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Snapshot
  • A 48-year-old woman presents to the physician with concern about a mass in her left breast. She notes that while doing a self breast exam a few weeks ago, she felt a small mass, but the mass has rapidly increased in size since then. On physical examination, the physician palpates a large, firm, mobile breast mass that is nontender to palpation. An incisional biopsy is performed and shows the histology seen in the image.
Introduction
  • Overview
    • phyllodes tumor is a rare, most commonly benign breast tumor that has a leaf-like appearance on gross section (phyllon is "leaf" in Greek) and cleft-like spaces on histology
  • Epidemiology
    • incidence
      • 0.3-0.5% of female breast tumors
    • demographics
      • almost exclusive in females
      • rare cases reported in males
      • median age is 40-49 years
  • Pathophysiology
    • nonepithelial neoplasm of the breast
    • 85-90% of phyllodes tumors are benign
    • benign phyllodes tumors may grow aggressively and can recur locally
  • Prognosis
    • 5-year survival for malignant tumors is 60-80%
Presentation
  • Symptoms
    • breast mass that rapidly ↑ in size in a few weeks
  • Physical exam
    • firm, mobile, nontender breast mass
      • very large phyllodes tumor may erode through skin and present as an external fungating mass
    • shiny overlying skin over mass
Imaging
  • Mammography
    • indications
      • important in the diagnosis of breast lesions, but findings are unreliable at differentiating between benign phyllodes tumors, malignant phyllodes tumors, and fibroadenomas
Studies
  • Breast biopsy
    • indications
      • open excisional breast biopsy
        • indicated for smaller lesions (< 5 cm)
      • incisional breast biopsy
        • indicated for large lesions (> 5 cm)
    • findings
      • long cleft-like spaces and myxoid cellular stroma
Differential
  • Fibroadenoma
    • key distinguishing factor
      • generally smaller than phyllodes tumors and do not exhibit rapid growth
  • Breast abscess
    • key distinguishing factor
      • typically develop as a complication of mastitis
      • localized, painful inflammation of the breast with fever
  • Breast adenocarcinoma
    • key distinguishing factor
      • classic findings on mammogram include presence of a spiculated, high-density mass and grouped microcalcifications
Treatment
  • Surgical
    • complete excision of the tumor
      • wide local excision with a rim of normal tissue included
        • 2 cm margin for small tumors and 5 cm margin for large tumors
      • indicated for benign phyllodes tumors
    • mastectomy
      • indicated for malignant phyllodes tumors

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