Non-Cancerous Breast Conditions

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Phyllodes tumors
Phyllodes (also spelled phylloides) tumors are rare breast tumors that, like fibroadenomas, contain 2 types of breast tissue: stromal (connective) tissue and glandular (lobule and duct) tissue. They are most common in women in their 30s and 40s, but they may be found in women of any age. The tumors are usually felt as a painless lump, but some may be painful. They may grow quickly and stretch the skin. They are often hard to tell from fibroadenomas on imaging tests, or even with fine needle or core needle biopsies. When seen under a microscope, the main difference between phyllodes tumors and fibroadenomas is that phyllodes tumors have an overgrowth of connective tissue. The cells that make up the connective tissue part can look abnormal under the microscope. Depending on how the cells look, phyllodes tumors may be classified as benign (non-cancerous), malignant (cancerous), or borderline (looking more abnormal than benign tumors, but not quite malignant). These types of tumors can behave differently. Phyllodes tumors are usually benign but in rare cases may be cancerous. Less than 5% of these tumors spread to other areas, such as the lungs, or come back (recur) in distant areas after treatment. In the past, both benign and malignant phyllodes tumors were referred to as cystosarcoma phyllodes. Phyllodes tumors (even benign ones) can sometimes come back in the same place if they are removed without taking some of the normal tissue around them. For

this reason, they are treated by removing the mass and a 1 to 2 cm (about to inch) area of normal breast tissue from around the tumor. Malignant phyllodes tumors are treated by removing them along with a wider margin of normal tissue, or by mastectomy (removing the entire breast) if needed. Malignant phyllodes tumors are different from the more common types of breast cancer. They do not respond to hormone therapy and are less likely than most breast cancers to respond to radiation therapy or the chemotherapy drugs normally used for breast cancer. Phyllodes tumors that have spread to distant areas are often treated more like sarcomas (soft-tissue cancers) than breast cancers. Because these tumors can recur, close follow-up with frequent breast exams and imaging tests are usually recommended after treatment.

Last Medical Review: 08/24/2012 Last Revised: 08/24/2012

Overview of Phyllodes Breast Tumor:

Phyllodes tumor is a very rare type of breast tumor, which can be benign (harmless) or malignant (cancerous). This type of tumor is called a "sarcoma," because it occurs in the connective tissue (stroma) of your breast, rather than in epithelial tissue (lining of ducts and lobes). Phyllodes tumors take their name from the Greek word phullon (leaf) because of their leaf-shaped growth pattern.

Phyllodes Tumor is a Rare Diagnosis:

Phyllodes tumors account for less than 1% of all breast cancers. Even though the tumor may be benign, it is still considered a type of breast cancer, because it has the potential to become malignant.

Also Known As:

phylloides tumor, PT, cystosarcoma phyllodes, cystosarcoma phylloides and sometimes called "giant fibroadenomas"

Signs and Symptoms of Phyllodes Tumor:

A Phyllodes tumor will feel like a firm, smooth-sided, bumpy (not spiky) lump in your breast tissue. Breast skin over the tumor may become reddish and warm to the touch. This type of breast tumor grows very fast so much so that the lump can become bigger in a couple of weeks. Since a Phyllodes tumor may resemble a fibroadenoma, these two conditions are often mistaken for each other. Most women who are diagnosed with Phyllodes tumor are usually premenopausal. In very rare cases, adolescent girls may be diagnosed with this type of breast tumor.

Tests Used to Diagnose Phyllodes Tumor:

On a mammogram, a Phyllodes tumor will have a well-defined edge. Neither a mammogram nor a breast ultrasound, however, can distinguish clearly between fibroadenomas and benign or malignant Phyllodes tumors. This type of breast tumor is not usually found near microcalcifications. Cells from a needle biopsy can be tested in the lab but seldom give a clear diagnosis, because the cells can resemble carcinomas and fibroadenomas. An open surgical biopsy, which results in a slice of tissue, will provide a better sample of cells and will result in a proper diagnosis for a Phyllodes tumor.

