| Phyllodes tumor |
| Classification and external resources |
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Micrograph of a phyllodes tumor (right of image) with the characteristic long clefts and myxoid cellular stroma. Normal breast and fibrocystic change are also seen (left of image). H&E stain.
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| ICD-10 |
C50, D24, D48.6 |
| ICD-9 |
217 |
| ICD-O: |
M9020 |
| DiseasesDB |
3396 |
| MeSH |
D003557 |
Phyllodes tumors (from Greek: phullon leaf), also cystosarcoma phyllodes, cystosarcoma phylloides and phylloides tumor, are typically large, fast growing masses that form from the periductal stromal cells of the breast. They account for less than 1% of all breast neoplasms.
Contents
- 1 Classification
- 2 Presentation
- 3 Treatment
- 4 Spectrum
- 5 References
- 6 External links
Classification
Phyllodes tumors are a fibroepithelial tumor composed of an epithelial and a cellular stromal component. They may be considered benign, borderline, or malignant depending on histologic features including stromal cellularity, infiltration at the tumor's edge, and mitotic activity. All forms of phyllodes tumors are regarded as having malignant potential. They are also known as serocystic disease of Brodie.
They are classified as a fibroepithelial tumor by ICD-O, but not by MeSH.
Women as young as 14 years old have developed the malignant form and it seems to be more aggressive in younger women. [1]
Presentation
Phyllodes tumor in mammography
Anatomopathological results of phyllodes tumor.
This was predominantly the tumor of adult women, with very few examples reported in adolescents. Patients typically present with a firm, palpable mass. These tumors are very fast growing, and can increase in size in just a few weeks. Occurrence is most common between the ages of 40 and 50, prior to menopause. This is about 15 years older than the typical age of patients with fibroadenoma, a condition with which phyllodes tumors may be confused. They have been documented to occur at any age above 12 years.
Treatment
The common treatment for phyllodes is wide local excision. Other than surgery, there is no cure for phyllodes, as chemotherapy and radiation therapy are not effective. The risk of developing local recurrence or metastases is related to the histologic grade, according to the above-named features. Despite wide excision a very high percentage of surgeries yielded incomplete excision margins that required revision surgery.[1]
A large recent study has derived a risk calculator for relapse risk of phyllodes tumors after surgery.[2]
A recent study (Aug 2009) by Barth et al. suggests that radiation treatment after breast-conserving surgery with negative margins significantly reduces the local recurrence rate for borderline and malignant tumors.[3]
Spectrum
Phyllodes tumors are considered to be on a spectrum of disease[4] that consists of fibroadenoma, fibroadenoma variant and benign phyllodes. Some would extend the spectrum to include malignant phyllodes tumors and frank sarcoma.[citation needed]
References
- ^ a b Guillot, E.; Couturaud, B.; Reyal, F.; Curnier, A.; Ravinet, J.; Laé, M.; Bollet, M.; Pierga, J. Y.; Salmon, R.; Fitoussi, A.; Breast Cancer Study Group of the Institut Curie (2011). "Management of Phyllodes Breast Tumors". The Breast Journal 17 (2): 129–137. doi:10.1111/j.1524-4741.2010.01045.x. PMID 21251125. edit
- ^ This is available at www.phyllodes.com. Tan PH, Thike AA, Tan WJ, Thu MM, Busmanis I, Li H, Chay WY, Tan MH (2012). "Predicting clinical behaviour of breast phyllodes tumours: a nomogram based on histological criteria and surgical margins.". J Clin Path. 65 (1): 69–76. doi:10.1136/jclinpath-2011-200368. PMID 22049216.
- ^ Barth RJ Jr, Wells WA, Mitchell SE, Cole BF (2009). "A prospective, multi-institutional study of adjuvant radiotherapy after resection of malignant phyllodes tumors.". Ann Surg Oncol. 16 (8): 2288–94. doi:10.1245/s10434-009-0489-2. PMID 19424757.
- ^ Deen SA, McKee GT, Kissin MW (1999). "Differential cytologic features of fibroepithelial lesions of the breast". Diagn. Cytopathol. 20 (2): 53–6. doi:10.1002/(SICI)1097-0339(199902)20:2<53::AID-DC1>3.0.CO;2-T. PMID 9951596.
External links
- Phyllodes Tumor Support Forums
- Phyllodes Tumor Group - We have over 180 members waiting to give you support and share information.
