Salvadori B, Cusumano F, Del Bo R et al.. Surgical treatment of phyllodes tumors of the breast. Cancer. 1989; 63 2532-2536
12 Zissis Ch, Apostolikas N, Konstantinidou A, Griniatsos J, Vassilopoulos P P. The extent of surgery and prognosis of patients with phyllodes tumor of the breast. Breast Cancer Res Treat. 1998; 48 205-210
13 Ciatto S, Bonardi R, Cataliotti L, Cardona G. Phyllodes tumor of the breast: a multicenter series of 59 cases. Eur J Surg Oncol. 1992; 18 545-549
14 Kapiris I, Nasiri N, A'Hern R, Healy V, Gui G P. 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; 27 723-730
15 Norris H J, Taylor H B. Relationship of histologic features to behavior of cystosarcoma phyllodes. Analysis of ninety-four cases. Cancer. 1967; 20 2090-2099
16 Halverson J D, Hori-Rubaina J M. Cystosarcoma phyllodes of the breast. Am Surg. 1974; 40 295-301
17 Chaney A W, Pollack A, McNeese M D et al.. Primary treatment of cystosarcoma phyllodes of the breast. Cancer. 2000; 89 1502-1511
18 Chen W H, Cheng S P, Tzen C Y et al.. Surgical treatment of phyllodes tumors of the breast: retrospective review of 172 cases. J Surg Oncol. 2005; 91 185-194
19 Hajdu S I, Espinosa M H, Robbins G F. Recurrent cystosarcoma phyllodes: a clinicopathologic study of 32 cases. Cancer. 1976; 38 1402-1406
20 West T L, Weiland L H, Clagett O T. Cystosarcoma phyllodes. Ann Surg. 1971; 173 520-528
21 Blichert-Toft M, Hansen J P, Hansen O H, Schiodt T. Clinical course of cystosarcoma phyllodes related to histologic appearance. Surg Gynecol Obstet. 1975; 140 929-932
22 Ben Hassouna J, Damak T, Gamoudi A et al.. Phyllodes tumors of the breast: a case series of 106 patients. Am J Surg. 2006; 192 141-147
23 Contarini O, Urdaneta L F, Hagan W, Stephenson Jr S E. Cystosarcoma phylloides of the breast: a new therapeutic proposal. Am Surg. 1982; 48 157-166
24 Mangi A A, Smith B L, Gadd M A, Tanabe K K, Ott M J, Souba W W. Surgical management of phyllodes tumors. Arch Surg. 1999; 134 487-492 discussion 492-493
25 Kario K, Maeda S, Mizuno Y, Makino Y, Tankawa H, Kitazawa S. Phyllodes tumor of the breast: a clinicopathologic study of 34 cases. J Surg Oncol. 1990; 45 46-51
26 Buchanan E B. Cystosarcoma phyllodes and its surgical management. Am Surg. 1995; 61 350-355
27 Pezner R D, Schultheiss T E, Paz I B. Malignant phyllodes tumor of the breast: local control rates with surgery alone. Int J Radiat Oncol Biol Phys. 2008; 71 710-713
28 Pezner R D, Schultheiss T E, Paz I B. Malignant phyllodes tumor of the breast: local control rates with surgery alone. Int J Radiat Oncol Biol Phys. 2008; 71 710-713
29 Hawkins R E, Schofield J B, Fisher C, Wiltshaw E, McKinna J A. The clinical and histologic criteria that predict metastases from cystosarcoma phyllodes. Cancer. 1992; 69 141-147
30 Morales-Vásquez F, Gonzalez-Angulo A M, Broglio K et al.. Adjuvant chemotherapy with doxorubicin and dacarbazine has no effect in recurrence-free survival of malignant phyllodes tumors of the breast. Breast J. 2007; 13 551-556
31 McGregor G I, Knowling M A, Este F A. Sarcoma and cystosarcoma phyllodes tumors of the breast—a retrospective review of 58 cases. Am J Surg. 1994; 167 477-480
32 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; 77 910-916
33 Tavassoli F A, Devilee P. Pathology and genetics of tumors of the breast and female genital organs. In: World Health Organization Classification of Tumors. Lyons: IARC Press; 2003: 99-103
34 Birch J M, Alston R D, McNally R J et al.. Relative frequency and morphology of cancers in carriers of germline TP53 mutations. Oncogene. 2001; 20 4621-4628
35 Mulero F, Roca V, Nicolás F et al.. Usefulness of quantification and visual analysis of the uptake of (99m)Tc-MIBI in the diagnosis of mammary lesions. Rev Esp Med Nucl. 2000; 19 192-198
36 Dillon M F, Quinn C M, McDermott E W, O'Doherty A, O'Higgins N, Hill A D. Needle core biopsy in the diagnosis of phyllodes neoplasm. Surgery. 2006; 140 779-784
37 Tan E Y, Tan P H, Yong W S et al.. Recurrent phyllodes tumours of the breast: pathological features and clinical implications. ANZ J Surg. 2006; 76 476-480
38 Lindquist K D, van Heerden J A, Weiland L H, Martin Jr J K. Recurrent and metastatic cystosarcoma phyllodes. Am J Surg. 1982; 144 341-343
39 Macdonald O K, Lee C M, Tward J D, Chappel C D, Gaffney D K. Malignant phyllodes tumor of the female breast: association of primary therapy with cause-specific survival from the Surveillance, Epidemiology, and End Results (SEER) program. Cancer. 2006; 107 2127-2133
40 Lai Y L, Weng C J, Noordhoff M S. Breast reconstruction following excision of phylloides tumor. Ann Plast Surg. 1999; 43 132-136
41 Sufi P A, Gittos M, Collier D S. Envelope mastectomy with immediate reconstruction (EMIR). Eur J Surg Oncol. 2000; 26 367-370
42 Carlson G W, Losken A, Moore B et al.. Results of immediate breast reconstruction after skin-sparing mastectomy. Ann Plast Surg. 2001; 46 222-228
43 Liang M I, Ramaswamy B, Patterson C C et al.. Giant breast tumors: surgical management of phyllodes tumors, potential for reconstructive surgery and a review of literature. World J Surg Oncol. 2008; 6 117-119

Warren Matthew RozenM.B.B.S. B.Med.Sc. P.G.Dip.Surg.Anat. Ph.D.

Department of Surgery

Western Hospital, Footscray, Victoria, Australia

eMail: warrenrozen@hotmail.com