THE EXTENT OF SURGERY AND PROGNOSIS OF PATIENTS WITH PHYLLODES TUMOR OF THE BREAST

In an attempt to clarify the controversial issues related to prognosis and therapeutic aspects of phyllodes tumors (PT), we retrospectively reviewed all cases of PT treated in our hospital during the last fifte en years. Re-examining the pathology material we found 84 cases, while thirteen more cases which had been initially classified as fibroadeno mas with areas of phyllodes tumor were rejected from the analysis beca use they were classified as fibroadenomas. Based on the criteria propo sed by Azzopardi and Salvadori and adopted by WHO, we found 55 benign PT (65.14%), 14 borderline PT (16.6%), and 15 malignant PT (17.8%). Th e median age of the patients with benign PT was 34 years, compared to 46.5 years for those with borderline tumors and 52 years for those wit h malignant. The median size of benign tumors was 3 cm, 9.5 cm for bor derline, and 7.25 cm for malignant. Out of 55 patients with benign PTs , 37 underwent wide local excision and the remaining 18, with small tu mors, underwent enucleation. In this group of patients, there was no r ecurrence after a median interval of 6.65 years. Eleven patients with borderline PT underwent wide local excision and three mastectomy; one immediately after an incomplete PT excision and the remaining two 8 mo nths and 2 years later due to a locally recurrent PT (the last one pro ven histologically in the permanent biopsy of the recurrence to be mal ignant). Twelve patients with malignant PT underwent mastectomy, eithe r during the same operation or following the results of the permanent section biopsy. Three more patients with malignant PT underwent wide l ocal excision. The size of the tumor in these patients was relatively small and the pathology report indicated clear margins with normal bre ast tissue surrounding the tumor. One patient with 8 cm diameter malig nant PT, who underwent mastectomy, passed away sixteen months later fr om widely spread metastases. Applying the criteria of Azzopardi and Sa lvadori, each case of PT can be managed successfully avoiding unnecess ary mastectomies.