Difference between revisions of "Phyllodes tumour"

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#redirect [[Breast_pathology#Phyllodes_tumour]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Phyllodes_tumour_-_very_low_mag.jpg
| Width      =
| Caption    = Phyllodes tumour. [[H&E stain]].
| Synonyms  =
| Micro      = either (1) or (2): (1) large slit-like spaces, (2) cellular stroma - may be myxoid; +/-infiltrative border, +/-mitoses, +/-nuclear atypia, +/-"stromal overgrowth" ~ stroma fills microscopic field (see ''microscopic'' section)
| Subtypes  = benign, borderline, malignant
| LMDDx      = [[fibroadenoma]], [[metaplastic breast carcinoma]], primary breast sarcoma, other [[sarcoma]]s
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      = mass with clefts - leaf-like structures
| Grossing  =
| Site      = [[breast]]
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      = mass lesion
| Symptoms  =
| Prevalence = uncommon
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = usually benign, may be malignant
| Other      =
| ClinDDx    = other breast tumours - often [[fibroadenoma]]
| Tx        = wide excision
}}
'''Phyllodes tumour''' is a tumour of the intralobular breast stroma. It may be benign or [[malignant]].
 
It was previously called '''cystosarcoma phyllodes'''. It is a type of [[fibroepithelial tumours of the breast|fibroepithelial tumour]].
 
==General==
*The name comes from the word "leaf".
**With imagination or psychotropic drugs, it may look like one: the epithelial component = the veins of the leaf.
*Wide excision -- this differs from fibroadenoma (just local excision).
*Approximately 6% are malignant.<ref name=pmid12689668>{{cite journal |author=Guerrero MA, Ballard BR, Grau AM |title=Malignant phyllodes tumor of the breast: review of the literature and case report of stromal overgrowth |journal=Surg Oncol |volume=12 |issue=1 |pages=27–37 |year=2003 |month=July |pmid=12689668 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0960740403000057}}</ref>
 
Notes:
*There are case reports of ''phyllodes tumours'' in the [[prostate gland]].<ref name=pmid20069045>{{Cite journal  | last1 = Bannowsky | first1 = A. | last2 = Probst | first2 = A. | last3 = Dunker | first3 = H. | last4 = Loch | first4 = T. | title = Rare and challenging tumor entity: phyllodes tumor of the prostate. | journal = J Oncol | volume = 2009 | issue =  | pages = 241270 | month =  | year = 2009 | doi = 10.1155/2009/241270 | PMID = 20069045 }}</ref>
* Outside of the breast a phyllodes-like histomorphology may represent an ''[[adenosarcoma]]''.<ref name=pmid20179434>{{Cite journal  | last1 = McCluggage | first1 = WG. | title = Mullerian adenosarcoma of the female genital tract. | journal = Adv Anat Pathol | volume = 17 | issue = 2 | pages = 122-9 | month = Mar | year = 2010 | doi = 10.1097/PAP.0b013e3181cfe732 | PMID = 20179434 }}</ref>
 
==Gross==
*Clefts/leaf-like structures.
*Friable - especially vis-à-vis a [[fibroadenoma]].
 
Image:
*[http://radiographics.rsna.org/content/29/3/907/F48.expansion.html Benign phyllodes tumour (rsna.org)].
 
==Microscopic==
Features - either 1, 2 or both of the following:
#Large slit-like spaces - '''key feature'''. †
#Cellular stroma  - '''key feature'''. †
#*May be [[myxoid stroma|myxoid]].
*+/-Infiltrative border.
*+/-Mitoses.
*+/-Nuclear atypia.
*+/-"Stromal overgrowth" ~ stroma fills microscopic field (see below).
 
