Phyllodes Tumour Of The Breast. A Case Series Of 53 Patients In Malaysia

Abstract Background Phyllodes tumour of the breast is a rare entity, accounting for 0.5% of breast neoplasms. It’s treatment and prognosis are variable, and still up for debate. Objective The purpose of this study is to explore the clinicopathologic features and treatment strategies of patients who underwent surgical treatment of phyllodes tumour at our institution. Materials and methods We retrospectively reviewed the medical records of 53 patients who had surgical treatment for phyllodes tumour in Hospital Putrajaya between January 2020 - October 2023. Results The mean age was 45.3 (22-80 years). The tumor grades were classified as benign (23 cases, 43.4%), borderline (16 cases, 30.2%) and malignant (14 cases, 26.4%) based on WHO grading system. The mean tumoral size was 112 mm (17-365). Thirty-one (58.5%) patients underwent a local excision of tumor (18 benign and 9 borderline cases) and twenty two patients (41.5%) underwent a mastectomy with or without reconstruction (5 benign, 7 borderline and 14 malignant). 9 of our patients underwent radiotherapy (4 borderline and 5 malignant). The 4 cases of borderline phyllodes had undergone mastectomy and had inadequate margin clearance. Among of our cases of malignant phyllodes, 5 (35.7%) of them had metastatic disease at presentation, and 2 patients progressed to metastases during follow up. Local recurrence developed in 6 patients, (4 malignant, 1 borderline, 1 benign), giving a local recurrence rate of 28.6% for malignant, 6.25% for borderline, and 4.3% for benign respectively. The shortest time to the development of local recurrence in malignant disease was 3 months, further highlighting the aggressiveness of the malignant variant of phyllodes. In our results there was a significant correlation between tumour size and grade. Conclusion PT represents a heterogeneous group of tumours with an unpredictable outcome. Histopathological classification is the strongest prognostic factor for prognosis and a larger size at presentation should increase the suspicion of malignancy.