BACK GROUND

Cystosarcoma phyllodes (CP) is an extremely rare form of

breast lesion with an unpredictable clinical course.

This accounts for 0.30.9% of all breast neoplasms and

approximately 2%-3% of all fibro-epithelial lesions of the breast.

Given their rarity, epidemiologic data are scant.
Study-Los Angeles county -17 yr period

Average annual incidence rate was 2.1 per million women, Higher incidence in Latina whites, as compared to non-Latina whites, Asians, and African American women

BACK GROUND
This neoplasm is manifested in women of all ages, including

adolescent and elderly.

Median age at presentation is 42 to 45 (10 to 82 yrs) Data - Tumor grade increases with mean age at diagnosis

Some case reports describe these tumors in men, usually in

association with gynecomastia

BACK GROUND
No etiologic or predisposing factors - exception of Li-Fraumeni

syndrome,
Rare autosomal dominant condition - development of multiple

tumors

They tend to be large, very fast-growing breast tumors that

evolve in a 'leaf-shaped' growth pattern.

Hence the diagnosis should be considered in all rapidly

growing breast nodules.

BACKGROUND- GROSS HISTOLOGY

Round to oval multinodular masses with a grayish white

appearance that resemble the head of a cauliflower

May be indistinguishable from fibroadenomas. Grow radially creating a pseudocapsule through which tongues

of stroma may protrude and grow into adjacent breast tissue

Necrosis and hemorrhage can occur in larger tumors.

BACKGROUND- MICROSCOPIC APPEARENCE

Range of appearances covers the spectrum from resembling a

benign fibroadenoma to a high-grade sarcoma.

Characteristic leaf-like architecture consists of elongated cleft-

like spaces that contain papillary projections of epithelial-lined stroma with varying degrees of hyperplasia and atypia.
The stromal elements are a key component in the

differentiation of phyllodes tumors from fibroadenomas and in distinguishing a benign from a malignant phyllodes tumor

BACK GROUND
Histologically, phyllodes tumors are classified as benign,

borderline or malignant.
The most commonly accepted criteria used for classification of

benign versus malignant tumors are as follows.

The degree of stromal cellular atypia Mitotic activity Infiltrative as compared to circumscribed tumor margins.

Presence or absence of stromal overgrowth (ie, presence of pure stroma

devoid of epithelium).

BACK GROUND
Benign -increased stromal cellularity with mild to moderate cellular atypia,

circumscribed tumor margins and low mitotic rate (less than 4 mitoses per 10 high power fields) and lack of stromal overgrowth.
Borderline -greater degree of stromal cellularity and atypia, a mitotic rate

from 4 to 9 mitosis per 10 high power fields , microscopic infiltrative borders and lack of stromal overgrowth.
Malignant - marked stromal cellularity and atypia, infiltrative margins, high

mitotic rate (more than 10 mitosis per 10 high power fields examined), and by the presence of stromal overgrowth.

BACK GROUND
In most large series, more than 50 percent - benign
Approximately 25 percent of phyllodes tumors are malignant, The histological classification of these neoplasms into benign,

borderline and malignant has not proven to be successful, because

Benign form of cystosarcoma phyllodes could manifest metastases. Malignant variant of cystosarcoma resulted in an excellent prognosis.

AIMS AND OBJECTIVES

This study aims to report the experience of the during a 2-year period and also to review the spectrum of histopathological findings in our subset of population.

MATERIALS AND METHODS

The data of Pathological specimens of patients with primary breast neoplasms, who were evaluated and

treated in Osmania General Hospital from August 2009 to September 2011 were analyzed.

RESULTS
Total number of breast tumours evaluated over a period of

2 years 126 cases

Total diagnosed as Phyllodes tumour- 11(8.7%) All diagnosed were Females. Mean age at presentation 47.18 (Range 30-74 Years)

AGE DISTRIBUTION
AGE GROUP 30-49 YEARS 50-70 YEARS >70 YEARS TOTAL NUMBER (%) 5 (45.45%) 5 (45.45%) 1(9.1%) 11(100%)

Malignant vs Benign
Phyllodes tumour Benign Malignant Total Number (%) 6(54.5%) 5(45.5%) 11(100%)

Malignant vs Benign
No. Of Cases Mean Age at presentation Range

Benign

6(54.5%)

44.67 14.16 Yrs

30-68 Yrs

Malignant

5(45.5%)

50.2 18.06 Yrs

30-74 Yrs

Total

11(100%)

47.18 15.46 Yrs

30-74 Yrs

Patterns of Malignancy
Patterns of Malignancy Number (%)

Necrosis and increased mitotic activity,

3 cases (60%)

Stromal pleomorphism with stromal outgrowth Infiltrating margin and necrosis.

1 case (20%)

1 case (20%)

Circumscribed border of tumour

Leaf-like processes containing cellular stroma lined with benign ductal epithelial cells projecting into the cystic space

Benign Phyllodes

Spindle cells with plump nuclei (arrow). Mitosis (double arrows)

Malignant Phyllodes

Distribution of Lesions
Present Study Benign Borderline 6 (54.5%) 0 (0%) S Abdelkrim et al 1 13 (50%) 7 (27%) M. S. Lenhard et al 2 12 (40% 8 (27%) Stamatkos et al
3

15 (68%) 2 (9%)

Malignant
Total
1.

5 (45.5%)
11 (100%)

6 (23%)
26 (100%)

10 (33%)
30 (100%)

5 (23%)
22 (100%

Soumaya Ben Abdelkrim et al. World Journal of Oncology 2010, 2. M. S. Lenhard et al. Journal of Clinical Oncology, 2006 ASCO Annual Meeting Proceedings Part I. Vol 24, No. 18S (June 20 Supplement), 2006. 3. Michael Stamatakos et al. International Seminars in Surgical Oncology 2009, 6:6

Age at Presentation- Comparison

Present Study No. of Cases Mean age at Presentation Range 11 47.18 15.46 Yrs 30-74 Yrs S Abdelkrim et al 26 40 Yrs 19-66 Yrs M. S. Lenhard et al 30 47 Years -

Population Characteristics By Grade

Present Study Mean Age (Range In Yrs) Benign 44.67 (30 - 68) S Abdelkrim et al Mean Age (Range In Yrs) 35.8 (19 - 55)

Borderline
Malignant

50.2 (30 - 74)

44.7 (34 - 52)

45.2 (29 - 66)

Total

47.18 (30 - 74)

40 (19 - 66)

CONCLUSIONS
Phyllodes Tumor is a rare but not an uncommon tumour. Significant number of the lesions tends to be malignant. Histopathological diagnosis and categorization is vital for

planning the treatment and to assess the prognosis.