IJCRR - 8(16), August, 2016
METASTATIC OVARIAN CYSTOSARCOMA PHYLLOIDES OF BREAST
Author: Papa Dasari, Haritha Sagili, Priyanka Yoga Purani
Background: Cystosarcoma Phylloides is a rare breast neoplasm constituting ? 1% of all breast neoplasms. These are mostly benign and reccur. Malignant cystosarcoma Phylloides can recur and metastasize to lung, bone and abdominal viscera. Metastasis to Ovary is not reported in literature.
Case: A 46 year old multiparous lady was diagnosed with a recurrent cystosarcoma of right breast and a large Ovarian mass which was causing her dyspnoea. The mass was of 30 weeks size and was firm and tender. CECT showed a large solid abdominopelvic mass with irregular enhancing septate extending from pelvis to infracolic area with minimal free fluid. Uterus and Ovaries could not be delineated. FNAC from the mass was reported as low-grade malignant mesenchymal tumour. CA 125 was within normal range. Laparotomy revealed a large fleshy mass with jelly like material which was adherent to intestines and pelvic and parietal peritoneum. Right ovary is not visualized. Left ovary parially visualised and incorporated into the mass. Excision of the mass with TAH and BSO was carried out. There was diffuse ooze from the pelvic and peritoneal cavity which was managed by packing, blood product transfusion and tranexamic acid. She received massive transfusion and survived. Later she developed haemoptysis and underwent tracheostomy and feeding ileostomy and was managed in ICU for 8 weeks. Palliative mastectomy and adjuvant Radiotherapy and chemotherapy were differed by Oncologists and hence she was discharged after 4 months of admission.
Conclusion: Managing ovarian metastasis from cystosarcoma phylloids can be challenging and the quality of life is poor when the primary disease is not managed adequately.
Keywords: Palliative mastectomy, Phylloid tumours, Ovarian tumour
Papa Dasari, Haritha Sagili, Priyanka Yoga Purani. METASTATIC OVARIAN CYSTOSARCOMA PHYLLOIDES OF BREAST International Journal of Current Research and Review. 8(16), August, 21-25
1. Parker SJ, Harries SA, Phylloid tumours. Postgrad Med J 2001;77:428–435
2. Ang TL Leong Ng VW, Fock KM, Teo EK, Chong CK. JOP. J Pancreas 2007; 8(1):35-38.
3. Chen WH, Cheng SP, Tzen CY, Yang TL, Jeng KS, Liu CL, Liu TP. Surgical treatment of phyllodes tumors of the breast: retro-spective review of 172 cases. J Surg Oncol. 2005 ;91(3):185- 194.
4. Grimes MM. Cystosarcoma phyllodes of the breast: histologic features, flow cytometric analysis, and clinical correlations.Mod Pathol. 1992;5:323-329..
5. Palko MJ1 , Wang SE, Shackney SE, Cottington EM, Levitt SB, Hartsock RJ. Flow Cytometric S fraction as a predictor of clinical outcome in Cystosarcoma Phylloides. Arch Pathol Lab Med. 1990 Sep;114(9):949-52.
6. Bharat RJ Jr. Histologic features predict local recurrence after breast conservating therapy of Phylloid tumours.. Breast Cancer Res Treat. 1999 ;57(3):291-5.
7. Kapali AS, Singh M, Deo SVS, Shukla NK, Muduly DK. Aggressive palliative surgery in metastatic Phylloids tumor: Im pact on quality of life.Ind J Palliat Care. 2010; 16 (2):101-104.
8. Khangembam BC, Sharma P,Singla S,Shingal A,Dhull VS, Bal C,Kumar R. .Malignant Phylloides tumour of the Breast metastasing to the Vulva.18 F-FDG PET-CT demonstrating rare metastasis from a rare tumour Nucl Med Mol Imaging .2012 46:232–233
9. Hines JR, Gordan RT, Widger C, Kolb T.Cystosarcoma Phylloids metastatic to a Brenner tumour of the ovary. Arch Surg 1976;111(3):299-300.
10. Jacklin RK, Ridgway PF,. Ziprin P,, Healy V, Hadjiminas D, and . Darzi A, “Optimising preoperative diagnosis in phyllodes tumour of the breast,”. J Clin Pathol, 2006; 59(5):454–459.
11. Hawkins RE,Wiltshaw E,Fisher C McKinna JA..Ifosphamide is an active drug for chemotherapy of metastatic Cystosarcoma Phylloides.Cancer.1992;69:2271-2275.
12. Wei J,Tan Yu-T, Cai Yu C, Yuan Z-Yu, Yang D, Wang SS.Predictive factors for local recurrence and distant metastasis of Phylloides tumours of the breast: a retrospective analysis of 192 cases at a single centre. Chin J Cancer; 2014; 33 (10):492- 500.