Treatment
There is no general and comprehensive consensus on the management of PBOS. Some consider it as a sarcoma and emphasized that the management of PBOS should be similar to that of other sarcomas(20,37); whereas, some others believe that it should be treated like triple-negative epithelial carcinomas(1). The value and effectiveness of chemotherapy have been emphasized, particularly with the tumor size more than 5 cm(38,39,40); however, there are still some reports that they did not offer chemotherapy to/for their patients(22,31) even with the tumor size of 6 cm(41). Although Axillary Lymph Node Dissection (ALND) or sentinel lymph node biopsy has been performed in some reports (18,22,23,40,42,43) in most of the reports ALND was not performed for the patients (2,3,4,24,44,45). Similar to chemotherapy, considering irradiation as a part of treatment is not widely accepted at least as far as the tumor size is not large enough and the margins are clear from tumoral deposits(4,31,38); however, chest wall irradiation has been suggested by some other authors to reduce the risk of local recurrence as a routine part of treatment (46). It seems that achieving a negative margin either with wide local excision or simple mastectomy without ALND is widely accepted/adapted and offering chemotherapy and radiotherapy should be based on prognostic factors of each patient. It is worth mentioning that due to the local recurrence and distant metastasis rate of about 40% within the first year(2,47), an aggressive approach including appropriate surgery and adjuvant therapy should be considered while administration of chemotherapy or radiotherapy must be balanced against the consequences of these treatments per case.