phylloides tumor (cystosarcoma phyllodes)

1. Dr Karrar Adil

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.

5. Microscopic classical leaf-like (phyllodes) appearance

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.

10. Differential diagnoses:
 Juvenile/giant fibroadenoma
 angiosarcoma
 breast abscess
 Breast carcinoma

11. Diagnosis :
 Mammography :
• evidence of calcifications & morphologic
evidence of necrosis.
• does not distinguish between benign, borderline,
and malignant phyllodes tumors.
 Ultrasound: Discrete structure with cystic
spaces.
 FNAC, core biopsy : investigations of choice.

12. Phyllodes tumor in mammography

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.

14. Thank you …