Notes:
* † Large slit-like spaces are required for a benign phyllodes tumour.
*# Slit-like spaces may absent in a borderline phyllodes ''or'' a malignant phyllodes.
*# A cellular tumour without features suggestive of malignancy and without slit-like spaces is a ''[[cellular fibroadenoma]]''.
*#*Some pathologists don't believe in ''cellular fibroadenoma'' - they call everything with stromal cellularity a ''phyllodes tumour''.<ref>URL: [http://www.breastpathologyconsults.com/blog/wp-content/uploads/2011/03/FEL_poster.pdf http://www.breastpathologyconsults.com/blog/wp-content/uploads/2011/03/FEL_poster.pdf]. Accessed on: 23 February 2012.</ref>
 
DDx:
*[[Fibroadenoma]].
*[[Metaplastic breast carcinoma]].
*Primary breast sarcoma.
*Other [[sarcoma]]s.
 
===Images===
<gallery>
Image:Phyllodes_tumour_-_very_low_mag.jpg | Phyllodes tumour - very low mag. (WC/Nephron)
Image:Phyllodes_tumour_-_low_mag.jpg | Phyllodes tumour - low mag. (WC/Nephron)
Image:Malignant phyllodes tumour.jpg |Malignant phyllodes tumour - low mag (WC)
Image:Malignant phyllodes tumour high magnification.jpg |Malignant phyllodes tumour - high mag (WC)
</gallery>
 
===Grading===
Phyllodes tumours are graded:
*Benign.
*Borderline.
*Malignant.
 
Grading phyllodes tumours - based on WMSP:<ref name=Ref_WMSP263>{{Ref WMSP|263}}</ref>
{| class="wikitable sortable"
! Feature
! Benign phyllodes
! Borderline phyllodes
! Malignant phyllodes
|-
| Circumscription
| Well
| Well
| Poor
|-
| Stromal overgrowth †
| none
| none
| may be present
|-
| Nuclear atypia
| mild
| mild-to-moderate
| moderate-to-marked
|-
| Mitoses per 10 [[HPF]]s ‡
| < 5
| 5-10
| >10
|-
| Heterologous elements
| +/- benign
| +/- benign
| +/- malignant
|-
| DDx
| [[fibroadenoma]]
| benign phyllodes, malignant phyllodes
| [[metaplastic breast carcinoma]], sarcoma
|-
|}
 
Notes:
* † Stromal overgrowth = epithelial elements absent in one low power field (LPF), defined as x40;<ref name=pmid17932112>{{cite journal |author=Taira N, Takabatake D, Aogi K, ''et al'' |title=Phyllodes tumor of the breast: stromal overgrowth and histological classification are useful prognosis-predictive factors for local recurrence in patients with a positive surgical margin |journal=Jpn. J. Clin. Oncol. |volume=37 |issue=10 |pages=730-6 |year=2007 |month=October |pmid=17932112 |doi=10.1093/jjco/hym099 |url=http://jjco.oxfordjournals.org/cgi/reprint/37/10/730}}</ref> ''LPF'' is not adequately defined - see [[LPFitis]].
* ‡ ''HPF'' is not adequately defined - see [[HPFitis]].
 
==Sign out==
===Benign===
<pre>
Right Breast Mass, Excision:
- Benign phyllodes tumour.
- NEGATIVE for malignancy.
</pre>
 
====Micro====
The sections show a well-circumscribed mass with a leaf-like architecture. There is no stromal overgrowth or atypia. Proliferative activity is not readily apparent.
 
==See also==
*[[Breast pathology]].
 
==References==
{{Reflist|2}}
 
[[Category:Diagnosis]]
[[Category:Breast pathology]]

Latest revision as of 19:59, 21 October 2021

Phyllodes tumour
Diagnosis in short

Phyllodes tumour. H&E stain.
LM either (1) or (2): (1) large slit-like spaces, (2) cellular stroma - may be myxoid; +/-infiltrative border, +/-mitoses, +/-nuclear atypia, +/-"stromal overgrowth" ~ stroma fills microscopic field (see microscopic section)
Subtypes benign, borderline, malignant
LM DDx fibroadenoma, metaplastic breast carcinoma, primary breast sarcoma, other sarcomas
Gross mass with clefts - leaf-like structures
Site breast
Signs mass lesion
Prevalence uncommon
Prognosis usually benign, may be malignant
Clin. DDx other breast tumours - often fibroadenoma
Treatment wide excision

Phyllodes tumour is a tumour of the intralobular breast stroma. It may be benign or malignant.

