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| ==Phyllodes tumour== | | ==Phyllodes tumour== |
| *Previously ''cystosarcoma phyllodes''. | | *Previously ''cystosarcoma phyllodes''. |
| | | {{Main|Phyllodes tumour}} |
| ===General===
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| *The name comes from the word "leaf".
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| **With imagination or psychotropic drugs, it may look like one: the epithelial component = the veins of the leaf.
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| *Wide excision -- this differs from fibroadenoma (just local excision).
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| *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>
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| Notes:
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| *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>
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| * 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>
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| ===Gross===
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| *Clefts/leaf-like structures.
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| *Friable - especially vis-à-vis a [[fibroadenoma]].
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| Image:
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| *[http://radiographics.rsna.org/content/29/3/907/F48.expansion.html Benign phyllodes tumour (rsna.org)].
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| ===Microscopic===
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| Features - either 1, 2 or both of the following:
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| #Large slit-like spaces - '''key feature'''. †
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| #Cellular stroma - '''key feature'''. †
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| #*May be [[myxoid stroma|myxoid]].
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| *+/-Infiltrative border.
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| *+/-Mitoses.
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| *+/-Nuclear atypia.
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| *+/-"Stromal overgrowth" ~ stroma fills microscopic field.
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| Notes:
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| * † Large slit-like spaces are required for a benign phyllodes tumour.
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| *# Slit-like spaces may absent in a borderline phyllodes ''or'' a malignant phyllodes.
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| *# A cellular tumour without features suggestive of malignancy and without slit-like spaces is a ''[[cellular fibroadenoma]]''.
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| *#*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>
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| DDx:
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| *[[Fibroadenoma]].
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| *[[Metaplastic breast carcinoma]].
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| *Primary breast sarcoma.
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| *Other [[sarcoma]]s.
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| ====Images====
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| <gallery>
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| Image:Phyllodes_tumour_-_very_low_mag.jpg | Phyllodes tumour - very low mag. (WC/Nephron)
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| Image:Phyllodes_tumour_-_low_mag.jpg | Phyllodes tumour - low mag. (WC/Nephron)
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| </gallery>
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| ====Grading====
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| Phyllodes tumours are graded:
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| *Benign.
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| *Borderline.
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| *Malignant.
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| Grading phyllodes tumours - based on WMSP:<ref name=Ref_WMSP263>{{Ref WMSP|263}}</ref>
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| {| class="wikitable sortable"
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| ! Feature
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| ! Benign phyllodes
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| ! Borderline phyllodes
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| ! Malignant phyllodes
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| |-
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| | Circumscription
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| | Well
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| | Well
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| | Poor
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| |-
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| | Stromal overgrowth †
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| | none
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| | none
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| | may be present
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| |-
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| | Nuclear atypia
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| | mild
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| | mild-to-moderate
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| | moderate-to-marked
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| |-
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| | Mitoses per 10 [[HPF]]s ‡
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| | < 5
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| | 5-10
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| | >10
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| |-
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| | Heterologous elements
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| | +/- benign
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| | +/- benign
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| | +/- malignant
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| |-
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| | DDx
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| | [[fibroadenoma]]
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| | benign phyllodes, malignant phyllodes
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| | [[metaplastic breast carcinoma]], sarcoma
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| |-
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| |}
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| Notes:
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| * † 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]].
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| * ‡ ''HPF'' is not adequately defined - see [[HPFitis]].
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| ==Pseudoangiomatous stromal hyperplasia== | | ==Pseudoangiomatous stromal hyperplasia== |