Because of its rarity among the breast tumors, malignant cystosarcoma phyllodes is one of the unfamiliar disease to both surgeon and pathologist. The outcome of these patients after treatment is difficult to predict, if it is determined merely by
the
clinical features or pathological findings of the patients. Therefore the unpredictable potential of the recurrence and metastasis of this disease is the most annoying problem t both pathologist and surgeon who must decide the extent of the
operation.
We have retrospectively analyzed the 7 female patients with the malignant cystsarcoma phyllodes of the breast who were treated at Department of Surgery, Seoul National University Hospital. The age distribution of them was from 22 to 75 years of
age(mean age; 37 years). The third and fourth decades in age comprised the half of the cases. The palpable mass was the most common chief complaints. The duration of the symptom was from 1 month to 30 years. Two patients had masses larger than 7
cm
in
diameter, and one patient less than 4 cm. Four patients had their lesions on the right side. One patient was suspected to present the enlargement of the axillary lymph node with no evidence of axillary metastasis by pathology. As a separate
lesion,
infiltrating duct carcinoma was observed on the ipsilateral side in one patient. Past history of the recurrence was identified in one patient. There were 14 benign, and 7 malignant cases(33%) during observed period. The microscopic findings were
as
follows; high cellularity of the tumor cells was observed in 5 patients(71.4%), with infiltrating contours in 3 patients(42.9%). The mitoses per 10 HPF were more than 5 in all cases. The cellular atypia was high in 3 patients(42.9%). Microscopic
hemorrhage and necrosis of the tumor cells were seen in 2 patients(28.6%) respectively. No axillary lymph node was invaded by tumors. Simple mastectomy with the axillary dissection or sampling were performed to all patients except one. Adjuvant
therapy
included chemotherapy and radiotherapy was practiced in 3 patients after the surgery. Follow-up of the patients was possible in 5 patients, and its duration varied from 1 month to 59 months. No recurrence or metastasis occured during this period.
These
results suggest that the prognosis of this disease can not be predicted by clinical features or microscopic grades independently, and simple mastectomy without axillary dissection is sufficent for the treatment.
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