Lecture notes for medical students

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2. Phyllodes Tumor (Cystosarcoma
Phyllodes)

3. Phyllodes Tumor (Cystosarcoma
Phyllodes)
• Sarkoma -fleshy tumor
• Phyllon -leaf”
• A rare, predominantly benign tumor that
occurs almost exclusively in the
female breast.
• Leaflike appearance when sectioned.
• Epithelial, cystlike spaces when viewed
histologically.

4. Phyllodes Tumor (Cystosarcoma
Phyllodes)
• Most of these tumors are benign, the term
cystosarcoma is misleading.
• The term currently favored is phyllodes
tumor.

5. Etiology

6. Etiology
• Idiopathic
• Congenital
• Traumatic
• Infections /Infestation
• Autoimmune
• Neoplastic (Benign/Malignant)
• Degenerative

7. Pathophysiology
• Develops from connective tissue of breast.
• 85-90% of phyllodes tumors are benign and that
approximately 10-15% are malignant.
• Benign phyllodes tumors do not metastasize, grow
aggressively and recur locally.
• Like other sarcomas, malignant phyllodes tumors
metastasize hematogenously.
• Difficult to distinguish fibroadenomas, benign
phyllodes tumors, and malignant phyllodes tumors

8. Clinical Features

9. Clinical Features
• Demography
• Symptoms
• Signs
• Prognosis
• Complications

10. Demography
•

11. Demography
• 1% of tumors in the breast.
• Phyllodes tumors occur almost exclusively
in females, though rare cases have been
reported in males.
• The tumors can develop in people of any
age; however, the median age is the fifth
decade of life.

12. Symptoms

13. Symptoms
• Larger mass+ rapid growth.
• Rarely involve the nipple-areola complex or
ulcerate to the skin.
• Patients with metastases may present with
such symptoms as dyspnea, fatigue, and
bone pain.

14. Signs

15. Signs
• Similar to those of fibroadenoma.
• A firm, mobile, well-circumscribed, nontender
breast mass.
• Curiously, phyllodes tumors tend to involve the
left breast more commonly than the right.
• Overlying skin may display a shiny appearance
and be translucent enough to reveal underlying
breast veins.
• A very large phyllodes tumor may erode through
overlying skin and present as an external
fungating breast mass.

16. Prognosis

17. Prognosis
• Excellent in benign.
• Poor in malignant

18. Complications

19. Complications
• Metastasis.
• Local recurrence.

20. Investigations

21. Investigations
• Laboratory Studies
– Routine
– Special
• Imaging Studies
• Tissue diagnosis
– Cytology
• FNAC
– Histology

22. Diagnostic Studies

23. Diagnostic Studies
Imaging Studies
• X-Ray
• USG
• CT
• Angiography
• MRI
• Endoscopy
• Nuclear scan

24. Histopathology

25. Histopathology
• Stromal tumour.
• Benign phyllodes tumors demonstrate a
markedly increased number of regular
fusiform fibroblasts in the stroma.
• Malignant phyllodes tumor-
– high degree of cellular atypia,
– Increased stromal cellularity
– Increased mitotic count.

26. Staging

27. Staging
• Benign (grade 1)
• Borderline (grade 2)
• Malignant (grade 3)

28. Differential Diagnosis

29. Differential Diagnosis
• Angiosarcoma
• Breast cancer
• Juvenile fibroadenoma
• Giant fibroadenoma
• Inflammatory
carcinoma
• Sclerosing adenosis
• Radial scar
• Traumatic Fat necrosis
• Fibrocystic change
• Breast abscess
• Adenocarcinoma
• Mastitis

30. Management

31. Management
• Wide local excision with a rim of normal tissue
included.
• The lesion should not be "shelled out," as might be
done with a fibroadenoma,
• continued follow-up care.
• If the tumor-to-breast ratio is sufficiently high to
preclude a satisfactory cosmetic result with
segmental excision, Total mastectomy, with or
without reconstruction.
• Axillary lymph node dissection for clinically
suspicious nodes.

32. Traumatic Fat Necrosis

33. Traumatic Fat Necrosis
• Clinical features - Pain & lump in the breast
• Lump is hard - extensive fibrosis caused by
tissue reaction
• D.D : Carcinoma breast
• Mammography findings - density lesion;
can have calcifications; may mimic
carcinoma breast
• Treatment - excision of the lump

34. Mastalgia:Introduction

35. Mastalgia:Introduction
• Breast pain is common and a symptom that
brings a woman to her physician. Usually it
is of functional origin and uncommonly is it
a symptom of breast cancer.
• Most patients with pain do not have breast
cancer.

36. Types

37. Types
• Cyclical mastalgia.
• Noncyclical mastalgia.

38. Cyclical mastalgia

39. Cyclical mastalgia
• Normal ovarian hormonal influences on breast
glandular elements frequently produce cyclical
mastalgia.
• It is most common in women in their mid-30s
• Pain is dull, diffuse
• Bilaterally symmetrical in the upper outer
quadrants.
• It is predominantly experienced in the luteal phase
of the menstrual cycle and abates
with menstruation.

40. MASTALGIA

41. MASTALGIA
• Menstruating age group
• Hormone related-ANDI
• Dull diffuse bilateral
• Upper outer quadrant

42. Noncyclical mastalgia

43. Noncyclical mastalgia
1.Non breast etiology specific significant
breast condition
• Cervical radiculopathy,
• Costochondritis,
• Intercostal muscle strain.
• Gastroesophageal reflux disorder,
symptomatic gallstones,
• Cardiovascular disease,
• Pulmonary pathology

44. Noncyclical mastalgia
2.Specific breast conditions:
• Breast cyst
• Breast cellulitis (mastitis) .
• Inflammatory breast cancer,
• Ca. Breast

45. Investigations

46. Investigations
• Laboratory Studies
– Routine
– Special
• Imaging Studies
• Tissue diagnosis
– Cytology
• FNAC
– Histlogy

47. Diagnostic Studies

48. Diagnostic Studies
Imaging Studies
• X-Ray: Mammography
• USG
• CT
• Angiography
• MRI
• Endoscopy
• Nuclear scan

49. MASTALGIA:MANAGEMENT

50. MASTALGIA:MANAGEMENT
1.Pain diary
2.Reassurance
3.Exclude caffeine
4.Low fat diet
5.Stop OCPs/HRT
6.stop smoking
7.drugs

51. MASTALGIA:Drugs
• ANALGESICS
• EVENING PRIM ROSE OIL
• GOSERELIN
• BROMOCRIPTIN
• DANAZOL

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