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# | '''Phyllodes tumour''' is a tumour of the intralobular breast stroma. It may be benign or [[malignant]]. | ||
It was previously called '''cystosarcoma phyllodes'''. | |||
==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. | |||
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) | |||
</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]]. | |||
==See also== | |||
*[[Breast pathology]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Breast pathology]] | |||