eMedicine Specialties > General Surgery > Thorax
Cystosarcoma Phyllodes: Treatment & Medication
Updated: Jan 30, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
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 |
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References
Hoover HC. Cystosarcomas of the breast. In: Raaf JH, ed. Soft Tissue Sarcomas: Diagnosis and Treatment. St Louis, Mo: Mosby; 1993:113-21.
Parker SJ, Harries SA. Phyllodes tumours. Postgrad Med J. Jul 2001;77(909):428-35. [Medline]. [Full Text].
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].
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.
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].
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].
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].
Contarini O, Urdaneta LF, Hagan W. Cystosarcoma phylloides of the breast: a new therapeutic proposal. Am Surg. Apr 1982;48(4):157-66. [Medline].
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].
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].
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].
Further Reading
Related eMedicine topics:
Breast Abscess and Masses
Breast Anatomy
Breast Cancer [Oncology]
Breast Cancer [Plastic Surgery]
Breast Cancer, Mammography
Breast Cancer, Ultrasonography
Breast, Fibroadenoma
Disorders of the Breast
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
Treatment & Medication: Cystosarcoma Phyllodes