Phyllodes tumors of the breast diagnostic and therapeutic dilemmas.

BACKGROUND: This article compares experiences in the diagnosis and treatment of phyllodes tumors from 2 regional institutions with the relevant literature. PATIENTS AND METHODS: From 1991 to 2005, 2,848 breast cancer patients were treated in our institutions, 36 (1.44%) for phyllodes tumors. The average tumor size was 5.1 cm (range 1.4-19.6). Triple assessment was the standard diagnostic algorithm. Wide excision with tumor-free margins was carried out in 29 (80.5%) cases and mastectomy in 7 (19.4%) cases. Axillary lymphadenectomy was performed in patients with positive lymph nodes. RESULTS: Histology showed the phyllodes tumors to be benign in 27 (75.0%), malignant in 6 (16.6%), and borderline in 3 (8.3%) cases. Follow-up was from 5 months to 16 years. In this period, recurrences of 3 (8.3%) malignant and 2 (5.6%) benign phyllodes tumors were diagnosed and treated. 10 (27.7%) patients treated with wide local excision showed deformities in the form of scarring. The steroid receptor status was of no prognostic value in our patients, and chemotherapy was used in only 1 (2.7%) patient. 5-year survival was 86.2%. CONCLUSION: Our study shows that tumor size, margin infiltration, mitotic activity and degree of cellular atypia are important prognostic factors. Problems in diagnosing this condition arise from its similarity to fibroadenoma. Although wide local excision is usually the treatment of choice, tumor recurrence is common. Axillary lymphadenectomy in malignant phyllodes tumors is, in our opinion, still controversial.

[Lung lesions in penetrating war injuries of the chest]. / Ozljede pluca kod ratnih penetrantnih trauma prsnog kosa.

Presentation is made of 157 patients with lung parenchymal lesions due to penetrating war injuries of the chest, 50.3% civilians and 49.3% soldiers. The wounds were mostly inflicted by cluster projectiles (71.4%), followed by firearms (25.5%) and sharp instruments (3.1%). The injuries were characterized as a combination of laceration and lung contusion. In case of lung laceration, a moderate to massive hemopneumothorax develops. Clinically, the manifestation of lung contusion may range from hardly observable dyspnea and hemophthisis through tachypnea, tachycardia and cyanosis. Most lesions of pulmonary parenchyma can be managed by thoracic drainage, whereas in case of massive bleeding and air loss thoracotomy and appropriate operative procedures are recommended. We used anterolateral thoracotomy as a sparing procedure, which involves minimal thoracic wall disintegration. When deciding on the choice of surgical procedures for the lesions of pulmonary parenchyma, care was taken to ensure to maximally spare the intact parenchyma. Minor resections (sutures, atypical resection, segmentectomies) were performed in 92%, whereas major resection (lobectomy, pulmectomy) had to be performed in 8% of thoracotomized patients. Rethoracotomy was done in two patients due to postoperative hemorrhage. The patient submitted to pulmectomy because of the hilus vasculature lesion died after the surgery. Early resuscitation, volume and blood replacement, rapid diagnosis, and early surgical intervention are the crucial factors that influence survival in patients with lung lesions due to penetrating injuries of the thorax.