Incisional biopsy of a breast mass in a 3 5-year-old woman demonstrates a hypercellular fibroadenoma (Cystosarcoma phyllodes) at the time of frozen section. Appropriate management of this lesion could include
Cystosarcoma phyllodes is a tumor most often seen in younger women. It can grow to enormous size and at times ulcerate through the skin. Still, it is a lesion with low propensity toward metastasis. Local recurrence is common, especially if the initial resection was inadequate. Simple re-excision with adequate margins is curative. Very large lesions may necessitate simple mastectomy to achieve clear margins. Axillary lymphadenectomy, however, is seldom indicated without biopsy-positive demonstration of tumor in the nodes. The low incidence of metastatic disease suggests that adjunctive therapy is indicated only for known metastatic disease, even when the tumors are quite large and ulcerated.
Wide local excision with a rim of normal tissue
Lumpectomy and axillary lymph- adenectomy
Modified radical mastectomy
Excision and postoperative radiotherapy
Breast