Phyllodes tumour of the breast: Clinical follow-up of 33 cases of this rare disease

Lenhard, Miriam; Kahlert, Steffen; Himsl, Isabelle; Ditsch, Nina; Untch, Michael; Bauerfeind, Ingo

doi:10.1016/j.ejogrb.2007.08.002

Cited by 70 publications

(62 citation statements)

References 24 publications

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“…2,3 Imaging findings of PT and FA overlap and as such lesions may be misdiagnosed. 4 Histologically, PTs can be identified by their distinctive leaf-like architecture and increased stromal cellularity. 5 Typically, PTs present as a palpable breast lump and were traditionally differentiated from FAs based on their larger size at presentation.…”

Section: Advances In Knowledgementioning

confidence: 99%

Phyllodes tumours of the breast: radiological presentation, management and follow-up

McCarthy¹,

Kavanagh²,

O'Donoghue³

et al. 2014

The British Journal of Radiology

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Results: 53 patients with 54 lesions were diagnosed as having a PT. The median age was 27.5, 35.0 and 38.5 years for benign, borderline and malignant PT, respectively. Borderline and malignant PTs were larger than benign PTs, with mean sizes of 33 and 42 mm compared with 29 mm. 38% of PTs were labelled by the reporting radiologist as fibroadenomas, including two borderline PTs and one malignant PT. In 24% of cases, the radiologist raised the possibility of PT in the report. 17 patients (40%) developed a new fibroepithelial breast lesion during follow-up of which 4 were recurrent PTs. Conclusion: Despite adequate surgical management, the development of further fibroepithelial lesions in the ipsilateral breast is common. 3-year clinical surveillance, with the addition of 6-monthly ultrasound is advised for females with initial borderline or malignant PT histology. Advances in knowledge:We propose a follow-up protocol with ultrasound based on the grade of the PT diagnosed for 3 years to detect recurrence.Phyllodes tumours (PTs) are rare biphasic fibroepithelial neoplasms accounting for ,1% of all breast lesions. 1 In the literature, they have been described as occurring in females aged 35-55 years, typically 15-20 years older than females with fibroadenomas (FAs) and with a higher incidence in Asian females.2,3 Imaging findings of PT and FA overlap and as such lesions may be misdiagnosed. 4 Histologically, PTs can be identified by their distinctive leaf-like architecture and increased stromal cellularity. 5 Typically, PTs present as a palpable breast lump and were traditionally differentiated from FAs based on their larger size at presentation.6 However, with increased breast awareness and screening programmes, smaller and incidental lesions are being found on imaging. 6 In symptomatic breast clinics, including this institution, "triple assessment" consisting an initial physical examination, followed by radiological imaging (ultrasound and/or mammography) and histological sampling either by fine-needle aspiration cytology (FNAC) or core biopsy is the standard diagnostic pathway for palpable breast lesions. The purpose of triple assessment is to provide a more accurate pre-operative diagnosis to ensure proper surgical planning and avoiding re-excision or tumour recurrence. 7According to the World Health Organization criteria, there are two grading systems for PTs; a two-tiered system or a three-tiered system. 8 Our institution employs the threetiered system, the subgroups being benign, borderline and malignant. Grading is based on semi-quantitative assessment of stromal cellularity, cellular pleomorphism, mitotic activity, margin appearance and stromal distribution. The standard procedure for treatment, no matter what the grade of the PT, is surgical wide local excision, preferably with clear margins of at least 1 cm. However, owing to the fact that most PTs are not fully diagnosed pre-operatively, initial surgery does not always provide adequate margins necessitating frequent post-operative re-excision of the margi...