Breast MRIs Assist Surgeons in Removal of Phyllodes Tumors:

An Italian study comparing mammograms, ultrasounds and breast MRIs of Phyllodes tumor reported that MRIs gave the most accurate image of these tumors and helped surgeons plan their operations. Even if the tumor was quite close to the chest wall muscles, the breast MRI could give a better image of a Phyllodes tumor than a mammogram or ultrasound.

Stages of Phyllodes Tumor:

Most breast cancers are classified as stages 1 to 4, but that is not the case with Phyllodes tumor. After a surgical biopsy, the pathologist will study the cells under a microscope. Two characteristics are considered: the speed at which the cells are dividing and the number of irregularly shaped cells in the tissue sample. Depending on how the cells meet these criteria, the tumor is classed as benign (harmless), borderline or malignant (cancerous). Most Phyllodes tumors turn out to be benign.

Prognosis for Phyllodes Tumor:

Your prognosis, or outlook after treatment, is very good for a benign Phyllodes tumor. There is a low chance of recurrence for a Phyllodes tumor, if you are 45 or older. For patients with a diagnosis of borderline or malignant tumors, your prognosis will vary. Borderline tumors have the potential to become cancerous, and even after surgery, if some cells remain (although in rare cases) they will metastasize. Malignant tumors can recur even two years after treatment and may spread to your lungs, bones, liver and chest wall. In a few cases, lymph nodes were involved as well.

Treatments for Phyllodes Tumor:

Surgery to remove a Phyllodes tumor is the standard treatment. This type of tumor does not respond well to radiation, chemotherapy or hormonal therapies. If your tumor is relatively small and benign, it may be removed with a lumpectomy. Large benign tumors may require a mastectomy, so as to remove both the tumor and a clean margin of breast tissue. Malignant tumors are removed with a wide local excision (WLE) or mastectomy to remove as much of the affected tissue as possible.
Sources: American Cancer Society. What is Breast Cancer? Invasive (or infiltrating) Ductal Carcinoma. Revised: 09/13/2007.

Ann Ital Chir. 2005 Mar-Apr;76(2):127-40. Surgical treatment and MRI in phyllodes tumors of the breast: our experience and review of the literature. Franceschini G, D'Ugo D, Masetti R, Palumbo F, D'Alba PF, Mul A, Costantini M, Belli P, Picciocchi A.

Phyllodes Tumors
Most Phyllodes tumors are benign, but 10 percent are malignant (cancerous). Cancerous Phyllodes tumors are an unusual presentation of breast cancer. These tumors are a form of sarcoma because they grow in the connective tissue of the breast, not in the ducts. This cancer is so rare that a confirmation by a second pathologist is required.

What are the symptoms of Phyllodes tumors?

These tumors will usually present as a smooth lump felt beneath the skin. The breast may become red or warm to the touch. These tumors can grow very fast, so it is important to have them evaluated as soon as possible. Symptoms can also mimic those of other types of breast cancer.

How are Phyllodes tumors diagnosed?

Same Day Results At our Breast Center, most women can learn within 24 hours of being seen by our team of breast cancer specialists whether they have breast cancer. We follow strict guidelines for biopsies and pathology reports. Our patients will receive the probability of cancer immediately following their biopsy procedure, and a pathology confirmation usually within 24 hours. Learn more about the steps of diagnosis, including:

Digital mammography Ultrasound MRI Staging workup (for malignant tumors) Biopsy Pathology

What is the treatment for Phyllodes tumors?

While the tumors are most often benign, it is still critical to remove the entire tumor. Even if one cell is left behind, it will grow back. Treatment involves excision of both the tumor and a wide margin of healthy tissue surrounding the tumor. For malignant (cancerous) tumors, depending on the stage and growth of the breast cancer, your physician may recommend a combination of any of the following:

Lumpectomy When this procedure is performed, wider margins are usually taken since leaving any remnants of the tumor can cause it to regenerate. Mastectomy

Radiation Chemotherapy

What is the prognosis for Phyllodes tumors?

For women with a malignant Phyllodes tumor, the prognosis depends on size, prognostic factors and other information obtained from the pathology results. Your oncologist will review this information with you.