eMedicine Specialties > General Surgery > Thorax

Cystosarcoma Phyllodes: Treatment & Medication

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

Treatment

Surgical Care

In most cases of cystosarcoma phyllodes, perform wide local excision, with a rim of normal tissue.7,8,9 No absolute rules on margin size exist. However, a 2 cm margin for small (<5 cm) tumors and a 5 cm margin for large (>5 cm) tumors have been advocated.

The lesion should not be "shelled out," as might be done with a fibroadenoma, or the recurrence rate will be unacceptably high.4

  • If the tumor to breast ratio is sufficiently high to preclude a satisfactory cosmetic result by segmental excision, total mastectomy, with or without reconstruction, is an alternative.
  • More radical procedures are not generally warranted.8
  • Perform axillary lymph node dissection only for clinically suspicious nodes. However, virtually all of these nodes are reactive and do not contain malignant cells.10

Consultations

Consult a general surgery specialist.

Medication

There is no proven role for adjuvant chemotherapy or radiation therapy in the treatment of phyllodes tumors. Response to chemotherapy and radiotherapy for recurrences and metastases has been poor, and no success with hormonal manipulation has been documented.

More on Cystosarcoma Phyllodes

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

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].

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

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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