2. Definition :
Breast tumor of mixed connective tissue &
epithelium (biphasic proliferation of stroma &
mammary epithelium)
Also known as serocystic disease of Brodie.
Classified as benign (85%), borderline, or
malignant.
3. Pathology :
Sharply demarcated from surrounding breast tissue,
which is compressed & distorted.
Connective tissue composes the bulk of these
tumors, which have mixed gelatinous, solid & cystic
areas.
Cystic areas represent sites of infarction & necrosis.
Gross cut tumor surface : Classical leaf-like
(phyllodes) appearence.
4. Stroma of a phyllodes tumor has greater cellular
activity than fibroadenoma.
Most malignant phyllodes tumors contain
liposarcomatous or rhabdomyosarcomatous
elements rather than fibrosarcomatous elements.
Evaluation of number of mitoses & presence or
absence of invasive foci at the tumor margins may
help to identify a malignant tumor.
6. Clinical Features :
Smooth, rounded, usually painless multinodular
lesion.
Peak incidence : 4th decade.
Large, mostly massive size but always mobile
over chest wall.
Bosselated surface with pressure necrosis of
overlying skin.
7. Diagnosis is suggested by larger size, a history
of rapid growth and occurrence in older
patients.
Differentiated from carcinoma by:
No fixity to skin and pectoralis.
no nipple retraction.
no LN involvement.
8. Metastases from malignant phyllodes tumors
occur via hematogenous spread, with common
sites including lung, bone, abdominal viscera and
mediastinum.
13. Treatment :
Surgery is the mainstay of treatment.
Small phyllodes tumors: Wide local excision
Large phyllodes tumors: Mastectomy
Phyllodes tumor with suspicious malignant
elements: Re-excision of biopsy site to ensure
complete excision of tumor with a 1 cm margin
Axillary dissection is not recommended because
axillary LN metastases rarely occur.
