Surgery
A 40-year-old presents with a right breast lump that has been present for 2 years.
On examination, there is firm lump about 4 x 5 cm in the inner quadrant, overlying skin is normal and no palpable axillary nodes (see report) Trucut biopsy: Cystosarcoma Phylloides. Which of the following is the most appropriate management?
Explanation
Core Concept: Phyllodes tumor (Cystosarcoma Phyllodes) is a rare fibroepithelial breast tumor that can be benign, borderline, or malignant. It has a high rate of local recurrence if not completely excised.
Clinical Presentation:
- Rapidly growing, painless, firm, mobile breast mass.
- Overlying skin may be shiny, stretched, or have prominent veins.
- Complications: Local recurrence, hematogenous metastasis (if malignant, typically to lungs/bones).
Diagnosis:
- First-line: Mammography and Ultrasound showing a well-circumscribed, multilobulated mass with cystic spaces.
- Gold standard: Core needle biopsy (Trucut) or excisional biopsy for histopathology (characteristic leaf-like architecture).
Management:
- Acute: Prompt surgical planning; no immediate emergency medical stabilization required.
- Long-term/Definitive: Wide local excision with at least 1 cm clear margins. Routine axillary lymph node dissection is not indicated as lymphatic spread is rare. Mastectomy is reserved for tumors too large for breast conservation.