Phyllodes tumors are rare breast tumors that are usually benign but can sometimes be malignant. They make up 1% of breast tumors. Phyllodes tumors typically present as large, rapidly growing masses in women over 40 years old. Diagnosis is made through biopsy and imaging tests. Treatment is complete surgical excision with wide margins. For malignant tumors, adjuvant radiation or chemotherapy may be considered. Prognosis is generally good for benign and borderline tumors treated with surgery alone, while malignant tumors have a 5-year survival rate of 60-80% even with additional treatment.

1. Phyllodes
tumor:Management
Dr Shambhavi Sharma
Resident 1st year

2. Introduction
• Also known as serocystic disease of Brodie or cystosarcoma phyllodes
• Greek word
Phyllon = leaf
Sarcoma = fleshy tumor

3. Epidemiology
• Age: over the age of 40
• Sex: almost exclusively on females
• Occurrence: 1% of tumors of breast, 2.5% of fibroepithelial tumors
• Mostly benign
• Average annual incidence rate of malignant phyllodes tumor is
2.1/million women
• May be associated with Li Freumani syndrome

4. Clinical presentation
Large, sometimes massive tumor
(Average size: 5cm)
Unilateral
Rapidly growing mass
Ulceration of overlying skin

5. Examination
Stretched,red,dilated veins
Smooth ,non tender, fluctuant
necrosis and hence cystic areas
Warmer,notfixed to skin or deeper muscles or chest wall
No nipple retraction
Lymph nodes palpaple (20%) (mostly reactive

6. Malignant phyllodes
More aggressive
Metastasize hematogenously
Lung, skeleton, heart, and liver – most common metastatic site
Mortality rate: 30%
May present with dyspnea, fatigue, and bone pain

7. Malignant phyllodes
• Malignant phyllodes tumor represent anywhere from 10–30% of all
phyllodes tumors.

8. ultrasonography
well-circumscribed, lobulated masses, heterogeneous internal echo
patterns, and a lack of microcalcifications
Mammography:

9. Invetsigations
CT scan : chest Excisional biopsy(cut section) histopathlogy
Invading chest wall
Cystic areas expansion and increased cellularity of the
stromal component
a leaf-like pattern

10. Classification

11. Differential diagnosis

13. TREATMENT:
SURGERY
• Complete Excision
2cm margin for small tumors
5cm margin for large tumor
• Lumpectomy/Wide Local Excision /Mastectomy depending on Size
• Axillary Lymph Node Dissection : usually not necessary

14. Postoperative adjuvant therapy
ADJUVANT CHEMOTHERAPY?
• role is Controversial!
• Should be considered for Malignant Phyllodes tumour

15. Adjuvant radiotherapy
•Not indicated for tumours that are Widely Excised
• Indicated for Borderline or Malignant Phyllodes tumours
• Reduces Local Recurrence but does not impact Survival.
• Rarely indicated following Mastectomy

16. Adjuvant hormone therapy
• No place for Hormonal therapy in Phyllodes Tumours

17. Post op complications
• Infection
• Seroma formation
• Local or distant recurrence

18. Follow up
• Most recurrence occur within first 2 years
• Clinical Follow-Up:
• Every 6 months in the First 2 years
• Then Annually
Annual Mammography: for Lumpectomy & Wide Local Excision cases
Chest X-ray/Chest Computed Tomography: 6 Monthly For Large (≥5 cm)
or Malignant Phyllodes Tumours

20. Prognosis
majority of patients with Benign and Borderline Phyllodes Tumours
Cured by Surgery
The 5 Year Survival Rate for Malignant Phyllodes Tumours
approximately 60-80%

21. complications
• Emotional distress due to the presence of breast cancer
• Ulceration of overlying skin may lead to secondary bacterial and/or fungal
infections
• Metastasis of the tumor to local and regional sites including to lymph nodes and
skin
• Recurrence of the tumor on incomplete surgical removal
• Side effects of chemotherapy: nausea, vomiting, hair loss, decreased appetite,
mouth sores, fatigue, low blood cell counts, and a higher chance of developing
infections

22. • Side effects of radiation therapy : sunburn-like rashes, red or dry
skin, heaviness of the breasts, general fatigue
• Lymphedema (swelling of an arm)
may form weeks to years after treatment that involves radiation
therapy to the axillary lymph node

23. THANK YOU