Approaches to phyllodes tumour of the breast: a review article

Abstract

Phyllodes tumours are rare entities of fibroepithelial diseases. The exact pathogenesis and their relationship with fibroadenomas are oblivious. Women aged between 35 to 55 years are commonly affected, even younger in Asian population. Triple assessment should be applied as a guide to management in any breast pathology. Clinical appearances are typically diagnostic for phyllodes tumours. Even though sometimes inconclusive, mammography and ultrasonography are the main imaging modalities. Although the role of cytology is debatable, presence of both epithelial and stromal elements supports the diagnosis especially in malignant type. Core biopsy is rather favored in view of higher accuracy for the diagnosis. Accurate preoperative assessment and histologic diagnosis allow correct surgical intervention and subsequent avoidance of reoperation. Surgical management can be either wide excision with more than 1 cm margins or mastectomy without axillary surgery. Local recurrence has been associated with inadequate excision of the pseudopod. Adjuvant radiotherapy is recommended for positive surgical margin and for local control of borderline and malignant phyllodes tumors. The role of chemotherapy and endocrine therapy has not been fully studied.

Phyllodes Tumor of the Breast during Pregnancy and Lactation; A Systematic Review

“…The most common presentation of PT is a breast lump, which used to be self-detected previously, and is frequently being detected in imaging recently. 50 This fact also applies to this study, where 90.7% of tumors presented as a mass; and the 9.3% which presented with breast enlargement showed a mass later on.…”

“…Previous review articles on this subject consisted of 7 patients (one bilateral: 8 tumors), 10 9 patients (one bilateral: 10 tumors), 29 and 14 patients (one bilateral: 16 tumors). 35 The mean age of patients in this study was 31 years (21-43 years), younger than the average of 40-45 years for usual PT 50 ; this difference is ordinary because gestational tumors are studied. The youngest patient was 21 and the oldest 43 years old.…”

“…The effect of systemic endocrine therapy or chemotherapy, as well as radiotherapy, has not been completely defined in the management of PT. 7,9,50 In our study, one patient with malignant PT had undergone both chemotherapy and radiotherapy, 4 and another had received radiation 45 after the operation.…”

“…Normally, benign PT is much more frequent than the malignant form. 50,54,55 On the other hand, most breast disorders presenting during pregnancy are benign. 51 Our study shows a higher frequency for malignant tumors compared to benign ones.…”

Caso Clínico: Tumor Phyllodes

“…La eficacia de la terapia adyuvante postoperatoria para el tumor phyllodes de mama no está clara, en varios estudios no hubo diferencias estadísticamente significativas entre tratamiento adyuvante postoperatorio versus ningún tratamiento en términos de supervivencia [2]. La hormonoterapia no tiene un rol en esta patología, no se ha documentado expresión de receptores hormonales como ha sucedió en el caso que se presenta por lo tanto la adyuvancia con hormas no está indicada y no ha sido administrada en el presente caso [9 -12].…”