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Breast Cancer (Expert Forum)
Need re-exision without no margin but with clear margin benign phyllodes tumor ?
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Need re-exision without no margin but with clear margin benign phyllodes tumor ?
by LucyCHOI, Mar 15, 2007 12:00AM
I had a excision 10 days ago because of phyllodes tomor and it turned out as a benign. But I'm worried about recurrence because my surgeon didn't cut enough breast tissue.
The tumor size was 4x3.8x4.4cm and tumor was allocated over lower inside of right breast and under the nipple.
Following is the pathology report after surgery.
** Received in formalin and labeled right breat mass is a lump of breast tissue, measuring 4.2x3.8x3.4 cm and weighing 26gm.
A relatively well-defined mass (4x3.8x4.4cm) is present. The cut surface of the mass is creamy white and solid without hemorrhage or necrosis.
Representative sections are submitted in four cassetes.(photox1)
- DIAGNOSIS: phyllodes tumor, benign with clear resection margin. **
The surgury was performed as a excision and remained nipple.
For nipple side, there was no margin and for other side of tumor about few mm margin was secured.
I am 31 years old and I am planning to be pregant at least one more time.
According to the this forum, 2cm margine is recommended even though the tumor is benign, pregnacy can issue tumor recurrence and a benign phyllodes tumor can be malignat when it recurrs.
So I'm wonder whether I need to perform re-excution to prevent recurrence. Do I need to perform re-excision or not?
The tumor size was 4x3.8x4.4cm and tumor was allocated over lower inside of right breast and under the nipple.
Following is the pathology report after surgery.
** Received in formalin and labeled right breat mass is a lump of breast tissue, measuring 4.2x3.8x3.4 cm and weighing 26gm.
A relatively well-defined mass (4x3.8x4.4cm) is present. The cut surface of the mass is creamy white and solid without hemorrhage or necrosis.
Representative sections are submitted in four cassetes.(photox1)
- DIAGNOSIS: phyllodes tumor, benign with clear resection margin. **
The surgury was performed as a excision and remained nipple.
For nipple side, there was no margin and for other side of tumor about few mm margin was secured.
I am 31 years old and I am planning to be pregant at least one more time.
According to the this forum, 2cm margine is recommended even though the tumor is benign, pregnacy can issue tumor recurrence and a benign phyllodes tumor can be malignat when it recurrs.
So I'm wonder whether I need to perform re-excution to prevent recurrence. Do I need to perform re-excision or not?
Doctor's Answer
by CCF-RN-JS, Mar 15, 2007 12:00AM
Dear LucyCHOI, The following information regarding phyllodes tumor is directly from the textbook “Cancer: Principles and Practice of Oncology” 6th edition, edited by DeVita,V., Hellman,S., and Rosenberg, S. Beyond this, in terms of your individual case, you would need to discuss any additional interpretations of the pathology report regarding the margins with your surgeon.
“The term phyllodes tumor includes a group of lesions of varying malignant potential ranging from completely benign (non-cancerous) to fully malignant sarcomas.
Phyllodes tumors are classified as benign, borderline, or malignant based on the nature of the tumor margins (pushing or infiltrative) and presence of cellular atypia, mitotic activity, and overgrowth in the stroma. There is disagreement about which of these criteria is most important, although most experts favor stromal overgrowth. The percentage of phyllodes tumors classified as malignant ranges from 23% to 50%. Axillary metastases are reported in less than 5% of cases, but are a poor prognostic sign when present. Metastases more commonly follow the pattern seen with sarcomas (with lung as the most common site) and histologically resemble sarcomas. Approximately 20% of phyllodes tumors recur locally if excised with no margin or a margin of a few millimeters of normal breast tissue, regardless of whether they are benign or malignant. A wide excision with a 2cm margin of normal breast tissue is appropriate therapy for benign and borderline phyllodes tumors unless they are so large that this is not cosmetically feasible. In the past, many authors have advocated mastectomy for the management of malignant phyllodes tumors. Since phyllodes tumors are not multicentric, there is no clear-cut biologic rationale for mastectomy, and series have reported the successful treatment of malignant phyllodes tumors with wide excision. The use of systemic therapy for malignant phyllodes tumors is based on guidelines for treating sarcomas.”
“The term phyllodes tumor includes a group of lesions of varying malignant potential ranging from completely benign (non-cancerous) to fully malignant sarcomas.
Phyllodes tumors are classified as benign, borderline, or malignant based on the nature of the tumor margins (pushing or infiltrative) and presence of cellular atypia, mitotic activity, and overgrowth in the stroma. There is disagreement about which of these criteria is most important, although most experts favor stromal overgrowth. The percentage of phyllodes tumors classified as malignant ranges from 23% to 50%. Axillary metastases are reported in less than 5% of cases, but are a poor prognostic sign when present. Metastases more commonly follow the pattern seen with sarcomas (with lung as the most common site) and histologically resemble sarcomas. Approximately 20% of phyllodes tumors recur locally if excised with no margin or a margin of a few millimeters of normal breast tissue, regardless of whether they are benign or malignant. A wide excision with a 2cm margin of normal breast tissue is appropriate therapy for benign and borderline phyllodes tumors unless they are so large that this is not cosmetically feasible. In the past, many authors have advocated mastectomy for the management of malignant phyllodes tumors. Since phyllodes tumors are not multicentric, there is no clear-cut biologic rationale for mastectomy, and series have reported the successful treatment of malignant phyllodes tumors with wide excision. The use of systemic therapy for malignant phyllodes tumors is based on guidelines for treating sarcomas.”
