phyllodes tumor

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Definition: Phyllodes tumors are rare, fast growing tumors that usually present in women in their 40s -50s. They can be benign, borderline or malignant, and are treated with wide local excision without axillary dissection. Histologically they are biphasic, with the stroma determining the grade.

Phyllodes tumor is a biphasic tumor and consists of hypercellular stroma underneath the cleft-like spaces lined by benign glandular epithelium. There are overalapping histologic features between fibroadenoma and phyllodes tumor. The amount and appearance of stroma helps distinguish between the two. Size larger than 4 cm and a history of rapid growth favors the diagnosis of phyllodes tumor.

Images

 Phyllodes tumor of the breast, arising in fibroadenoma

• https://twitter.com/KUSAURAP/status/742577555241238529
• https://twitter.com/NRiddleMD/status/767766059713699840
• https://twitter.com/CancerCureNow/status/798196889870999552

 FNA: Cytology of Borderline Phyllodes Tumor

• https://twitter.com/NRiddleMD/status/767765047837851650

 A spindle cell tumor in core bx (L) can be a phyllodes tumor where the epithelial component goes unsampled

• https://twitter.com/brstpathology/status/722057078479699968

 Phyllodes tumor with lipoblastic differentiation

• https://twitter.com/VandaTorousMD/status/851642361792823296

Types

 benign phyllodes tumor
 borderline phyllodes tumor
 malignant phyllodes tumor

Microscopy

 Multiple, polypoid nodules are separated by cleft-like spaces.
 Possible pre-existing old fibroadenoma.

• It has acellular fibrous stroma and atrophic ducts.

 The phyllodes tumor contains hyperplastic ducts and cellular stroma.
 Hyperplastic ducts surrounded by fibrous stroma with low and high cellularity.
 In the fibrosarcomatous stroma, the tumor cells have elongated, hyperchromatic nuclei undergoing active mitosis.
 Irregular infiltrative borders extending into adipose tissue.

See also

 mammary fibroepithelial tumors

Videos

 Differentiating fibroadenoma from phyllodes tumor.

• https://youtu.be/-vWM4eE96Zk
• https://youtu.be/x13cCXFDCqs

Open references

 Updates on Phyllodes Tumor of the Breast. 2016 @ArchivesPath http://www.archivesofpathology.org/doi/pdf/10.5858/arpa.2016-0042-RA

 http://www.sciencedirect.com/science/article/pii/S2352646716300059

References

 Wang ZC, Buraimoh A, Iglehart JD, Richardson AL. Genome-wide analysis for loss of heterozygosity in primary and recurrent phyllodes tumor and fibroadenoma of breast using single nucleotide polymorphism arrays. Breast Cancer Res Treat. 2006 Jun;97(3):301-9. PMID: 16791486