Cystosarcoma phylloides

Uncommon breast lesion with a cystic component, fleshy appearance with papillary features of stromal connective tissue lined with epithelium.

Fibroepithelial lesions that constitute less than 1% of all breast neoplasms.

The tumors are defined as benign, borderline, and malignant on the basis of histological grading.

Usually present with large size and managed by wide excision, or mastectomy requiring clear margins.

Malignant and borderline subtypes have high rates of local recurrence and are capable of metastases.

Arise from interlobular stroma.

Can occur at any age but most commonly present in the 6th decade of life.

Occurs about 10-20 years later than the average presentation of a fibro adenoma.

Most patients present with a palpable mass and few are detected by mammogram.

Most lesions behave as a benign lesion and the majority are not cystic in nature. tumors vary from a few centimeters to massive size.

Larger lesions have bulbous protrusions with nodules of proliferating stroma with an epithelial covering.

Low grade lesions are similar to fibroadenomas but have increased cellularity and mitotic features.

High grade lesions must be differentiated from soft tissue sarcomas.

Higher grade lesions may recur.

Must be resected with wide margins to prevent local recurrence and axillary lymph node dissection is not indicted.

The treatment paradigm has shifted from total mastectomy to breast conserving surgery with less mobility and improved cosmesis.

Guidelines recommend tumor free margins of at least 1 cm.

Positive resection margins reported in up to 15% and is a strong predictor of local recurrence with reexcision is highly recommended.

Despite negative resection margins, 13-27% of patients treated with breast conserving surgery experience local recurrence.

While they may recur locally this lesion only rarely metastasizes.

Rare high-grade lesions can be aggressive, tend to local recurrence and may have distant hematogenous metastases.

Increased incidence among Latin Americans.

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