Although phyllodes tumor may have been described as early as the 1770 s, it was first fully characterized in 1838by johannes muller, who used the term cystosarcoma phyllodes. Phyllodes tumors fillodes or fullohdeez can also be spelled phylloides tumors fulloydeez. Effective treatment of a malignant breast phyllodes tumor. Treatment of patients with distant metastases from. Phyllodes tumor masquerading as a fungating breast mass. First reported in 1838, pt of the breast accounts for less than 1% of all breast masses. Jan, 2017 phyllodes tumors follow up care by jonas wilson, ing. Breast reconstruction was performed using a skin graft. Phyllodes tumor of the breast is a rare fibroepithelial breast tumor that comprise 0. Pdf phyllodes tumor of the breast semantic scholar. Phyllodes tumors pt are uncommon biphasic fibroepithelial lesions of the breast, characterized by proliferation of both the epithelial and stromal components and comprise less than or equal to 1% of all primary breast tumors. Phyllodes tumor of the breast textbook of uncommon cancer.
Phyllodes tumors pts of the breast are a rare type of tumor that account for breast tumors in females and usually present as a large lump of 35 cm in size. Learn more about the causes, risk factors, symptoms, diagnosis, treatment, and outlook for phyllodes tumors. Phyllodes tumors are rare fibroepithelial tumors that comprise breast malignancies, uncommonly encountered even by those who specialize in the treatment of breast cancer. Cureus malignant phyllodes tumor of the breast in a 26year. Here, we present a case of a female patient with a huge malignant pt with rapid progression in a short period. It indicates the characteristics of cancer cells and how likely a tumor is to spread.
Fibroepithelial lesions with cellular stroma in breast core needle biopsy cnb specimens may result in either broadenoma or phyllodes tumor at excision. In contrast to invasive carcinoma of breast, pts develop in the mesenchymal fibroepithelial tissues. Jan 19, 2011 the mainstay of treatment for phyllodes tumors remains excision with a safe surgical margin, taking advantage breast conserving surgery where amenable. Several histological features are used to grade pt into 3 categories. Our objective was to provide an overview of the clinical, pathologic, and therapeutic aspects of this rare. They account for less than 1% of all breast neoplasms. Summary of patient characteristics and initial management age years 44 1779 type of surgery breast conserving 157 95% breast conserving using oncoplasty 3 1. This rare breast tumour with a variable clinical course usually affects women between the ages of 30 and 50. Magnetic resonance imaging of benign phyllodes tumors of the breast. After 17 months the mass shows interval enlargement on follow up sonogram, from 4. There are a number of different treatments doctors recommend. Phyllodes tumor can be considered benign, borderline, or. All breast lumps should be triple assessed and the diagnosis of a phyllodes tumour considered in women.
Phyllodes tumors should be removed with, at least, 1 cm free margins, especially if theyre malignant tumors. Total mastectomy of left breast was performed thereafter, and pathology diagnosis was malignant phyllodes tumor. Genetic and clinical characteristics of phyllodes tumors. Juvenile phyllodes tumor of the breast sciencedirect. The stroma is moderately cellular and the stromal cells show moderate nuclear atypia hematoxylineosin, original magnifications 340 a and d, 320 b and f, 310 c, and 3100 e and g.
A mammography of the right breast reveals an oval, circumscribed, hyperdense mass in the right inner breast, above the implant, with an approximate size of 3. Therapeutic approachs to breast phyllodes tumor 8 are insufficient for the differential diagnosis between malignant and benign disease 79. Objective phyllodes tumors are biphasic tumors consisting of epithelial and stromal components that account for less than 1% of all breast tumors. Introductionphyllodes tumors, rare fibroepithelial tumors of the breast, account for 0. Phyllodes tumor of the breast genetic and rare diseases. Phyllodes tumor pt of the breast, particularly malignant phyllodes tumor mpt, is a rare fibroepithelial neoplasm. Phyllodes tumors are often misdiagnosed as fibroadenomas, and.
