Cystosarcoma phyllodes, often known as phyllodes tumor, are an uncommon type of breast tumor that primarily affects females. While making up fewer than 1% of all breast neoplasms, it is crucial for medical students to be familiar with the clinical appearance, diagnosis, and treatment of these tumors. The goal of this blog post is to provide you a thorough description of phyllodes tumors so that you can better comprehend them and practice your clinical skills.

Introduction and Epidemiology

With their leaf-like appearance under the microscope, phyllodes tumors get their name from the Greek words “phyllon” and “odes,” which mean “like.” Based on histological characteristics, they are fibroepithelial tumors that can be divided into benign, borderline, and malignant categories. To distinguish between these categories, the World Health Organization (WHO) classification system is frequently employed.

The majority of cases affect women, with the median age of diagnosis being between 40 and 50 years old. Nonetheless, there have been a few isolated reports of phyllodes tumors in males. These cancers often lack hormone receptors and don’t have any known risk factors.

Clincial Features:

Phyllodes tumors typically manifest as a breast mass that is palpable, painless, and clearly outlined. A distinguishing characteristic that sets it apart from fibroadenomas, which grow more slowly, is its rapid growth over a period of weeks to months. Particularly in situations of big or malignant tumors, some patients may have breast pain, nipple retraction, or skin abnormalities, such as erythema or ulceration.

Diagnostic Assessment

The following actions are taken during the assessment of a suspected phyllodes tumor:

A complete breast examination should be done, including visual inspection and palpation of the axillary lymph nodes as well as both breasts.

a. Imaging Studies: The primary imaging modalities for assessing a breast mass are mammography and ultrasound. On mammography, phyllodes tumors often present as well-defined round or oval masses, while on ultrasound, they may take on lobulated or irregular shapes with mixed echogenicity. To distinguish phyllodes tumors from fibroadenomas or other breast diseases, imaging alone might not be enough.

c. Core Needle Biopsy: To distinguish phyllodes tumors from other breast lesions, a core needle biopsy is the recommended technique for acquiring tissue samples. As the histologic characteristics of phyllodes tumors coincide with those of other fibroepithelial lesions, like fibroadenomas, it may be difficult to appropriately diagnose these tumors. To make a certain diagnosis, an excisional biopsy may occasionally be required.

d. Histopathological Evaluation: The assessment of histological features, such as stromal cellularity, stromal overgrowth, nuclear atypia, and mitotic activity, is used to determine the diagnosis and categorization of phyllodes tumors. Based on these characteristics, the WHO classification system divides phyllodes tumors into benign, borderline, and malignant categories.

Management

Surgery is the main method of treatment for phyllodes tumors. Depending on the tumor’s size, location, and histologic grade, the surgical technique is chosen.

Broad local excision, also referred to as a lumpectomy, entails the removal of the tumor and a margin of healthy tissue. It is the method of choice for benign and tumors on the verge of malignancy, with the aim of obtaining surgical margins that are at least 1 cm clear.

b. Mastectomy: When appropriate margins cannot be attained with wide local excision, a mastectomy may be considered for big tumors, recurrent tumors, or malignant phyllodes tumors. As lymphatic spread is uncommon, axillary lymph node dissection is typically not necessary.

c. Adjuvant Therapy: It is unclear how effective adjuvant therapy is in treating phyllodes tumors. Patients with positive or near surgical margins, borderline or malignant tumors, or recurrent disease may be candidates for radiation therapy. Chemotherapy and hormone therapy are typically only used for metastatic or recurring conditions because their benefits are unknown.

Assessment and Follow-Up

The histologic grade and the effectiveness of the surgical excision determine the prognosis of phyllodes tumors. The prognosis for benign tumors is very good, with a recurrence rate of only 10-15%. Borderline tumors have a small risk of spreading and a greater recurrence incidence (20–25%). A 25–40% chance of recurrence and a 25–25% chance of metastasis are associated with malignant tumors.

Regular clinical examinations and imaging tests are often part of follow-up to check for local recurrence or the emergence of additional breast lesions. The number of follow-up visits may change based on the tumor grade and personal risk factors.

Conclusion

Rare breast cancers called phyllodes tumors can be difficult to diagnose and treat for medical experts. In order to provide the best possible patient care, it is crucial to comprehend their clinical presentation, diagnostic assessment, and treatment options.

This exclusive video on Phyllodes Tumor highlights all the aspects of Phyllodes tumor