It was previously called cystosarcoma phyllodes. It is a type of fibroepithelial tumour.

General

  • The name comes from the word "leaf".
    • With imagination or psychotropic drugs, it may look like one: the epithelial component = the veins of the leaf.
  • Wide excision -- this differs from fibroadenoma (just local excision).
  • Approximately 6% are malignant.[1]

Notes:

Gross

  • Clefts/leaf-like structures.
  • Friable - especially vis-à-vis a fibroadenoma.

Image:

Microscopic

Features - either 1, 2 or both of the following:

  1. Large slit-like spaces - key feature. †
  2. Cellular stroma - key feature. †
  • +/-Infiltrative border.
  • +/-Mitoses.
  • +/-Nuclear atypia.
  • +/-"Stromal overgrowth" ~ stroma fills microscopic field (see below).

Notes:

  • † Large slit-like spaces are required for a benign phyllodes tumour.
    1. Slit-like spaces may absent in a borderline phyllodes or a malignant phyllodes.
    2. A cellular tumour without features suggestive of malignancy and without slit-like spaces is a cellular fibroadenoma.
      • Some pathologists don't believe in cellular fibroadenoma - they call everything with stromal cellularity a phyllodes tumour.[4]

DDx:

Images

  • Phyllodes tumour - very low mag. (WC/Nephron)

  • Phyllodes tumour - low mag. (WC/Nephron)

  • Malignant phyllodes tumour - low mag (WC)

  • Malignant phyllodes tumour - high mag (WC)

Grading

Phyllodes tumours are graded:

  • Benign.
  • Borderline.
  • Malignant.

Grading phyllodes tumours - based on WMSP:[5]

Feature Benign phyllodes Borderline phyllodes Malignant phyllodes
Circumscription Well Well Poor
Stromal overgrowth † none none may be present
Nuclear atypia mild mild-to-moderate moderate-to-marked
Mitoses per 10 HPFs ‡ < 5 5-10 >10
Heterologous elements +/- benign +/- benign +/- malignant
DDx fibroadenoma benign phyllodes, malignant phyllodes metaplastic breast carcinoma, sarcoma

Notes:

  • † Stromal overgrowth = epithelial elements absent in one low power field (LPF), defined as x40;[6] LPF is not adequately defined - see LPFitis.
  • ‡ HPF is not adequately defined - see HPFitis.

Sign out

Benign

Right Breast Mass, Excision:
- Benign phyllodes tumour.
- NEGATIVE for malignancy.

Micro

The sections show a well-circumscribed mass with a leaf-like architecture. There is no stromal overgrowth or atypia. Proliferative activity is not readily apparent.

See also

References

  1. ↑ Guerrero MA, Ballard BR, Grau AM (July 2003). "Malignant phyllodes tumor of the breast: review of the literature and case report of stromal overgrowth". Surg Oncol 12 (1): 27–37. PMID 12689668. http://linkinghub.elsevier.com/retrieve/pii/S0960740403000057.
  2. ↑ Bannowsky, A.; Probst, A.; Dunker, H.; Loch, T. (2009). "Rare and challenging tumor entity: phyllodes tumor of the prostate.". J Oncol 2009: 241270. doi:10.1155/2009/241270. PMID 20069045.
  3. ↑ McCluggage, WG. (Mar 2010). "Mullerian adenosarcoma of the female genital tract.". Adv Anat Pathol 17 (2): 122-9. doi:10.1097/PAP.0b013e3181cfe732. PMID 20179434.
  4. ↑ URL: http://www.breastpathologyconsults.com/blog/wp-content/uploads/2011/03/FEL_poster.pdf. Accessed on: 23 February 2012.
  5. ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 263. ISBN 978-0781765275.
  6. ↑ Taira N, Takabatake D, Aogi K, et al (October 2007). "Phyllodes tumor of the breast: stromal overgrowth and histological classification are useful prognosis-predictive factors for local recurrence in patients with a positive surgical margin". Jpn. J. Clin. Oncol. 37 (10): 730-6. doi:10.1093/jjco/hym099. PMID 17932112. http://jjco.oxfordjournals.org/cgi/reprint/37/10/730.
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