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Section: Advances In Knowledgementioning

confidence: 99%

Phyllodes tumours of the breast: radiological presentation, management and follow-up

McCarthy¹,

Kavanagh²,

O'Donoghue³

et al. 2014

The British Journal of Radiology

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“…1 Benign and borderline phyllodes tumors carry the potential for local recurrence, with the risk of metastasis primarily limited to malignant phyllodes tumors. [2][3][4][5] Precise classification of these benign and low-grade fibroepithelial neoplasms can be difficult in daily practice. The morphologic features of fibroadenomas with pronounced intracanalicular growth pattern and of benign phyllodes tumors overlap, leading to high interobserver variability in classification of these lesions, even among breast pathology experts.…”

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confidence: 99%

Benign and low-grade fibroepithelial neoplasms of the breast have low recurrence rate after positive surgical margins

2016

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Breast phyllodes tumors are uncommon fibroepithelial neoplasms with a range of histologic features. Surgical excision is the primary management, but the need for excision to negative margins in benign and borderline phyllodes tumors is unclear. Here, we review the surgical management patterns and outcomes of 90 patients with benign and low-grade fibroepithelial lesions of the breast treated at our institution, including 19 borderline phyllodes tumors, 52 benign phyllodes tumors, and 19 representative neoplasms with overlapping features of fibroadenoma and benign phyllodes tumors, which were classified as 'fibroadenomas with phyllodal features'. In total, 52 (58%) had positive surgical margins on first excision, and of these 17 (33%) underwent re-excision to achieve negative margins. Residual tumor was identified in three (18%) re-excisions. Patients with fibroadenoma with phyllodal features were more likely to have a positive surgical margin than with benign phyllodes tumors or borderline phyllodes tumors (89 vs 49%, P = 0.0015), and were less likely to undergo re-excision for positive margins (12 vs 43%, P = 0.031). In total, there were three recurrences (3%), with one per fibroadenoma with phyllodal features, benign phyllodes tumor, and borderline phyllodes tumor. There was no statistically significant difference in recurrence rates between patients with positive or negative margins, or between patients with positive margin with or without re-excision. The extent of the positive margin did not predict recurrence. In conclusion, the recurrence rate of benign and low-grade fibroepithelial lesions is low and not associated with the original margin status. Patients with fibroadenomas with phyllodal features, benign phyllodes tumors, or selected borderline phyllodes tumors and positive margins on initial excision may be managed conservatively, with close follow-up and timely re-excision of any potential recurrence.

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“…Other parameters such as stromal hypercellularity, stromal atypia, stromal overgrowth, and mitosis, were significantly associated with local recurrence (19). The most important risk factor for recurrence is the resection done within 1-2 cm negative surgical margins (20). It is important that these factors be identified and appropriate surgical procedure be selected to ensure clear margins.…”

Section: Discussion Discussionmentioning

confidence: 99%

Recurrent Giant Phyllodes Tumour in a Young Female: A Case Report

Koshariya¹,

Sharma²,

Gehlot³

et al. 2016

JTMR

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Phyllodes tumors (PTs) are uncommon neoplasms of the breast, constituting 0.3 to 0.9% of all breast tumors in females comprised of both stromal and epithelial elements. The term cystosarcoma phyllode was coined by Johannes Muller, a misleading term as tumors are rarely cystic and the majority follow a benign clinical course. The term giant phyllodes is used when the tumor size exceeds 10 cm in diameter. WHO (World Health Organization) classification has identified three categories of phyllodes tumors of the breast (PT): benign, borderline and malignant. The mainstay of treatment of non-metastatic phyllodes tumors of the breast is complete surgical resection with wide resection margins. Local recurrence up to 50 % after surgery has been reported in Phyllodes tumors. We report a case of two episodes of recurrent phyllodes tumor in a young female.

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Phyllodes tumour of the breast: Clinical follow-up of 33 cases of this rare disease

Cited by 70 publications

References 24 publications

Phyllodes tumours of the breast: radiological presentation, management and follow-up

Phyllodes tumours of the breast: radiological presentation, management and follow-up

Benign and low-grade fibroepithelial neoplasms of the breast have low recurrence rate after positive surgical margins

Recurrent Giant Phyllodes Tumour in a Young Female: A Case Report

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