Phyllodes tumor
Encyclopedia
Phyllodes tumors also cystosarcoma phyllodes, cystosarcoma phylloides and phylloides tumor, are typically large, fast growing masses that form from the periductal stromal cell
s of the breast
. They account for less than 1% of all breast neoplasms
.
, 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 considered breast cancer, as even the benign form is 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
.
Approximately 60-70% of examined tumors are benign, the proportion of benign cases is higher in young women.
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.
. Other than surgery, there is no cure for phyllodes, as chemotherapy & 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.
One study has suggested that total mastectomy is more effective than breast-conserving surgery
.
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.
of disease that consists of fibroadenoma
, fibroadenoma variant and benign phyllodes. Some would extend the spectrum to include malignant phyllodes tumors and frank sarcoma
.
Stromal cell
In cell biology, stromal cells are connective tissue cells of any organ, for example in the uterine mucosa , prostate, bone marrow, and the ovary. They are cells that support the function of the parenchymal cells of that organ...
s of the breast
Breast
The breast is the upper ventral region of the torso of a primate, in left and right sides, which in a female contains the mammary gland that secretes milk used to feed infants.Both men and women develop breasts from the same embryological tissues...
. They account for less than 1% of all breast neoplasms
Neoplasia
Neoplasm is an abnormal mass of tissue as a result of neoplasia. Neoplasia is the abnormal proliferation of cells. The growth of neoplastic cells exceeds and is not coordinated with that of the normal tissues around it. The growth persists in the same excessive manner even after cessation of the...
.
Classification
Phyllodes tumors are a fibroepithelial tumor composed of an epithelial and a cellular stromal component. They may be considered benignBenign
A benign tumor is a tumor that lacks the ability to metastasize. Common examples of benign tumors include moles and uterine fibroids.The term "benign" implies a mild and nonprogressive disease. Indeed, many kinds of benign tumors are harmless to human health...
, borderline, or malignant
Malignant
Malignancy is the tendency of a medical condition, especially tumors, to become progressively worse and to potentially result in death. Malignancy in cancers is characterized by anaplasia, invasiveness, and metastasis...
depending on histologic features including stromal cellularity, infiltration at the tumor's edge, and mitotic activity. All forms of phyllodes tumors are considered breast cancer, as even the benign form is 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
Medical Subject Headings
Medical Subject Headings is a comprehensive controlled vocabulary for the purpose of indexing journal articles and books in the life sciences; it can also serve as a thesaurus that facilitates searching...
.
Approximately 60-70% of examined tumors are benign, the proportion of benign cases is higher in young women.
Presentation
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
Menopause
Menopause is a term used to describe the permanent cessation of the primary functions of the human ovaries: the ripening and release of ova and the release of hormones that cause both the creation of the uterine lining and the subsequent shedding of the uterine lining...
. This is about 15 years older than the typical age of patients with fibroadenoma
Fibroadenoma
Fibroadenomas of the breast, are lumps composed of fibrous and glandular tissue. Because breast cancer can also appear as a lump, doctors may recommend a tissue sample to rule out cancer in older patients...
, 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 excisionWide local excision
A wide local excision is a surgical procedure to remove a small area of diseased or problematic tissue with a margin of normal tissue. This procedure is commonly performed on the breast and to skin lesions, but can be used on any area of the body....
. Other than surgery, there is no cure for phyllodes, as chemotherapy & radiation therapy are not effective. The risk of developing local recurrence or metastases
Metastasis
Metastasis, or metastatic disease , is the spread of a disease from one organ or part to another non-adjacent organ or part. It was previously thought that only malignant tumor cells and infections have the capacity to metastasize; however, this is being reconsidered due to new research...
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.
One study has suggested that total mastectomy is more effective than breast-conserving surgery
Breast-conserving surgery
Breast-conserving surgery is a less radical cancer surgery than mastectomy. Breast-conserving surgery, as in a lumpectomy removes part of the breast tissue during surgery, as opposed to the entire breast.-Contraindications:...
.
A recent study (Aug 2009) by Barth et al. suggests that radiation treatment after breast-conserving surgery
Breast-conserving surgery
Breast-conserving surgery is a less radical cancer surgery than mastectomy. Breast-conserving surgery, as in a lumpectomy removes part of the breast tissue during surgery, as opposed to the entire breast.-Contraindications:...
with negative margins significantly reduces the
local recurrence rate for borderline and malignant tumors.
Spectrum
Phyllodes tumors are considered to be on a spectrumSpectrum
A spectrum is a condition that is not limited to a specific set of values but can vary infinitely within a continuum. The word saw its first scientific use within the field of optics to describe the rainbow of colors in visible light when separated using a prism; it has since been applied by...
of disease that consists of fibroadenoma
Fibroadenoma
Fibroadenomas of the breast, are lumps composed of fibrous and glandular tissue. Because breast cancer can also appear as a lump, doctors may recommend a tissue sample to rule out cancer in older patients...
, fibroadenoma variant and benign phyllodes. Some would extend the spectrum to include malignant phyllodes tumors and frank sarcoma
Sarcoma
A sarcoma is a cancer that arises from transformed cells in one of a number of tissues that develop from embryonic mesoderm. Thus, sarcomas include tumors of bone, cartilage, fat, muscle, vascular, and hematopoietic tissues...
.
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