Phyllodes Tumors of the Breast: The Role of Pathologic Parameters

Abstract

We aimed to establish whether morphologic parameters were prognostically important in a large series of breast phyllodes tumors in Asian women. Of 335 phyllodes tumors diagnosed at the Department of Pathology, Singapore General Hospital, Singapore, between January 1992 and December 2002, 250 (74.6%) were benign, 54 (16.1%) borderline, and 31 (9.3%) malignant, based on histologic review of archival slides. Of the women, 43 (12.8%) experienced recurrences during the follow-up period. Recurrent disease was correlated with grade or classification (P = .028), stromal atypia (P = .016), stromal hypercellularity (P = .046), and permeative microscopic borders (P = .021). Multivariate analysis revealed that independent predictors of recurrence were pseudoangiomatous stromal hyperplasia (PASH) and margin status, whereby the presence of PASH and complete or negative margins reduced recurrence hazards by 51.3% and 51.7% respectively. The 7 women who died of disease during follow-up had malignant phyllodes tumor at the outset and experienced recurrences, and death was preceded by distant metastases.

p53 and c-kit (CD117) protein expression as prognostic indicators in breast phyllodes tumors: a tissue microarray study

“…The relationship between clinicopathologic parameters and onset of first local recurrence has been previously discussed. 15 Of note, there was no statistically significant association of p53 immunostaining (epithelium, myoepithelium or stroma) with recurrent disease. On the other hand, CD117 stromal immunopositivity was correlated with recurrence (P ¼ 0.001), with cases showing stromal reactivity for CD117 being more likely to recur than those that were negative (Table 5).…”

“…Patient details and tumor laterality were determined from accession forms, while tumor size was obtained from the surgical pathology reports. Histologic review and classification into benign, borderline and malignant categories, as previously defined, 15 relied on a constellation of findings, namely degree of stromal hypercellularity, cytologic atypia, mitotic activity, stromal overgrowth and nature of the borders (circumscribed vs permeative).…”

“…Details are as previously documented. 15 Briefly, tumor size for the series ranged from 0.9 to 25 cm (mean 5.4 cm, median 4 cm). Histologic classification revealed 250 (75%) benign, 54 (16%) borderline and 31 (9%) malignant lesions.…”

“…We recently described the pathologic parameters of a large series of phyllodes tumors, 15 and found that grade, as well as the individual histologic components of stromal atypia, stromal hypercellularity and permeative microscopic borders were correlated with recurrent disease. On multivariate analysis however, it was margin status, as well as pseudoangiomatous stromal hyperplasia that were independently predictive of recurrence.…”

Immunohistochemical expression of heparan sulfate correlates with stromal cell proliferation in breast phyllodes tumors

“…Phyllodes tumors have a higher frequency in Asian women. 18,19 Classification into three categories of benign, borderline and malignant is based on a spectrum of histological features such as stromal hypercellularity, mitotic rate, and nature of microscopic margins. However, there are still difficulties in accurate categorization of phyllodes tumors and predicting their clinical outcome.…”