Phyllodes Tumors of the Breast

Phyllodes breast tumors are very rare, accounting for 1 % of all breast lumps. It is also known as cystosarcoma phylloides. The tumor develops in the breast connective tissue, which is also known as the stroma. The stroma consists of fatty tissue and breast ligaments, which holds the breast together.
(unlike breast cancer which develops from the milk ducts and breast lobules)

It is usually benign but a small percentage can have malignant presentation.

It can occur at any age but more common in women  between 40 - 50 years old.
It tends to grow rapidly within a short period compared to fibroadenoma.
It has almost similar presentation to a fibroadenoma

Symptoms and Signs

Painless breast lump which is firm, smooth or lobulated surface.
If enlarged, it can stretch the skin and causes thinning of the breast skin.

Protruding and lobulated palpable mass with very thin skin as it protrudes through capsule

 

Diagnosis & Investigation

Mammogram, Breast Ultrasound
Core biopsy
CT scan whole body (if hard and fixed to chest wall and to see it’s involvement to chest wall muscle)

 

Types of Phyllodes Tumour

  • Benign (about 85-90% presentation are non cancerous)
  • Borderline (features between non cancerous and cancerous)
  • Malignant (10-15% are cancerous)

 

Treatment

Surgery  - it is important that the entire tumour is removed with preferably 5mm to 1cm margin of normal breast tissue around it to prevent recurrence

  • Wide excision biopsy
  • Mastectomy +/- reconstruction

 

Follow up

Benign phyllodes tumour can recur or come back therefore regular follow up with scans are advised.  Further surgery will be advised for recurrent tumor and some may need radical surgery with flap repair.

Borderline or malignant phyllodes do not respond to chemotherapy or hormonal therapy therefore only radical surgery is mandatory if it recurs back.

Phyllodes tumor that spread to other parts of body like underlying chest wall muscle are treated like soft-tissue sarcomas

Close and short term follow-up (4-6 months) with frequent breast examination and imaging test are highly recommended because these tumors can come back

 

Malignant Phyllodes

  • Malignant phyllodes tumor are aggressive
  • Commonest metastatic site are lungs followed by bone, heart and liver
  • No treatment for systemic metastases

 

Reference:

 

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