Pdf we aimed to establish whether morphologic parameters were prognostically important in a large series of breast phyllodes tumors in. Phyllodes tumor is a rare fibroepithelial neoplasm of the breast, with unpredictable clinical behavior. Phyllodes tumor is a rare breast tumor, with the malignant phenotype being the rarest of them all. They most commonly affect women from 35 to 55 years of age, and very few cases have been reported in men 36. P hyllodes tumor cystosarcoma phyllodes1 of the breast is a rare fibroepithelial lesion that accounts for less than 1% of all primary breast neoplasms. Most phyllodes tumors occur in women between 35 and 55 years old 1,3,4,5. These tumors are categorized as benign, borderline, or malignant based on a combination of histologic features. Pancreatic metastasis from malignant phyllodes tumor of.
These tumors, which are usually painless, tend to grow quickly, but rarely spread outside of the breast. They form a wide variety of tumors ranging from benign to malignant. In three women aged 51, 37 and 58 years, with a palpable tumour in the breast, excision and pathological examination led to the diagnosis of phyllodes tumour. The name phyllodes, which is taken from the greek language and means leaflike, refers to that fact that the tumor cells grow in a leaflike pattern. Surgical therapy is the gold standard for the treatment of phyllodes tumors. Fineneedle aspiration biopsy suggested the diagnosis of phyllodes tumor in only 3 cases. These tumors are classified as benign, borderline or malignant based on histologic features, which include stromal cellularity and atypia, mitotic index, infiltrative margins and stromal overgrowth. They get their name from the leaflike pattern in which they grow phyllodes means leaflike in greek. It occurs in females in the third and fourth decades. Phyllodes tumor page 1 of 4 md anderson cancer center. Differentiation of phyllodes breast tumors from fibroadenomas. Cutaneous scalp metastases of malignant phyllodes tumor. They are graded as benign, borderline or malignant based on the world health organisation who classification, according to a constellation of 5. It has been reported that these tumors are usually benign and both the stromal component and the epithelial.
Breast cancer is the second most common cancer found in women after skin cancer but that doesnt mean men arent at risk as well. For borderline or malignant phyllodes tumors or in cases of local tumor recurrence, mastectomy, and immediate breast reconstruction may become the preferred option. One year later, the tumor recurred in the right a 2. Phyllodes tumor is a very rare tumor of the breast, incidence being 0. The aim of this study was to describe the clinical, mammographic, and sonographic findings of phyllodes tumor of the breast and correlate them to the benign or malignant pathological nature of the lesion and its clinical behavior. Malignant phyllodes tumors of the breast occur infrequently and are difficult to treat with chemotherapy. Most studies suggested margins of at least 10 mm while some recent studies suggested narrower margins without an increased risk of local recurrences lr and distant metastases dm. Phyllodes tumors of the breast are rare, accounting for less than 1% of all breast tumors. With the nonoperative management of fibroadenomas widely adopted, the importance of phyllodes tumours today lies in the need to differentiate them from other benign breast lesions. Phyllodes tumor of the breast is a rare biphasic fibroepithelial neoplasm that has the potential for recurrence and metastases. Three of the later tumors, one benign and two malignant, recurred after several months. Phyllodes tumor pt is a rare tumor of the breast, which may occur during pregnancy or lactation.
By korin miller theres a pretty common belief out there that if a we. Mammography and ultrasonography are mainstay of routine imaging of breast lumps. Phyllodes tumors are generally classified into benign, borderline, and malignant tumors 6,7. Jul, 2020 phyllodes tumor resembles intracanalicular fibroadenoma at the benign end of the spectrum while malignant phyllodes tumor can be mistaken for primary breast sarcoma or sarcomatous carcinoma. Phyllodes tumors pts of the breast are rare, accounting for less than 1% of all breast tumors. Phyllodes tumors pts of the breast are an infrequent fibroepithelial neoplasm that accounts for less than 1% of all breast neoplasm. A lump in the breast isnt always a symptom of breast cancer. Muller coined the term cystosarcoma phyllodes based on the leaflike projections of the tumor extending into the cystic spaces and sarcomatous stromal growth.
