Memenin Filloides Tümörlerinin Klinikopatolojik Özellikleri

Yıl 2020, Cilt: 22 Sayı: 2, 91 - 95, 30.08.2020

Saliha Karagöz Eren Yunus Dönder Tamer Ertan Ebru Akay Alaettin Arslan

https://doi.org/10.18678/dtfd.710317

Öz

Amaç: Memenin filloides tümörleri nadir görülen meme tümörleridir ve tüm meme neoplazmlarının %1’inden daha azını oluştururlar. Bu çalışmanın amacı filloides tümör nedeniyle hastanemizde opere edilen olguların klinikopatolojik özelliklerini irdelemektir.

Gereç ve Yöntemler: Histopatolojik olarak 9 yıllık süre içerisinde filloides tümör tanısı konulan 16 olgu retrospektif olarak hastane tıbbi kayıtlarından incelendi.

Bulgular: Yaş ortalaması 45,6±15,3 yıl olan 16 kadın hasta vardı. Preoperatif tanı için 5 olguya manyetik rezonans görüntüleme yapıldı ve 4'ü filloides tümör olarak raporlandı, bu hastaların tümü histopatolojik olarak yüksek gradeli filloides tümörlerdi (borderline veya malign). Preoperatif dönemde tanı amaçlı kor biyopsi 14 hastaya yapıldı ve iki hastaya histopatolojik olarak filloides tümör tanısı konuldu. Altı hastada hipersellüler fibroadenom ve filloides tümör arasında ayrım yapılamadı. Meme koruyucu cerrahi 10 (%62,5) hastada en sık yapılan operasyon tipi olup, meme koruyucu cerrahi yapılan ve cerrahi sınır pozitif gelen üç hasta tekrar ameliyat edildi. Patolojik tanı sırasıyla yedi (%43,8), beş (%31,3) ve dört (%25,0) hastada benign, borderline ve malign idi. Postoperatif patoloji sonuçlarına göre ortanca tümör çapı 6 cm olarak ölçüldü. Ortanca takip süresi 36 aydı. Bu sürede sistemik metastaz ya da lokal nüks görülmedi.

Sonuç: Sağlam cerrahi sınırla geniş eksizyon, hastalığın cerrahi yönetimi ve lokal rekürrensin önlenmesi için en önemli faktör olarak görünmektedir. Preoperatif dönemde tanı koymak sınır pozitifliğini önleyerek sekonder cerrahi müdahale ihtiyacını azaltmaya katkıda bulunur.

Anahtar Kelimeler

Filloides tümör, meme, cerrahi

Clinicopathologic Features of Phyllodes Tumor in Breast

Öz

Aim: Phyllodes tumors are rare breast neoplasms comprising less than 1% of all breast neoplasms. The objective of this study was to consider the clinicopathological features of phyllodes tumors that underwent surgery in our hospital.

Material and Methods: We retrospectively analyzed the medical records of 16 patients who had histologically diagnosed phyllodes tumors over 9 years.

Results: There were 16 female patients with a mean age of 45.6±15.3 years. Magnetic resonance imaging was performed in 5 cases for preoperative diagnosis, and 4 were reported as phyllodes tumors, all of these patients were having high-grade phyllodes tumors (borderline or malignant) histopathologically. Preoperative core biopsy was performed in 14 patients, and histopathologically phyllodes tumor was diagnosed in two patients. In six patients, differentiation between hypercellular fibroadenoma and phyllodes tumor could not be performed. Breast-conserving surgery was the most common type of operation performed in 10 (62.5%) patients, three patients with positive margins were underwent reoperation. The pathological diagnoses were benign, borderline, and malignant in seven (43.8%), five (31.3%) and four (25.0%) patients, respectively. The median diameter of the tumors was measured as 6 cm after the postoperative pathological analysis. The median follow-up time was 36 months. During this time, there was no local or systemic recurrence.

Conclusion: Wide excision with a clear margin appears to be the most important factor in the management of these tumors and in the prevention of local recurrence. The preoperative diagnosis of phyllodes tumors contributes to decreasing the necessity for secondary surgical intervention avoiding border positivity.

