CYSTOSARCOMA PHYLLODES

                                         CYSTOSARCOMA PHYLLODES

     
 This is a rare predominantly benign tumour that occurs almost exclusively in the female breast. It is also called phyllode sarcoma, phyllodes tumour or serocystic disease of Brodie. They are typically large, fast growing mass that form from the periductal stromal cells of the breast. Phyllodes tumour is the most commonly occurring non-epithelial neoplasm of the female breast, although it represents only about 1% of tumours in the breast. It occurs usually in premenopausal women 30-50 years of age but can also occur in the young. Reports suggest that about 85-90% of phyllodes tumours are benign and that approximately 10-15% are malignant.

      They are circumscribed, fast growing and exhibit hypercellular stroma. It has some features similar to giant fibroadenoma but exhibits far more hyperplasia, pleomorphism and mitotic activity.

      Clinically, the patient presents with a fast growing breast mass. A small mass may rapidly increase in size in the few weeks before the patient seeks medical attention. On examination of the breast, despite the size of the mass, they remain mobile on the chest wall. That’s, there is a firm, mobile, well circumscribed, non-tender breast mass. Occasionally, ulceration of the overlying skin occurs because of pressure necrosis. Curiously, cystosarcoma phyllodes tend to involve the left breast more commonly than the right but reason for this is unknown.

       The diagnosis is based on history, physical exam, histology and other investigations deemed fit. Histologically, there is fibrosis, stroma hypercellularity, atypia and mitosis. Mammograghic  findings (that is, the appearance of round densities with smooth borders) are similar to those of fibroadenoma.

       The treatment is excision biopsy including some normal breast tissue (wide local excision with a clear margin of normal breast tissue). Recurrence occurs in 25% of patients over 10 years and 5% of these become malignant.