Breast Cancer Awareness Month

Breast Seminar

Seyed Morteza Mahmoodi

History 37 year old multiparous c/o growing mass in right breast since last 1 year Recently ulcerated, painful, bleeding, Rapidly grew before 6 month Previous breast US done in a private hospital Not currently lactating No previous breast disorders Review of systems normal No PMH 2 C-sections and no other PSH No FH of malignancies No significant social history

Examination 30 X 20 cm OQ right breast Overlaying skin Shinny, dilated veins, stretched skin Shallow 5 X 4 cm ulcer upper outer

quadrant Redness, swollen, pus in the ulcer base No nipple discharges

Palpation Non-tender, firm, well demarcated, Irregular, lobulated borders, freely mobile,

smooth surface Area around the ulcer warm Not fluctuant, not compressible, Normal contralateral breast No LN were palpable

Differential Diagnosis

Giant fibroadenoma Phylloides tumor Carcinoma

Phyllodes

Most common nonepithelial neoplasm of the breast

1% of tumors in the breast 85-90% benign Cyst-sarcoma-

phyllodes Phyllodes tumor

Benign Vs. Malignant Benign Tendency to grow aggressively Recurs locally Malignant Recurrent malignant tumors seem to be more aggressive Metastasis to lungs, skeleton, heart, and liver hemtogenously Metastasis to axillary lymph nodes occurred in only 2% Symptoms from metastasis seen as early as a few months to

as late as 12 years after the initial therapy 30% of patients with malignant phyllodes tumors die from the

disease Mostly within 3 years of the initial treatment

No cures for systemic metastases exist

Workup Imaging Studies Procedures Histologic Findings

                                                                  

Fibroadenoam Phyllodes

FibroadenomaPhyllodes tumour

Phylodes Vs. Fibroadenoma(Fibroepithelial Tumors) History Physical Examination Mammography US FNAC Core needle biopsy Histopathology Management

Surgical Treatment Wide local excision with adequate margin

of normal breast tissues regardless of histological type

Margins 2cm, 5cm Mass should not be ‘shelled out’ Quadranectomy Mastectomy LN involvement

Radiotherapy & Chemotherapy Role of radiotherapy remains unclear May be considered for high-risk phyllodes

tumors, including those >5cm, with stromal overgrowth, with >10 mitoses/high-power field, or with infiltrating margins

Doxorubicin and ifosfamide-based chemotherapies

Outcomes Locar recurrences of approximately 26% Stromal overgrowth, larger tumor size, and

involved margin were all significantly correlated with LR.

5-year survival rate malignant phyllodes tumour ranges from 54% to 82%

10-year ranges from 23% to 42%

Thank U