Phyllodes Tumors of The Breast

Phyllodes tumors of the breast 23/05/15 6:48 PM
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Phyllodes tumors of the breast
Authors Section Editors Deputy Editor

Ana M Grau, MD, FACS Lori J Pierce, MD Don S Dizon, MD, FACP
A Bapsi Chakravarthy, MD Daniel F Hayes, MD
Rashmi Chugh, MD Anees B Chagpar, MD, MSc, MA,
MPH, MBA, FACS, FRCS(C)
All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Apr 2015. | This topic last updated: Feb 20, 2014.
INTRODUCTION — Phyllodes tumors are uncommon fibroepithelial breast tumors that are capable of a diverse
range of biologic behavior. In their least aggressive form, they behave similarly to benign fibroadenomas, although
with a propensity to recur locally following excision without wide margins. At the other end of the spectrum are
tumors that metastasize distantly, sometimes degenerating histologically into sarcomatous lesions that lack an
epithelial component [1,2].
The terminology of phyllodes tumors has evolved. All such tumors were originally called "cystosarcoma phyllodes" by
Johannes Muller in 1838 [1]. However, they only occasionally have cystic components, and they are not true
sarcomas by either cellular origin or biologic behavior. The term "phyllodes", which means leaf-like, describes the
typical papillary projections that are seen on pathologic examination. Since the original description, over 60
synonyms have been applied to this entity until the adoption of the term phyllodes tumors by the World Health
Organization [3,4].
EPIDEMIOLOGY AND RISK FACTORS — Phyllodes tumors account for fewer than 0.5 percent of all breast
malignancies [4,5]. Given their rarity, epidemiologic data are scant. In a study from Los Angeles county over a 17
year period, the average annual incidence rate was 2.1 per million women, and there was a higher incidence in
Latina whites, as compared to non-Latina whites, Asians, and African American women [6].
The vast majority occur in women, in whom the median age at presentation is 42 to 45 (range 10 to 82 years) [3,6-8].
Data indicate that the tumor grade increases with mean age at diagnosis [9]. Some case reports describe these
tumors in men, usually in association with gynecomastia [3].
No etiologic or predisposing factors have been associated with phyllodes tumors, with the exception of Li-Fraumeni
syndrome, a rare autosomal dominant condition that is characterized by the development of multiple tumors [10].
(See "BRCA1 and BRCA2: Prevalence and risks for breast and ovarian cancer" and "Li-Fraumeni syndrome".)
Some believe that phyllodes tumors arise from benign epithelial fibroadenomas due to their close histologic
resemblance and molecular similarities [1,3,11]. However, this remains an ongoing debate. (See "Overview of
benign breast disease".)
CLINICAL PRESENTATION AND DIAGNOSIS — Phyllodes tumors are generally first identified as a breast mass or
an abnormal mammographic finding.
Physical examination — On examination, most patients have a smooth, multinodular, well-defined, firm mass that
is mobile and painless [1,7]. Tumor size is variable, ranging from 1 to 41 cm (average 4 to 7 cm) [4,8]. Shiny,
stretched, and attenuated skin may be seen overlying a large tumor [1]. Nipple retraction, ulceration, chest wall
fixation, and bilateral disease are rare but described [1,12].
Tumors may be slow or rapidly growing, or they may exhibit a biphasic growth pattern. As they grow, phyllodes
tumors can distort the breast or cause superficial ulceration through pressure necrosis. The mass may be visible on
inspection, especially if it expands quickly.
Although palpable axillary lymphadenopathy can be identified in up to 20 percent of patients, metastatic involvement
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of lymph nodes is rare [4,7].
Imaging — The typical appearance of a phyllodes tumor on mammography is a smooth, polylobulated mass
resembling a fibroadenoma [1]. Approximately 20 percent of phyllodes tumors present as a nonpalpable mass
identified on screening mammography [13]. (See "Breast imaging for cancer screening: Mammography and
ultrasonography" and "Diagnostic evaluation of women with suspected breast cancer".)
Suspicion for a phyllodes tumor rather than a fibroadenoma is based on large tumor size at presentation or rapid
growth [1]. Patients with a suspicious lesion on mammography should have an ultrasound examination. Phyllodes
lesions are primarily solid, hypoechoic and well circumscribed on ultrasonography. Although not always present,
cystic areas within the mass may increase the level of suspicion for phyllodes tumors [14].
The role of magnetic resonance imaging (MRI) in the diagnosis and management of phyllodes tumors is not clear
