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Summary![toggle arrow icon](https://manus-media.amboss.com/icons/chevron_up.svg)
Phyllodes tumor is a rare fibroepithelial breast tumor that typically manifests in individuals between 40–50 years of age as a painless, multinodular breast mass. Unlike fibroadenomas, phyllodes tumors tend to increase in size more rapidly over time. On breast ultrasound, phyllodes tumors appear as a hypoechoic solid mass containing cysts; on mammography, they appear as a hyperdense mass. Biopsy is required for diagnostic confirmation. Histological findings of stromal cellularity and leaf-like architecture distinguish phyllodes from fibroadenoma. Phyllodes tumors are categorized as benign, borderline, and malignant according to the following features: border infiltration, mitotic activity, stromal atypia, and hypercellularity. Malignant or borderline phyllodes tumors can metastasize hematogenously. Surgical excision is recommended for nonmetastatic disease. Metastatic phyllodes tumors carry a poor prognosis; management (e.g., palliative surgery, chemotherapy) should be tailored to the individual. Phyllodes tumors have a high rate of recurrence after surgical excision.
Epidemiology![toggle arrow icon](https://manus-media.amboss.com/icons/chevron_up.svg)
Clinical features![toggle arrow icon](https://manus-media.amboss.com/icons/chevron_up.svg)
- Painless, multinodular lump in the breast, with an average size of 4–7 cm
- Variable growth rate: may grow slowly over many years, rapidly, or have a biphasic growth pattern
Compared to phyllodes tumors, fibroadenomas tend to be smaller in size, remain the same size or grow slowly, and usually occur in younger (20–30 years) women. [3]
Diagnostics![toggle arrow icon](https://manus-media.amboss.com/icons/chevron_up.svg)
Follow age-appropriate diagnostic workup for a palpable breast mass. The findings specific to phyllodes tumor are described here.
Phyllodes tumors and fibroadenomas have similar clinical presentations and imaging features. If phyllodes tumor is suspected, a biopsy is necessary to confirm the diagnosis. [3]
Imaging findings
- Breast ultrasound: hypoechoic solid mass that may contain cysts [4][5]
- Mammography: hyperdense mass [3][5]
Phyllodes tumors may be indistinguishable from fibroadenomas on imaging, but features such as larger size, the presence of cysts, or a hyperdense mass on mammography should raise concern for phyllodes tumor. [3]
Biopsy
- Indications: all patients with suspected phyllodes tumor [3]
- Modalities [2][3][6]
-
Findings [6]
- Leaf-like architecture with papillary projections ; of epithelium-lined stroma (connective tissue) [7]
- Phyllodes tumors are histologically categorized as benign, borderline, or malignant. [3][6]
Stromal cellularity and leaf-like architecture are key histological findings that distinguish phyllodes tumors from fibroadenomas. [3]
While phyllodes tumors are typically benign, some are malignant and have the potential to metastasize. Phyllodes tumors should be considered malignant until proven otherwise. [3][4]
Treatment![toggle arrow icon](https://manus-media.amboss.com/icons/chevron_up.svg)
Refer all patients with phyllodes tumors to a breast surgeon or surgical oncologist for management.
- Benign phyllodes tumor: surgical excision
-
Borderline or malignant phyllodes tumor: Assess for metastases (e.g., CT chest).
- Nonmetastatic disease:
- Wide excision (1 cm margin), if feasible
- Adjuvant radiation may be considered to minimize the risk of recurrence.
-
Metastatic disease:
- Palliative surgery
- Chemotherapy may be considered on an individual basis.
- Nonmetastatic disease:
Prognosis![toggle arrow icon](https://manus-media.amboss.com/icons/chevron_up.svg)
- High risk of recurrence after excision [3]
- Borderline and malignant phyllodes can metastasize hematogenously.
- Metastatic phyllodes tumor has a poor prognosis.