- Cystosarcoma Phyllodes
- Phyllodes Support Group
- Phyllodes group on Facebook
- Phyllodes Tumor Recurrence Risk Assessment Calculator
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Connective/soft tissue tumors and sarcomas (ICD-O 8800–9059) (C45–C49/D17–D21, 171/214–215)
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| Not otherwise specified (8800–8809) |
- Soft-tissue sarcoma
- Desmoplastic small-round-cell tumor
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| Connective tissue neoplasm |
| Fibromatous (8810–8839) |
| Fibroma/fibrosarcoma: |
- Dermatofibrosarcoma protuberans
- Desmoplastic fibroma
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| Fibroma/fibromatosis: |
- Aggressive infantile fibromatosis
- Aponeurotic fibroma
- Collagenous fibroma
- Diffuse infantile fibromatosis
- Familial myxovascular fibromas
- Fibroma of tendon sheath
- Fibromatosis colli
- Infantile digital fibromatosis
- Juvenile hyaline fibromatosis
- Plantar fibromatosis
- Pleomorphic fibroma
- Oral submucous fibrosis
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| Histiocytoma/histiocytic sarcoma: |
- Benign fibrous histiocytoma
- Malignant fibrous histiocytoma
- Atypical fibroxanthoma
- Solitary fibrous tumor
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| Myxomatous (8840–8849) |
- Myxoma/myxosarcoma
- Cutaneous myxoma
- Superficial acral fibromyxoma
- Angiomyxoma
- Ossifying fibromyxoid tumour
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| Fibroepithelial (9000–9039) |
- Brenner tumour
- Fibroadenoma
- Phyllodes tumor
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| Synovial-like (9040–9049) |
- Synovial sarcoma
- Clear-cell sarcoma
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| Lipomatous (8850–8889) |
- Lipoma/liposarcoma
- Myelolipoma
- Myxoid liposarcoma
- PEComa
- Chondroid lipoma
- Intradermal spindle cell lipoma
- Pleomorphic lipoma
- Lipoblastomatosis
- Spindle cell lipoma
- Hibernoma
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| Myomatous (8890–8929) |
| general: |
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| smooth muscle: |
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| skeletal muscle: |
- Rhabdomyoma/rhabdomyosarcoma: Embryonal rhabdomyosarcoma
- Alveolar rhabdomyosarcoma
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- Leiomyoma
- Angioleiomyoma
- Angiolipoleiomyoma
- Genital leiomyoma
- Leiomyosarcoma
- Multiple cutaneous and uterine leiomyomatosis syndrome
- Multiple cutaneous leiomyoma
- Neural fibrolipoma
- Solitary cutaneous leiomyoma
- STUMP
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| Complex mixed and stromal (8930–8999) |
- Adenomyoma
- Pleomorphic adenoma
- Mixed Müllerian tumor
- Mesoblastic nephroma
- Wilms' tumor
- Malignant rhabdoid tumour
- Clear-cell sarcoma of the kidney
- Hepatoblastoma
- Pancreatoblastoma
- Carcinosarcoma
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| Mesothelial (9050–9059) |
- Mesothelioma
- Adenomatoid tumor
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see also Template:Connective tissue
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anat (h/n, u, t/d, a/p, l)/phys/devp/hist
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noco (m, s, c)/cong (d)/tumr, sysi/epon, injr
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Tumors: breast cancer (C50/D24, 174–175/217) – Histopathologic classification
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| Fibroepithelial/stromal |
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| Ductal, lobular, and medullary |
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Ductal
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- Ductal carcinoma in situ (DCIS): Paget's disease of the breast
- Comedocarcinoma
- Invasive ductal carcinoma (IDC)
- Intraductal papilloma
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Lobular
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- Lobular carcinoma in situ (LCIS)
- Invasive lobular carcinoma (ILC)
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Medullary
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Other/ungrouped
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- Inflammatory breast cancer
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| Precursor lesions |
- Atypical ductal hyperplasia
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| Other |
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| Related subjects |
- Main article
- Classification
- Risk factors (Alcohol, Hereditary breast—ovarian cancer syndrome, BRCA mutation)
- Screening
- Treatment
- Breast cancer awareness
- Pink ribbon
- National Breast Cancer Awareness Month
- List of breast cancer patients by occupation
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