ABSTRACT
Background: Phyllodestumors (PT) of the breast are rare and their prognosis and treatment are still subject of discussion. The purpose of this study is to determine the prognostic factors of this rare tumor. Patients and Methods: We retrospectively reviewed the medical records of 170 patients who had histologically confirmed PT, collected over a period of 24 years in one single Institute (Salah Azaiz Institute). Results: The mean age was of 38.7 years (14-75 years). The mean tumor size was 82.6 mm (15-300). According to criteria of WHO classification, tumors were classified into three groups: benign (97 cases, 57.1%), borderline (22 cases, 12.9%) and malignant (51 cases, 30%). One hundred and twenty eight patients (75.2%) were treated conservatively (96 benign, 17 borderline and 15 malignant) and 42 (24.7%) by radical surgery (6 borderline and 36 malignant). For malignant PT treated by local excision with or without reexcision of the tumor bed, the 5-year overall and recurrence free survivals were 46.2% and 44.2% vs. 55 and 63.8% when the surgery was radical (mastectomy with or without axillary dissection) (P=not significant and P=0.01). The rate of recurrence was 15.3 % (26) after a mean follow-up of 40 months (6 benign, 6 borderline and 14 malignant). Twelve patients developed metastases (7%). The 5-year overall and recurrence free survivals were 92.8% and 91.7%, respectively. In univariate analysis, age and recurrences are not of prognostic value for survival, while tumor size, histotype, necrosis, stromal overgrowth, cytonuclearatypia, tumor margins and number of mitosis were significant prognostic factors for survival. In multivariate study, stromal overgrowth and cytonuclearatypia remained independent predictors for survival. The tumor size and margins status were independent predictors for local recurrence. Conclusion: According to our results, the most important factor for local recurrence is the tumor size and the margins status and for the overall survival is the stromal overgrowth and the cytonuclearatypia. The best treatment remains wide local excision for the benign forms while total mastectomy appears to be correlated to better recurrence free survival in large malignant PT.
ABSTRACT
Breast myoepithelioma is rare. A case is reported of a 71 year old femal. The tumor was clinically, radiologically and macroscopically demarcated. Diagnosis was based on histological and immunohistochemical studies. At the time of diagnosis the tumor was composed of myoepithelial cells with few cellular atypias and a low mitotic activity. Tumor cells expressed vimentin, actin, 5100 protein and cytokeratin. No local or distant metastases were found. The patient had been treated initially with a large excision of tumor. Local recurrences detected 1 year after initial syrgery and showed a similar morphology and immunoreactivity with higher mitotic activity. Mastectomy with axillary dissection was performed. No recurrences and no distant metastases detected 2 years later. Myoepithelial tumors generally considered as benign or low- grad lesion can give rise to a wide range of clinical evolution