Can you feel the difference between a breast cyst vs. Other names for these tumors are phylloides tumor and cystosarcoma phyllodes. Postsurgical treatments are still a matter of debate. Phyllodes tumor is an uncommon biphasic breast tumor, with the ability to recur and metastasize, and it behaves biologically like a stromal neoplasm. Phyllodes tumor, core needle biopsy, oncoplastic breast surgery, breast reconstruction background phyllodes tumor is a very rare breast tumor that comprises 0. Based on the pathologic degree of stromal cellularity, atypia, stromal overgrowth, status of tumor border and mitoses, the world health organization categorized pts as benign. Us scan of a 28yearold patient with a palpable left breast tumor shows a 3. The johns hopkins breast center in baltimore, md, offers expert diagnosis and treatment for benign and cancerous phyllodes tumors.
When it comes to differentiating between a breast cyst vs. Phylloides tumor is a welldefined lesion from surrounding tissue. Surgical excision is the primary mode of treatment and the tumour is often enucleated since a definitive preoperative diagnosis of phyllodes tumour is seldom made. They can be completely benign tumors to fully malignant sarcomas. A 44yearold woman presented to our hospital with a rapid growth mass in her right breast, measuring 20 cm. A 48yearold woman was diagnosed with a malignant phyllodes tumor in her right breast and underwent total right mastectomy. Oct 17, 2018 phyllodes tumors are rare, but they are usually benign. The sensitivity of core biopsy for the diagnosis of phyllodes tumor is greater than that of fna biopsy, but neither core biopsy nor fna biopsy can always differentiate phyllodes tumors from fibroadenomas. In most series, all phyllodes tumors may recur, but only the borderline and malignant phyllodes tumors metastasize. Pts are classified as benign, borderline, and malignant phyllodes based on histological features such as cellular atypia, mitotic count, tumor necrosis, stromal. Clinically, it is typically a large, smooth and fastgrowing mass that forms from the periductal stroma of the breast 2. Phyllodes tumours are rare fibroepithelial lesions that account for less than 1% of all breast. Phyllodes tumors are rare fibroepithelial lesions, with an incidence of 2.
Phyllodes tumours pts of the breast are uncommon fibroepithelial neoplasms, comprising 0. Pt is classified histologically as benign, borderline, or malignant, and a malignant pt has greater potential to metastasize than benign pt. In their least aggressive form, phyllodes tumors behave like benign fibroadenomas, although with a propensity to recur locally following excision without wide margins. In this case the clinical appearance has led to phyllodes tumor, characterized by lumps very rapidly enlarging, well demarcated, altered contour and vein. We present a case of a 63yearold woman with malignant phyllodes tumor in her left breast. During 35 years after radical excision, in one patient followed by radiotherapy, no recurrences were seen. Malignant phyllodes tumor is the most aggressive mesenchymal tumor of the breast, with a five year survival rate of 50 60%. Dec 07, 2020 background malignant phyllodes tumors pts of the breast occur infrequently and are difficult to treat with adjuvant therapy. Phyllodes breast tumors and other fibroadenomas cannot be precisely differentiated on breast mri. Ultrasonography is an alternative to mammograms for detecting breast lesions especially in mammographically dense breasts 23,24,25.
They tend to grow quickly, so theyre usually felt as a lump first. Of course, your specialist is the main person whose advice you should follow but it doesnt do anyone harm. In the present study, the case of a 63yearold female patient with a huge pt in the left breast is. Author disclosuresthe authors report no actual or potential conflicts of interes. Phyllodes tumor pt of the breast is a relatively rare fibroepithelial tumor that accounts for breast neoplasms. Pdf phyllodes tumor of the breast during pregnancy and. Sep 15, 2020 purpose phyllodes tumors pt of the breast are rare fibroepithelial neoplasms. Phyllodes tumor, benign right breast sp core needle biopsy december 16, 2014 final diagnosis 27. Phyllodes tumors are most common in women in their 40s, but women of any age can have them. Magnetic resonance imaging findings and surgical treatment. A giant malignant phyllodes tumor of breast post mastectomy. This study is looking at a rare type of tumour called phyllodes tumour that generally occur in the breast. Phyllodes tumors are often misdiagnosed as fibroadenomas, and the masses are usually so large that surgical resection may cause breast deformity.
