Management of cvstosarcoma phylioides in a young female:

Ans: A (Wide excision with a margin) Ref: Robbins Pathologic Basis of Disease, 8th edition & Bailey and Love's Short Practice of Surgery 25th EditionExplanation:PHYLLODES TUMORThey are a fibroepithelial tumor composed of an epithelial and a cellular stromal component.Phyllodes tumors arise from intralobular stromaMost patients present in the sixth decade.The majority is detected as palpable masses, but a few are found by mammography.Aka cvstosarcoma phy llodes and serocystic disease of brodie.However, the term phyllodes tumor is preferred, since most are benign and are not cystic.Around 70% are benign.MorphologyThe tumors vary in size from a few centimeters to massive lesions.The larger lesions have bulbous protrusions (phyllodes "leaflike") due to the presence of nodules of proliferating stroma covered by epithelium.In some tumors these protrusions extend into a cystic space.Low-grade lesions resemble fibroadenomas but contain more cellular and contain mitotic figures. High-grade lesions have foci of mesenchymal differentiation (DD: soft-tissue sarcomas).The frequent chromosomal mutation is amplification of EGFR.TreatmentExcision with wide margins or by mastectomy (to avoid local recurrences).Axillary lymph node dissection is not indicated, because of nodal metastases is rare.I he majority are low-grade tumors that may recur locally but only rarely metastasize.Rare high-grade lesions behave aggressively, with frequent local recurrences and distant hematogenous metastases in about one third of cases.Malignant Phyllodes - Total Mastectomy.