Thursday, December 3, 2009

Case Report of a Cystosarcoma Phyllodes – an Article Review

Flipping through my current copy of The Journal of the Arkansas Medical Society, I was surprised to see this case report (full reference below) of a 30.8 pound cystosarcoma phyllodes of the breast. The accompanying photos are impressive. Many questions filled my head – Why did the woman wait so long to seek care? How did she manage to physically do her daily chores on the farm? How did she manage to find clothing to wear?Photo scanned in from article

I scanned this photo in from the article. The patient’s history is as follows:

A 54-year-old self-employed cattle farmer first noticed a small tumor in her left breast at age 19. Over time, the tumor grew from the size of a small pea to a massive size. Finally, family members convinced the patient to seek medical attention. …. Also, there was
no family history of breast cancer on either side of her family. …….The patient, 5’5”, 201 pounds, presented with the left breast entirely replaced with a solid, irregularly shaped, somewhat moveable mass of tremendous size. She had a very deep groove on her left shoulder from her bra strap, very enlarged veins, and no ulcerations, bleedings, or discharge noted. The nipple-areolar complex was shifted medially about 10 cm, and there were no palpable supraclavicular or axillary nodes. The tumor extended toward, but not into, the left axilla. The tumor measured 60 cm from the superior to the inferior tip, and 97 cm circumferentially from laterally to medially.

The article gives a short review of cystosarcoma Phyllodes, pointing out that this is a rare, predominantly benign tumor of
the breast. They point out the tumor was first described in 1928. The name cystosarcoma phyllodes comes from the Greek word, “sarcoma” implying a fl eshy tumor, and “phyllo” for leaf.

Currently, the tumor is more commonly called a Phyllodes Tumor. Whichever term is used, the tumor accounts for only 0.4-1% of all breast tumors. This tumor is most common in women in their 40’s to 50’s. The usual presentation is a patient who felt a small mass which then rapidly increased in size over a few weeks.

Most are benign, but 10-30% may be malignant —either low-grade or high-grade. Benign tumors do not metastasize,
but may grow aggressively and can reoccur locally.

The tumor rarely involves the nipple-areolar complex. Most ( 64-76%) present in the upper outer quadrant of the breast. Most (73%) are over 5 cm in diameter. This mobile mass has distinct borders like a fibroadenoma, and mammagram
findings may be similar.

The primary treatment is complete surgical removal of the tumor with adequate margins. This may be wide local excision or a total mastectomy. Low axillary node dissection is recommended if nodes are enlarged, the tumor is greater than 4 cm, or the biopsy shows a high-grade tumor.

Chemotherapy is not recommended though radiation therapy may be with high-grade malignant tumors.

The article is a nice case report and interesting review.

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Related posts

Breast Masses in Adolescent Girls (July 24, 2008)

REFERENCES

Case Report of a 30.8 Pound Cystosarcoma Phyllodes of Breast; Journal of the Arkansas Medical Society, Vol 106, No 6, pp134-136; Connie Hiers MD, John Cook MD, Elizabeth Sales MD

2 comments:

Gizabeth Shyder said...

I would love to see a picture of the histology. I'll bet that was a high-grade tumor, probably with heterologous sarcomatous elements. Especially given the nodes.

I thought only ovarian tumors got that big.

Chrysalis Angel said...

Holy smokes! What do people tell themselves that makes that something you just live with? I can not imagine. Poor thing.

You do have some interesting cases on your site.