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  IN THIS Article
 ::  Introduction
 ::  Case report
 ::  Discussion
 ::  References

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Year : 1985  |  Volume : 31  |  Issue : 4  |  Page : 215-6

Bilateral cystosarcoma phylloides with osteogenic sarcomatous stroma (a case report with review of literature).

How to cite this article:
Pandit A A, Vora I M, Shenoy S G, Gurjar A M. Bilateral cystosarcoma phylloides with osteogenic sarcomatous stroma (a case report with review of literature). J Postgrad Med 1985;31:215

How to cite this URL:
Pandit A A, Vora I M, Shenoy S G, Gurjar A M. Bilateral cystosarcoma phylloides with osteogenic sarcomatous stroma (a case report with review of literature). J Postgrad Med [serial online] 1985 [cited 2023 Sep 21];31:215. Available from:

  ::   Introduction Top

Cystosarcoma phylloides (CSP) occurs rarely in the breast. It constitutes only 1% of all the mammary tumours and 2.5% of the mammary fibro-epithelial lesions.[8]The behaviour of the tumour is not related to its histological appearance[8]and therefore, it is advisable to report it as cystosarcoma phylloides with fibrosarcomatous stroma, rather than 'malignant cystosarcoma phylloides'. The sarcomatous stromal elements, described in the descending order of frequency are fibrosarcoma, liposarcoma, fibrosarcoma with liposarcoma, chondrosarcoma, rhabdomyosarcoma and osteogenic sarcoma.[8]Many metastatic lesions to distant organs are described;[6],[7]however, only 5 cases of bilateral CSP are recorded in the literature.[2],[3],[7]The purpose of presenting this case is its rare bilaterality as well as osteogenic sarcomatous stroma.

  ::   Case report Top

A 32 year old lactating female was admitted 2 months after her delivery with complaints of a lump in the left breast for 4 months. Simple extended mastectomy of the left breast was performed. A small lump in the right breast was also noticed a month later and was biopsied.
The resected specimen of left breast, was measuring 25 x 18 x 10 cm. It was covered by skin and was ulcerated just above the nipple. The ulcer was measuring 5 cm, in diameter and was hypopigmented. The rest of the skin had orange peel like appearance. The tumour was bosselated and consisted of multiple nodules, varying from 3 to 6 cm in diameter. Cut section of the tumour showed multiple yellowish and whitish solid and cystic areas, and areas of gritty consistency[Fig. 1].
Three small axillary lymph nodes were dissected, which were homogenous on cut surface.
The lump in the right breast measured 2.5 x 2 x 1 cm and had yellowish, necrotic, partly solid and partly cystic and gritty appearance. The tumour of left breast showed epithelial component, as well as cellular stroma. The epithelial component revealed elongated, leaf-like ducts, lined by hyperplastic epithelium showing the remnants of fibroadenoma.[Fig. 2]. At places, the cellular stroma was pushing the epithelium into cystic spaces, obliterating the lumen of the cysts. The stromal component was very cellular and showed marked variation. The cells were found to be polygonal, with large hyperchromatic nuclei and scanty cytoplasm. Tumour giant cells, as well as many osteoclast like giant cells were present. There were large areas of neoplastic osteoid, and neoplastic bone formation giving an appearance of oesteogenic sarcoma to the stroma. Histological diagnosis of cystosarcoma phylloides with osteogenic sarcomatous stroma was made[Fig. 3].
The lump from the right breast also showed a similar tumour with areas of osteogenic sarcoma but with more areas of breast lobules showing evidence of lactation.
The axillary lymph nodes revealed granulomas consisting of epitheloid cells, giant cells and occasional Langhan's giant cell without definite caseation.

  ::   Discussion Top

All the cases of bilateral CSP reported so far except one occurred in young women in association with pregnancy and lactation.[2],[3],[7]Adair[1]has proposed lactation as a precipitating factor in the metamorphosis of bilateral CSP.
Many workers have shown clinical as well as microscopic evidence of development of CSP from fibroadenoma.[2],[4],[9]In the present case also, intracanalicular fibroadenoma was seen at the peripheral part of the tumour, and the hyperplastic ductular epithelium. However, Pietruszka[8]found hyperplastic epithelium in benign cases and atrophic or normal epithelium in malignant cases. In a few cases of mammary tumours, bone and osteoid tissues have been reported. Sugano[9]reported cells ultrastructurally resembling benign histocytic giant cells in the vicinity of haemorrhagic areas in infiltrating duct carcinoma and lobular carcinoma. In the present case also, osteoclast like giant cells were seen near the haemorrhagic area. Epitheloid granulomas have been described in regional lymph nodes[5]in cases of malignancy as seen in this case.

  ::   References Top

1.Adair, F. E. and Herrmann, J. B.: Sarcoma of the breast with a report of thirty cases. Surgery, 19: 55-73, 1946.  Back to cited text no. 1    
2.Azzopardi, J. G.: Problems in Breast Pathology'. In the series of 'Major Problems in Pathology' Volume 11. W. B. Saunders and Company, Philadelphia, London and Toronto, 1979, pp 346-365.  Back to cited text no. 2    
3.Bader. E. and Isaacson, C.: Bilateral malignant cystosarcoma phylloides, Brit. J. Surg., 48: 519-521, 1961.  Back to cited text no. 3    
4.Curran. R. C. and Dodge, O . G.: Sarcoma of breast with particular reference to its origin from fibroadenoma. J. Clin. Pathol., 15: 1-16, 1962.  Back to cited text no. 4    
5.Gregorie, H. B., Othersen, H. B. and Moore, M. P. Jr.: The significance of sarcoid-like lesions in association with malignant neoplasms. Amer. J. Surg., 104: 577-586, 1962.  Back to cited text no. 5    
6.Norris, H. J. and Taylor, H. B.: Relationship of histological features to behaviour of cystosarcoma phylloides-analysis of ninety four cases. Cancer, 20. 2090-2099, 1967.  Back to cited text no. 6    
7.Notley, R. G. and Griffiths, H. J. L.: Bilateral malignant cystosarcoma phylloides. Brit. J. Surg., 52: 360-362, 1965.  Back to cited text no. 7    
8.Pietruszka, M. and Barnes, L.: Cystosarcoma Phylloides-a clinicopathological analysis of 42 cases. Cancer, 41: 1974 1983, 1978.  Back to cited text no. 8    
9.Sugano, I., Nagao, K., Kondo, Y., Mabeshima, S. and Murakami, S.: Cytologic and ultrastructural studies of a rare breast carcinoma with osteoclast like giant cells. Cancer, 52: 74-78, 1983.  Back to cited text no. 9    

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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
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