eMedicine Specialties > General Surgery > Thorax

Cystosarcoma Phyllodes: Differential Diagnoses & Workup

Author: Donald R Lannin, MD, Professor, Clinician-Educator Track, Department of Surgery, Section of Oncology; Executive Director, Co-Medical Director, Yale Comprehensive Breast Center
Coauthor(s): Anastasios K Konstantakos, MD, Clinical Associate Surgeon, Department of Cardiovascular Surgery, Billings Clinic, Billings, Montana; John H Raaf, MD, PhD, Professor, Department of Surgery, Case Western Reserve University
Contributor Information and Disclosures

Updated: Jan 30, 2009

Differential Diagnoses

Angiosarcoma
Breast Cancer

Other Problems to Be Considered

Juvenile fibroadenoma
Giant fibroadenoma
Inflammatory carcinoma
Sclerosing adenosis
Radial scar
Fat necrosis
Fibrocystic change
Breast abscess
Adenocarcinoma
Mastitis

Workup

Laboratory Studies

  • No specific hematologic tumor markers or other blood tests can be used to diagnose cystosarcoma phyllodes.

Imaging Studies

  • Although mammography and ultrasonography generally are important in the diagnosis of breast lesions, they are notoriously unreliable in differentiating benign cystosarcoma phyllodes (CSP) from the malignant form of the condition or from fibroadenomas. Thus, findings on imaging studies are not definitively diagnostic of CSP.6

Procedures

  • Fine-needle aspiration for cytologic examination usually is inadequate for the diagnosis of phyllodes tumors. Core biopsy is more reliable, but there still can be sampling errors and difficulty in distinguishing the lesion from a fibroadenoma.
  • Open excisional breast biopsy for smaller lesions or incisional biopsy for large lesions is the definitive method for diagnosing phyllodes tumors.

Histologic Findings

All phyllodes tumors contain a stromal component that can vary significantly in histologic appearance from one lesion to another. In general, benign phyllodes tumors demonstrate a markedly increased number of regular fusiform fibroblasts in the stroma. Occasionally, highly anaplastic cells with myxoid changes are observed. A high degree of cellular atypia, with increased stromal cellularity and an increased mitotic count, is almost always observed in the malignant form of cystosarcoma phyllodes. Ultrastructurally, in the benign and malignant forms of phyllodes tumors, nucleoli may reveal a coarsely meshed nucleolonema and abundant cisternae in the endoplasmic reticulum.

More on Cystosarcoma Phyllodes

Overview: Cystosarcoma Phyllodes
Differential Diagnoses & Workup: Cystosarcoma Phyllodes
Treatment & Medication: Cystosarcoma Phyllodes
Follow-up: Cystosarcoma Phyllodes
References
Further Reading
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References

  1. Hoover HC. Cystosarcomas of the breast. In: Raaf JH, ed. Soft Tissue Sarcomas: Diagnosis and Treatment. St Louis, Mo: Mosby; 1993:113-21.

  2. Parker SJ, Harries SA. Phyllodes tumours. Postgrad Med J. Jul 2001;77(909):428-35. [Medline]. [Full Text].

  3. Jones AM, Mitter R, Poulsom R, et al. mRNA expression profiling of phyllodes tumours of the breast: identification of genes important in the development of borderline and malignant phyllodes tumours. J Pathol. Dec 2008;216(4):408-17. [Medline].

  4. Brooks HL, Priolo S, Waxman. Cystosarcoma phylloides: a case report of an 11-year survival and review of surgical experience. Contemp Surg. 1998;53:169-72.

  5. Yohe S, Yeh IT. "Missed" diagnoses of phyllodes tumor on breast biopsy: pathologic clues to its recognition. Int J Surg Pathol. Apr 2008;16(2):137-42. [Medline].

  6. Cole-Beuglet C, Soriano R, Kurtz AB. Ultrasound, x-ray mammography, and histopathology of cystosarcoma phylloides. Radiology. Feb 1983;146(2):481-6. [Medline]. [Full Text].

  7. Chen WH, Cheng SP, Tzen CY, et al. Surgical treatment of phyllodes tumors of the breast: retrospective review of 172 cases. J Surg Oncol. Sep 1 2005;91(3):185-94. [Medline].

  8. Contarini O, Urdaneta LF, Hagan W. Cystosarcoma phylloides of the breast: a new therapeutic proposal. Am Surg. Apr 1982;48(4):157-66. [Medline].

  9. Pezner RD, Schultheiss TE, Paz IB. Malignant phyllodes tumor of the breast: local control rates with surgery alone. Int J Radiat Oncol Biol Phys. Jul 1 2008;71(3):710-3. [Medline].

  10. Gullett NP, Rizzo M, Johnstone PA. National surgical patterns of care for primary surgery and axillary staging of phyllodes tumors. Breast J. Jan-Feb 2009;15(1):41-4. [Medline].

  11. Jones AM, Mitter R, Springall R, et al. A comprehensive genetic profile of phyllodes tumours of the breast detects important mutations, intra-tumoral genetic heterogeneity and new genetic changes on recurrence. J Pathol. Apr 2008;214(5):533-44. [Medline].

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Keywords

cystosarcoma phyllodes, breast tumor, breast lump, breast tumors, breast lumps, phyllodes tumor, phyllodes, cystosarcoma, phyllodes breast, cystosarcoma phylloides, fibroadenoma, giant fibroadenoma, benign breast tumor, breast mass, nonepithelial neoplasm of the breast, breast examination, breast self-examination, malignant phyllodes tumor, malignant CSP, nontender breast mass, open excisional breast biopsy

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Contributor Information and Disclosures

Author

Donald R Lannin, MD, Professor, Clinician-Educator Track, Department of Surgery, Section of Oncology; Executive Director, Co-Medical Director, Yale Comprehensive Breast Center
Donald R Lannin, MD is a member of the following medical societies: Alpha Omega Alpha, American Cancer Society, and American College of Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Anastasios K Konstantakos, MD, Clinical Associate Surgeon, Department of Cardiovascular Surgery, Billings Clinic, Billings, Montana
Disclosure: Nothing to disclose.

John H Raaf, MD, PhD, Professor, Department of Surgery, Case Western Reserve University
John H Raaf, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Association of Endocrine Surgeons, American College of Surgeons, American Society of Clinical Oncology, Central Surgical Association, and Society of Surgical Oncology
Disclosure: Nothing to disclose.

Medical Editor

Brian James Daley, MD, MBA, FACS, Associate Program Director, Professor, Department of Surgery, Division of Trauma and Critical Care, University of Tennessee School of Medicine
Brian James Daley, MD, MBA, FACS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Chest Physicians, American College of Surgeons, American Medical Association, Association for Academic Surgery, Association for Surgical Education, Eastern Association for the Surgery of Trauma, Shock Society, Society of Critical Care Medicine, Southeastern Surgical Congress, and Tennessee Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Michael A Grosso, MD, Consulting Staff, Department of Cardiothoracic Surgery, St Francis Hospital
Michael A Grosso, MD is a member of the following medical societies: American College of Surgeons, Society of Thoracic Surgeons, and Society of University Surgeons
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other

 
 
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