Phyllodes Tumors of the Breast

OBJECTIVE To study all patients with phyllodes tumors of the breast which were diagnosed at King Hussien Medical Center and Prince Rashid Military Hospital between the 1st of may 2002 till January 2009. METHODS A total of 26 patients diagnosed to have phylloedes tumors were retrieved from the hospital records. All cases were analyzed and assessed in two main categories: demographical characteristics and histopathological parameters. The demographical characteristics included: sex and age of the patients, and tumor size while the histopathological aspects were divided into three subgroups: Benign, Borderline and Malignant tumors with its stromal components characteristics. All the histopathological reports for specimens sent by surgeons were reviewed by 2 senior pathologists. Statistical analysis was done by using Chi square and P-Value. RESULTS All our patients were females; their age range between 17-67 years, the mean patient age at presentation was 39 years. Out of the 26 patients diagnosed to have phyllodes tumor, 6 had breast-conserving therapy and 20 women had mastectomy. The types of Phyllodes tumors include: A-Benign phyllodes tumors (15 cases), B-Borderline phyllodes (7cases) and C-malignant phyllodes (4 cases). With significant values of benign tumors occurrence (p<0.01)), while borderline and malignant ones were not significant (NS) in comparison to the benign type. There were two cases below the age of 20 and one above the age of 65, with right breast involvement in eleven out of twenty six cases (42%), fifteen out of twenty six cases have involvement of the left breast (58%) and no cases found of bilateral phyllodes tumors of the breast. The greatest dimension of the tumors ranged from 1 to 15 cm, with a mean of 5 cm. Approximately 73.1% of tumors were less or equal to 5 cm in the greatest dimension and 26.9% >5 cm. The duration of symptoms varied from one month to ten year.s Six patients had painful swellings, whereas in twenty patients the pain was absent. Four patients had recurrent tumors; the distinctive features of those with recurrent tumors were the histological findings of stromal over growth and the presence of positive resection margin. In our series, we found that three patients of those with recurrence discovered to have stromal over growth. While one only had a previous positive resection margin without stromal overgrowth. CONCLUSION Rapid growth of phyllodes tumor does not necessarily imply malignancy. In our series, clinical tumor's size was not the significant factor for recurrence. Local recurrence occur in patients who were treated with breast-conserving surgery, and it is highly significant when there is stromal over growth (P value <0.01 and Chi square of 8.21) in comparison with the resection margin without stromal overgrowth (P value <0.1 and Chi square of 3.23) which gives a clue for further studies about the stromal factor role in recurrence of the tumor.