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Updated: Dec 26 2021

Phyllodes Tumor

  • 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
  • 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
  • Prognosis
    • 5-year survival for malignant tumors is 60-80%
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