phyllodes tumor (cystosarcoma phyllodes)

Epidemiology

• • most common in middle aged & elderly women
  • rare in patients < 20 years of age

Pathology

• gross appearance
  • tumors generally firm & rubbery, but may be gelatinous
  • cut surface may have cauliflower appearance
  • may be foci of hemorrhage & necrosis (features of malignancy)
• histopathology
  • shares features of fibroadenoma
  • prominent intracanalicular pattern
  • stromal hypercellularity is most important distinguishing feature
• metastases after local recurrence most frequently involves the lungs, via blood

Clinical manifestations

• rapidly enlarging mass may occur, sometimes at the site of a pre-existing, long-standing mass
• generally larger than fibroadenomas
• surface projections are often present

Laboratory

• flow cytometry for ploidy & S-phase population may be useful for determining prognosis

Differential diagnosis

• fibroadenoma
• benign versus malignant phyllodes tumor

Management

• resection:
  • incomplete resection may account for local recurrence
  • axillary dissection NOT indicated
• prognosis
  • generally benign
  • more likely to recur locally than fibroadenoma
  • in rare cases, may metastasize*
  • tumor size does not determine prognosis

* transformation to periductal sarcoma

More general terms

• neoplasm; tumor