Pb. Rajan et al., CYSTOSARCOMA-PHYLLODES IN ADOLESCENT GIRLS AND YOUNG-WOMEN - A STUDY OF 45 PATIENTS, The American journal of surgical pathology, 22(1), 1998, pp. 64-69
Cystosarcoma phyllodes (CP) is an uncommon tumor in adolescent girls a
nd young women. This study seeks to define the clinical and pathologic
features of CP in this unusual clinical setting. Forty-five CPs (34 b
enign and 11 malignant) in prepubertal and adolescent girls and young
women were studied. Classification of the tumors was based on the foll
owing morphologic features: stromal cellularity, nuclear atypia, mitot
ic activity, necrosis, and the nature of tumor borders. Surgical thera
py was local excision or mastectomy. The age of the patients ranged fr
om 10 to 24 years (mean 17.7). The tumors measured 1.4 cm to 10.2 cm a
t their widest point (mean 4.6). Both breasts were affected equally. T
hirty-two patients were treated by local excision with or without reex
cision and four patients by mastectomy. Follow-up was available for 36
patients for a mean of 58.4 months. Local recurrence was reported in
six of the 36 cases (16%) (four benign and two malignant). The six pat
ients with recurrent disease had infiltrative tumor borders and positi
ve surgical margins microscopically. There was a single instance of sy
stemic metastases from a high-grade malignant tumor with rhabdomyosarc
omatous stromal differentiation and a high mitotic rate. At last follo
w-up, 34 patients were alive with no evidence of disease,one patient w
as alive with pulmonary metastases, and one patient died of an unrelat
ed cause. We concluded that CP in adolescent girls and young women is
not more aggressive than in older patients. Infiltrative tumor borders
and positive surgical margins are the best histologic predictors for
local recurrence. Mitotic activity is the most important criterion for
assessing the metastatic potential. CP in this age group should be tr
eated to maximize breast conservation. Mastectomy may be required to o
btain clear margins for CPs that cannot be managed by excision because
of large tumor size relative to breast volume.