CENTRAL-NERVOUS-SYSTEM COMPLICATIONS OF CYSTOSARCOMA-PHYLLODES

Background. Cystosarcoma phyllodes (CP) is an uncommon fibroepithelial breast neoplasm that rarely involves the central nervous system (CNS) . Methods. The authors encountered two patients with CNS metastases an d reviewed the literature to identify reports of CP affecting,the nerv ous system. Patients must have been reported in sufficient detail to c haracterize clinical course, extent of tumor burden, and histologic ty pe of the primary tumor and metastasis to be included in the study. Re sults. Eleven cases were identified from the literature, but only six were presented in sufficient detail for analysis. Including the curren t patients, the mean age of patients with CP metastases was 52 years. The time between initial diagnosis and CNS involvement was 5 years. Pa renchymal brain metastases respond poorly to treatment, with a mean su rvival of 29 days, whereas survival is significantly longer with CNS i nvolvement secondary to epidural extension of tumor from adjacent bony structures. Local recurrence or widespread metastases nearly always w ere present at the time of CNS involvement. Conclusions. Brain metasta ses from CP are refractory to therapy and carry a dismal prognosis. Pa tients with CP and brain metastases should undergo brain biopsy to exc lude metastases from associated epithelial breast tumors, which have s ignificantly better prognoses. Patients with compressive lesions arisi ng from bone have a better prognosis and may benefit from aggressive m anagement.