Diagnostic radiation oncology: Malignant cystosarcoma phylloides

Background: Cystosarcoma phylloides is a rare, mostly benign tumor of the b reast. in most cases curative treatment is possible with complete surgical excision of the lesions. However. there is a high local recurrence rate up to 46%. There are only few reported successful treatments with radiotherapy in cystosarcoma phylloides. Radiotherapy is indicated in patients with loc oregional recurrent disease and those with symptomatic metastases. Patient: We present a case of a 54-year-old woman with a painless mass in t he right breast. Clinical examination showed a large. firm tumor and axilla ry lymph node metastases. The patient underwent mastectomy and axillary lym ph node dissection. Histopathology showed a cystosarcoma phylloides measuri ng 30 x 25 x 15 cm as well as lymph node metastases measuring 9.5 cm. Despi te a R-0 resection the patient developed 4 thoracic wall recurrences within 2 years. At 18 months there were additional multiple pulmonary and pleural lesions with a maximum diameter of 6.5 cm. Subsequently the patient receiv ed polychemotherapy. There was a significant response of the thoracic wall disease as well as of the pulmonary and pleural lesions. Six months later t here was further progress of the thoracic wall disease and the pulmonary le sions. Following this the patient underwent radiation therapy of her right thoracic wall with 50 Gy which lead clinically to a quick response. For the past 5 months there has been no evidence of thoracic wall disease recurren ce. Conclusion: This is an unusual case of cystosarcoma phylloides and response to different that therapeutic modalities. Cystosarcoma phylloides showed t o be a radiosensitive tumor. Thus postoperative radiation therapy is indica ted to prevent local recurrences.