RECURRENT CYSTOSACROMA PHYLLOIDES TUMOUR OF BREAST WITH LIPOSRCOMATOUS DIFFERENTIATION

Cysteosarcoma phylloides (CP) constitutes a rare form of breast neoplasia, which represents less than 1% of total breast neoplasias and only 2,3% of all fibro-epithelial breast tumors.It is termed "cystosarcoma phylloides" because of the extensions of the tumor mimicking the shape of leaves, intruding within the cystic cavities of the tumor. Phyllodes tumours of the breast are characterized by having both an epithelial as well as stromal component and these usually comprise almost 3% of all fibroepithelial tumours. They are exceptional in this aspect to convert into a stromal sarcoma of the breast after multiple recurrences. The stromal component of phyllodes tumor has the potential to undergo metaplasia to cartilage, bone, smooth muscle and striated muscle as well as their respective malignant neoplasms. The liposarcomatous differentiation of the stromal elements of phyllodes tumor is extremely rare. The recurrence rate is 1 6-28% after mastectomy or wide-wedge resection and 28- 46% after simple enucleation of the tumor. The tumor metastasizes via the vascular route; about two thirds of metastases are to the lungs, fewer are to the bone, liver, and myocardium. Phylloides tumor occurs mostly in women in their fifth or sixth decade, and occasionally in women younger than 20 years old.

Giant tumors of the breast in adolescents and types of reconstruction during thelarche.

e12614 Background: Tumors like cystosarcoma phylloides may exhibit malignant potential and occur already in young adolescents in their thelarche. Adolescents often do not report the growth of a tumor in the breast due to lack of knowledge or shame. The necessity for surgical intervention interferes with the normal development of the breast, however must be performed due to the deformation of the growing breast and the malignant potential of cystosarcoma phylloides. Methods: We report on two young girls, 13 years of age, who presented with giant cystosarcoma phylloides and fibroadenomas, with tumor diameters of 9 and 13 cm in their thelarche with extension to whole volume of the breast. Results: Both tumors were removed via an axillary access to the breast to avoid scars in the developing breast and removed with free margins at first surgical intervention. Autologous reconstruction by lateral thoracic wall advancement mammaplasty in one patient and implant based reconstruction as a temporary spacer have been used for reconstruction. The young patients showed a high degree of satisfaction in validated Breast QoL questionnaires. Conclusions: Surgical intervention in giant cystosarcoma phyllodes of the breast in adolescents require careful planning of surgery and avoid unnecessary scars in the developing breast. Axillary approach for surgical removal of the tumor and replacement by thoracic wall advancement mammoplasty or temporary implant-based reconstruction may both be safely applied in thelarche.