Name l Define l Risk l Detect l Treatment l Stage/Grade l Followup l Mets/Recur l Link
Names - Synonyms
Phyllodes tumor (benign or malignant), phylloides tumor, phyllodes tumour, phylloides tumour, Muller's tumor, cystosarcoma phyllodes, phyllodes, PT, and CSP.
Phyllodes tumors are often large, bulky, fast growing masses that form from the intralobular stroma of the breast. They may be considered benign, borderline, or malignant depending on infiltration and mitoses. PT's account for less than 1% of all breast neoplasms.
Risk Factors - Causes
There may be a link between fibroadenomas and phyllodes, but this is being argued continually. Patients are normally women, in their 40's; although several younger and older women have been diagnosed. They are more prevalent in Latin American and Asian females. PT's have rarely been found in men.
The breast lump will normally feel like a solid (firm) palpable mass, that is movable. It commonly grows rapidly and the lump may be painful. The skin over larger PT's may have blue discolored and dilated veins. The lymph nodes under the armpit of the corresponding arm may be swollen.
Clinically, they are difficult to evaluate. PT's have a leaf-like appearance with projections of stroma that may extend into the ducts. On mammogram, they will appear well defined with a smooth and sometimes lobulated border. Fine needle aspirates may not include enough tissue to microscopically evaluate these tumors; therefore, core biopsies are preferred over FNA.
Many diagnostic tools will be used to evaluate your Phyllodes tumor, including gross examination, radiological filming, and cytological or histological examination. Since this is such an unusual and rare tumor, a second or even third pathology/diagnostic review is highly recommended.
The primary treatment for Phyllodes tumors is surgical excision, with wide clean margins, or mastectomy (either partial or complete). Since lymph node involvement is rare (10%), axillary dissection may or may not be done. Recurrence of Phyllodes tumors is usually treated with further surgery.
Chemotherapy and hormonal treatments are unproven. Dr. Barth at Norris Cotton Cancer Center has completed a clinical trial on Phyllodes and radiotherapy (with lumpectomy) that showed that there is some advantage to this choice.
Stage - Grade
Borderline tumors are defined as having 5-9 mitoses/10 high power fields, with pushing or infiltrating margins, and 2+ atypia. Malignant phyllodes tumors are defined as having 10 or more mitoses/10 HPF, with predominantly infiltrating margins, and usually 3+ atypia (with occasional 2+ atypia). Features suggesting malignant behavior include high cellularity, cellular atypia, high mitotic count, large tumor size, histological growth pattern, pleomorphism and stroma characteristics.
These tumors can be considered unpredictable in growth and metastatic activity. There have not been enough statistical numbers of cases to definitively say what will occur. So, followups are extremely important and should continue through your lifetime.
Metastasis - Recurrence
When PT's metastasize, they usually do so through the blood vessels, with no lymph node involvement. Most common sites for metastatic growth are the lungs, bone, and abdominal viscera. Benign tumors can be very aggressive in their growth and recurrence rates. Consequently, it has been suggested that all phyllodes tumors should be regarded as having a malignant potential.
Phyllodes Tumor Support Forums
Phyllodes Tumor Personal Stories