Phyllodes tumors are uncommon fibroepithelial neoplasms of the breast that account for only 0. Phyllodes tumors of the breast american cancer society. May 09, 2019 phyllodes tumors are uncommon fibroepithelial breast tumors that are capable of a diverse range of biologic behaviors. Management of malignant phyllodes tumours of the breast. Although the percentage of cases in men is much lower than in women, male breast cancer accounts for a por. Jun 29, 2015 phyllodes tumor, benign right breast sp core needle biopsy december 16, 2014 preop diagnosis 24. Pts were initially described by muller in 1838 as cystosarcoma phyllodes. Pdf phyllodes tumors of the breast sunil badve academia.
Clonal analysis of fibroadenoma and phyllodes tyimorof. Similarly, separation of the malignant phyllodes tumour from spindle cell metaplastic carcinoma and primary breast sarcoma can be problematic. Traditionally, phyllodes tumors are graded by the use of a set of histologic data into benign, borderline, and malignant. On imaging, a large, dumbbellshaped, predominantly cystic mass with thin peripheral enhancement was noted. Understanding the clinical and sonographic features of phyllodes tumors may aid the radiologist in predicting biological behavior, including the like lihood of benign versus borderline or malignant phyllodes tumors at pathologic analysis. Phyllodes tumors pts, which are rare and mostly benign in nature, are fibroepithelial tumors of the breasts. An 82yearold female patient had 10yearduration of palpable huge tumor on left breast which was in rapid growth in recent months. A phyllodes tumor of the breast is a rare fibroepithelial tumor, accounting for 0. Surgical excision and oncoplastic breast surgery in 32. Surgery is the first line of treatment for pts, and chemotherapy and irradiation may be useful in certain patients but not all. Jul 04, 2016 phyllodes tumors of the breast are rare tumors that start in the connective stromal tissue of the breast. Here, we present an effective chemotherapy strategy for recurrent malignant breast phyllodes tumors. Prognostic immunohistochemical, and molecular features of benign and evaluation of proliferative activity and dna content in the malignant phyllodes tumors of the breast.
Case presentation a 44yearold woman presented to our hospital with a rapid growth mass in her right breast, measuring 20 cm. Doru paul, md, is triple boardcertified in medical oncology, hematology, and inter. These are rare breast tumors that start in the connective stromal tissue of the breast. Symptoms, causes, diagnosis, treatment, and outlook. They are classified by who into benign, borderline and malignant variants based on stromal cellularity, cellular atypia and pleomorphism, mitotic index, stromal overgrowth, tumor margin, and the presence or absence of heterologous differentiation. They are rarely observed in adolescents, with only 20 cases reported 1. Phyllodes tumors of the breast are unusual fibroepithelial tumors that exhibit a wide range of clinical behavior. This becomes of particular importance with rare breast tumors, which are difficult to diagnose due to their varying presentations. Phyllodes tumor is a very rare tumor of the breast, incidence being between 0. A low magnification of the primary breast phyllodes tumour with a cystic space into which stromal fronds projected.
Tumor grade is part of a pathology report used to stage breast cancer. To revisit this article, visit my profile, then view saved stories. Management of phyllodes breast tumors guillot 2011 the. Width of margins in phyllodes tumors of the breast. Phyllodes tumors are a rare type of breast tumor that can keep coming back, even if its benign. We continue to monitor covid19 cases in our area and providers will notify you if there are scheduling chang. Despite bilateral mas tectomy, rightsided local recurrences developed.
According to the world health organization who phyllodes tumors are classified into three categories as benign, borderline and malignant. This study shows diagnostic experience, surgical management and follows up of patients with this disease during a period of ten years in a oncology referral center. After surgery, six tumors were classified as benign and six as malignant, three of which being of lowgrade malignancy. The stroma is markedly cellular and the stromal cells show marked nuclear pleomorphism. Unpublished subscribe to hematology news challenge yourself, build your knowledge privacy policy do not sell my personal information terms of use editorial policy cookie policy ad policy medscape customer support frequently asked questions. She was initially diagnosed as having a borderline phyllodes. The distinction of phyllodes tumors from cellularjuvenile fibroadenomas is particularly challenging as the latter may show a cellular stroma. The average age of patients with phyllodes tumor is around 40 years, and 10 to 20 years older than those with fibroadenoma 1. Furthermore, whereas a mammogram may reveal the phyllodes tumor as a welldefined, round, or lobulated mass 18,19,20, a mammogram alone cannot distinguish a phyllodes tumor from a fibroadenoma 21,22. The current world health organization classification system proposes a 3tiered grading system. Malignant phyllodes tumor with metastases to lung, adrenal. Phyllodes tumor is rare in lactating breasts because the lactating breast normally demonstrates lobular and acinar hyperplasia to meet the physiological function and requirement during lactation. Phyllodes tumours are uncommon tumours of the breast, the majority of which are benign 1.
