A Cross Sectional Study on Surgical Management of Phyllodes Tumours at a Teaching Tertiary Institution in India

Background: Phyllodes tumours are rare fibroepithelial lesions of the breast. The words “phyllodes” are derived from the latin phyllodium and greek phullodes meaning leaf like. Unlike breast carcinoma, phyllodes tumors start outside of the ducts and lobules, in the breast’s connective tissue, called the stroma which includes the fatty tissue and ligaments that surround the ducts, lobules, and blood and lymph vessels in the breast.

Aim: The aim of the study is to clinical presentation and management of phyllodes tumour.

Methods: A prospective study was conducted in the department of surgery in a medical college and hospital in central India over a period from March 2006 to March 2016. A total of 96 female patients of phyllodes tumour were included in this study. A detailed clinical history and examination of the breast lump were done.

Results: Out of 98 patients, the majority of patients were in the age group of 31 - 40 years. The mean age of presentation was 37 years ranging from 12 years to 57 years. 43.75% of patients had breast lumps involving all four quadrants of the breast. All patients were subjected to surgical management. The modality of treatment available for surgical management of phyllodes tumor includes wide local excision, lumpectomy, simple mastectomy and radical mastectomy. The surgical management includes wide local excision in 28, lumpectomy in 26, simple mastectomy in 40 and radical mastectomy in 02 patients. Three histotypes of phyllodes tumor, i.e., benign (42 cases, 43.75%), borderline (12 cases, 12.5%), and malignant (42 cases, 43.75%) were observed in the present study. The adjuvant radiotherapy may be effective in reducing the risk of local recurrence. Three drugs such as ifosfamide, cisplatin and etoposide have been described to be effective for malignant phyllodes.

Conclusions: Preoperative diagnosis and proper management are crucial in phyllodes tumours because of their tendency to recur and malignant potential in some of these tumours. Excision of the phyllodes tumour with a wide margin of healthy tissue is a safe and effective method of local control. A positive axillary lymph node enlargement would necessitate an axillary lymph node dissection followed by chemotherapy and radiotherapy.