Anahtar Kelimeler

Phyllodes tumor, breast, surgery

Kaynakça

• Macdonald OK, Lee CM, Tward JD, Chappel CD, Gaffney DK. Malignant phyllodes tumor of the female breast: association of primary therapy with cause-specific survival from the Surveillance, Epidemiology, and End Results (SEER) program. Cancer. 2006;107(9):2127-33.
• Ditsatham C, Chongruksut W. Phyllodes tumor of the breast: diagnosis, management and outcome during a 10-year experience. Cancer Manag Res. 2019;11:7805-11.
• Chen WH, Cheng SP, Tzen CY, Yang TL, Jeng KS, Liu CL, et al. Surgical treatment of phyllodes tumors of the breast: retrospective review of 172 cases. J Surg Oncol. 2005;91(3):185-94.
• Reinfuss M, Mituś J, Duda K, Stelmach A, Ryś J, Smolak K. The treatment and prognosis of patients with phyllodes tumor of the breast: an analysis of 170 cases. Cancer. 1996;77(5):910-6.
• Ang MK, Ooi AS, Thike AA, Tan P, Zhang Z, Dykema K, et al. Molecular classification of breast phyllodes tumors: validation of the histologic grading scheme and insights into malignant progression. Breast Cancer Res Treat. 2011;129(2):319-29.
• Barth RJ Jr, Wells WA, Mitchell SE, Cole BF. A prospective, multi-institutional study of adjuvant radiotherapy after resection of malignant phyllodes tumors. Ann Surg Oncol. 2009;16(8):2288-94.
• Hassouna JB, Damak T, Gamoudi A, Chargui R, Khomsi F, Mahjoub S, et al. Phyllodes tumors of the breast: a case series of 106 patients. Am J Surg. 2006;192(2):141-7.
• Rajan PB, Cranor ML, Rosen PP. Cystosarcoma phyllodes in adolescent girls and young women: a study of 45 patients. Am J Surg Pathol, 1998,22(1):64-9.
• Islam, S, Saroop S, Bheem V, Naraynsingh V. Largest giant juvenile fibroadenoma of the breast. BMJ Case Rep. 2019;12(1):e227277.
• Sosin M, Pulcrano M, Feldman ED, Patel KM, Nahabedian MY, Weisler JM, et al. Giant juvenile fibroadenoma: a systematic review with diagnostic and treatment recommendations. Gland Surg. 2015;4(4):312-21.
• Khurshid A, Kayani N, Bhurgri Y. Phylloides tumors in adolescent girls and young women in Pakistan. Asian Pac J Cancer Prev. 2006,7(4):563-6.
• Adesoye T, Neuman HB, Wilke LG, Schumacher JR, Steiman J, Greenberg CC. Current trends in the management of phyllodes tumors of the breast. Ann Surg Oncol. 2016,23(10):3199-205.
• Chao TC, Lo YF, Chen SC, Chen MF. Sonographic features of phyllodes tumors of the breast. Ultrasound Obstet Gynecol. 2002:20(1):64-71.
• Foxcroft LM, Evans EB, Porter AJ. Difficulties in the pre-operative diagnosis of phyllodes tumours of the breast: A study of 84 cases. Breast. 2007;16(1):27-37.
• Tan H, Zhang S, Liu H, Peng W, Li R, Gu Y, et al. Imaging findings in phyllodes tumors of the breast. Eur J Radiol. 2012;81(1):e62-9.
• Ward ST, Jewkes AJ, Jones BG, Chaudhri S, Hejmadi RK, Ismail T, et al. The sensitivity of needle core biopsy in combination with other investigations for the diagnosis of phyllodes tumours of the breast. Int J Surg. 2012;10(9):527-31.
• Sotheran W, Domjan J, Jeffrey M, Wise MH, Perry PM. Phyllodes tumours of the breast- a retrospective study from 1982-2000 of 50 cases in Portsmouth. Ann R Coll Surg Engl. 2005;87(5):339-44.
• Kim YJ, Kim K. Radiation therapy for malignant phyllodes tumor of the breast: An analysis of SEER data. Breast. 2017;32:26-32.
• Tan BY, Acs G, Apple SK, Badve S, Bleiweiss IJ, Brogi E, et al. Phyllodes tumours of the breast: a consensus review. Histopathology. 2016;68(1):5-21.
• Tan PH. Fibroepithelial tumours and hamartomas of the breast. In: WHO Classification of Breast Tumours Editorial Board, editors. WHO Classification of Tumours: Breast Tumours. 5th ed. Lyon: IARC; 2019. p.172-6.