Learn more about the causes, risk factors, symptoms, diagnosis, treatment, and outlook for. Phyllodes tumors have benign mo rphologic features and contrast enhancement characteristics suggestive of malignancy in 33% of cases. The disease was only controlled after fullthickness chest wall resection, a procedure rarely reported in medical litera ture for this purpose. Information is controversial in the literature regarding to the optimal surgical management. Benign phyllodes tumor of the breast recurring as a. Unremarkable hospital stay discharged on the second postop day course in the ward 26. Case presentation a 48yearold woman presented to our hospital with a mass in her right breast figure 1. Together we will beat cancer about cancer cancer types cancers in general causes of cancer coping with cancer health professionals ge. A complex diagnosis is based on pathologic, radiologic, and clinical findings, with controversies about what is the best therapeutic strategy. Phyllodes tumor bfna or core biopsy may not distinguish a fibroadenoma from a phyllodes tumor in some cases.
Clinical notes, pathology records, and phyllodes tumor of the breast. Pdf how to approach phyllodes tumors of the breast. Malignant phyllodes tumor pt is one of the rare breast tumors that is difficult to diagnose. Background phyllodes tumors pt are uncommon biphasic tumors, accounting for less than 1% of all breast primary neoplasms. Malignant phyllodes tumor of the breast with metastasis. Jun 01, 2020 breast tumors in adolescents are mostly benign lesions usually associated with normal development of the breast, malignancy is rare with an incidence of about 0. Request pdf phyllodes tumors of the breast phyllodes tumor is a rare fibroepithelial neoplasm of the breast with a very variable, but usually benign, course.
The clinical presentation of this tumor is unilateral, and the behavior and. Phyllodes tumor, like fibroad enoma, presents as a welldemarcated and mobile breast tumor and is. Metabolic tumor volume in metastatic breast cancer mdedge hematology and oncology. A study looking at phyllodes breast tumours cancer research uk. Apart from the large size that some tumours can grow to. We report a patient who underwent several procedures for breast phyllodes tumor treatment. Complete surgical resection is the standard treatment for localized breast phyllodes tumors. Distant metastases in phyllodes tumours of the breast. If the phyllodes tumor of the breast is benign or borderline histology, radiation therapy. Only 500 cases of phyllodes tumor are diagnosed annually in the usa. Phyllodes tumours are rare fibroepithelial lesions that account for less than 1% of all breast neoplasms.
Sep 20, 2012 phyllodes tumor of the breast is a rare biphasic fibroepithelial neoplasm that has the potential for recurrence and metastases. Effective treatment of a malignant breast phyllodes. It can be difficult to tell the difference between a benign phyllodes tumor and a fibroadenoma, which is the most common type of benign breast tumor. What is the role of genetic counseling and testing in this young patient who does not have a family history of breast cancer. Case3 malignant pt of right breast in 39yearold woman d,e. Core needle biopsy of the tumor was inconclusive not fibroadenomaphyllodes according to the classification in table 2. Mar 09, 2019 phyllodes tumors of the breast are rare, accounting for less than 1% of all breast tumors. Phyllodes tumor of the breast textbook of uncommon. Malignant phyllodes tumor of the breast with rapid. Our objective was to provide an overview of the clinical, pathologic, and therapeutic aspects of this rare tumor. Pdf fullthickness chest wall resection for recurrent. Here, we report a case of an adolescent with a lump in her left breast which the histopathology revealed to be a benign phyllodes tumor. In this study, we aimed to present clinicopathologic symptoms of. They are most common in women in their 30s and 40s, although women of any age can be affected.
Dec 01, 2016 phyllodes tumors are rare fibroepithelial tumors that account for 0. If breast cancer is diagnosed at an early enough stage, its treatable. They account for less than 1% of all breast tumors and display a wide range of biological behaviors, ranging from benign to highly aggressive. Malignant phyllodes tumour with metastasis to the lung.
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