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Surgery

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Breast

Question
15 out of 93
 

A smooth rubbery 3 cm lesion is removed from the breast of a 35-year-old woman with a preoperative diag­nosis of fibroadenoma. Histologically this lesion is found to be a phyllode tumor. Appropriate management at this time is



A Observation only

B Re-excision of the area with a I cm margin

C Total (simplE. mastectomy

D total mastectomy with axillary dissection

Ans. B Re-excision of the area with a I cm margin (Ref. Schwartz surgery 8TH EDN PG 487)

a. The nomenclature, presentation, and diagnosis of phyllodes tumors (including cystosarcoma phyllodes) have posed many problems for surgeons.

b. These tumors are classified as benign, borderline, or malignant.

c. Borderline tumors have a greater potential for local recurrence.

d. Mammography evidence of calcifications and morphologic evidence of necrosis do not distinguish between benign, borderline, and malignant phyllodes tumors, it is difficult to differentiate benign phyllodes tumors from the malignant variant and from fibroadenomas.

e. Phyllodes tumors are usually sharply demarcated from the surrounding breast tissue, which is compressed and distorted.

f. Most malignant phyllodes tumors contain liposarcomatous or rhabdomyosarcomatous elements rather than fibrosarcomatous elements.

g. Small phyllodes tumors are excised with a 1-cm margin of normal-appearing breast tissue.

h. When the diagnosis of a phyllodes tumor with suspicious malignant elements is made, re-excision of the biopsy site to insure complete excision of the tumor with a 1-cm margin of normal-appearing breast tissue is indicated.

i. Large phyllodes tumors may require mastectomy.

j. Axillary dissection is not recommended as axillary lymph node metastases rarely occur.

Breast Flashcard List

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