How are phyllodes tumors (cystosarcoma phyllodes) diagnosed and treated in pediatric breast disorders?

Updated: Apr 01, 2019
  • Author: Harsh Grewal, MD, FACS, FAAP; Chief Editor: Robert K Minkes, MD, PhD  more...
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Answer

Phyllodes tumor manifests as a painless breast mass. [14] Patients may have a history of sudden enlargement of a previously stable mass. The mass may be dramatically large; thinning of overlying skin and increased vascularity of the area may be present. This tumor is very rare, accounting for only 0.5% of all breast tumors. [15]

Generally, US cannot be used to distinguish between a fibroadenoma and a phyllodes tumor. The differentiation between a fibroadenoma and a phyllodes tumor lies in histologic examination. Phyllodes tumors are fibroepithelial lesions with more cellular stroma with nuclear atypia and mitotic figures. As many as 25% of phyllodes tumors are considered malignant, but histologic classification does not reliably predict behavior. [15]

The management of a benign or malignant phyllodes tumor involves wide excision with a margin of normal breast tissue. Positive resection marigins, stromal overgrowth, and infiltrative tumor borders are associated with increased local recurrence. [16, 15] . Malignant phyllodes tumors rarely metastasize to the axilla. Axillary dissections are indicated for patients with palpable lymph nodes. Local recurrence and hematogenous spread, even after complete resection, may occur with as many as 22% of malignant tumors. [15]


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