Surgical management of phyllodes tumors

Hypothesis: Although phyllodes tumors have minimal metastatic potential, we hypothesized that they have a proclivity for local recurrence and should b e excised with a wide margin. We reviewed the clinical and radiological app earance of phyllodes tumors and analyzed the role of surgical treatment in their management. Design: Medical records, imaging studies, pathology reports, and interventi ons were reviewed. Setting: A large tertiary care teaching hospital. Patients: Between 1980 and 1997, 40 patients with phylodes tumors were iden tified through the tumor registry at the Massachusetts General Hospital, Bo ston. Main Outcome Measures: Surgical resection margins, rates of local recurrenc e, incidence of distant metastases, and survival. Results: All 40 patients were female, with a mean age of 41 years. Each pat ient had a palpable mass or a mammographic finding that was indistinguishab le from a fibroadenoma on examination. Tumor size ranged from 5 mm to 28 cm . Local recurrence correlated with excision margins (P<.05), but not with t umor grade or size. Local recurrence occurred in 5 patients, each of whom h ad positive margins or margins less than 1 cm after excision. After reexcis ion with a l-cm margin, these individuals remained free of recurrence. One patient developed metastatic disease after total mastectomy and died after chemotherapy. Conclusions: Phyllodes tumors mimic fibroadenomas and are often excised wit h close margins. Primary excision or reexcision with a l-cm margin is recom mended. Mastectomy is indicated for patients with large lesions. Lymph node metastases are unusual and occur secondary to necrotic tumor. Chemotherapy is based on guidelines for the treatment of sarcomas, not breast adenocarc inoma.