[15]. A retrospective study of 30 patients with biopsy confirmed phyllodes tumors showed that malignant phyllodes
tumors are seen as well-circumscribed tumors with irregular walls, high signal intensity on T1-weighted images and
low signal intensity on T2-weighted images [16]. Cystic change may be seen as well. Interestingly, a rapid
enhancement pattern is seen more commonly with benign rather than malignant phyllodes tumors, which is the
opposite of the pattern seen with adenocarcinomas of the breast [16,17].
When the diagnosis of a phyllodes tumor has been made on core biopsy, breast MRI may prove helpful in
determining the extent of disease and facilitating pre-operative planning [17]. However, the use of breast MRI in
surgical planning for phyllodes tumors is controversial as there are very little data on its role in this setting as they
are so rare.
Biopsy — Fine needle aspiration biopsy has been associated with high false negative results and low overall
accuracy for the diagnosis of phyllodes tumors [18]. However, special attention to three major cytological features
(fibromyxoid stromal fragments with spindle nuclei, fibroblastic pavements, and spindle cells of fibroblastic nature)
can improve the diagnosis of phyllodes tumor on FNA [19].
Core needle biopsy is the preferred method for making a diagnosis [20]. There are some features that are useful in
distinguishing phyllodes tumors and fibroadenomas on core biopsy. These include increased cellularity, mitosis,
stromal overgrowth, and fragmentation (stroma with epithelium at one or both ends of the fragment) of the biopsy
specimen.
A core needle biopsy of a phyllodes tumor can result in a 25 to 30 percent false negative rate [21-23]. For this
reason, if a solid mass has a benign biopsy but subsequently exhibits rapid growth or becomes symptomatic,
excisional biopsy should be performed. Additionally, if a core biopsy is indeterminate, then an excisional biopsy will
be necessary to make the diagnosis. (See "Breast biopsy".)
PATHOLOGY — Grossly, phyllodes tumors are round to oval multinodular masses with a grayish white appearance
that resemble the head of a cauliflower; they may be indistinguishable from fibroadenomas (picture 1) [1]. Phyllodes
tumors grow radially creating a pseudocapsule through which tongues of stroma may protrude and grow into
adjacent breast tissue [24]. Necrosis and hemorrhage can occur in larger tumors [1].
Microscopically, the range of appearances covers the spectrum from resembling a benign fibroadenoma to a high-
grade sarcoma. The characteristic leaf-like architecture consists of elongated cleft-like spaces that contain papillary
projections of epithelial-lined stroma with varying degrees of hyperplasia and atypia (figure 1) [3].The stromal
elements are a key component in the differentiation of phyllodes tumors from fibroadenomas and in distinguishing a
benign from a malignant phyllodes tumor [22].
Histologically, phyllodes tumors are classified as benign, borderline or malignant [1,4,25]. The most commonly
accepted criteria used for classification of benign versus malignant tumors are as follows [4,6,7,26,27]:
The degree of stromal cellular atypia
● Mitotic activity
● Infiltrative as compared to circumscribed tumor margins

● Presence or absence of stromal overgrowth (ie, presence of pure stroma devoid of epithelium)
In most large series, more than 50 percent of phyllodes tumors are classified as benign [1,28]. Approximately 25
percent of phyllodes tumors are malignant, although this figure varies significantly depending on the series [1,2,29].
The classification criteria are summarized here [1]:
● Benign phyllodes tumors are characterized by increased stromal cellularity with mild to moderate cellular
atypia, circumscribed tumor margins and low mitotic rate (less than 4 mitoses per 10 high power fields) and
lack of stromal overgrowth.
● Borderline tumors have a greater degree of stromal cellularity and atypia, a mitotic rate from 4 to 9 mitosis per
10 high power fields, microscopic infiltrative borders, and lack of stromal overgrowth.
● Malignant phyllodes tumors are characterized by marked stromal cellularity and atypia, infiltrative margins, high
mitotic rate (more than 10 mitosis per 10 high power fields examined), and by the presence of stromal
overgrowth [4,7,26,27].
Some authors have suggested that these histologically defined categories may not reliably predict clinical behavior
[2,8]. When strict adherence to well-established histologic criteria are used, benign and borderline phyllodes tumors
rarely recur following wide excision [30]. In a series of 443 women treated for phyllodes tumor, multivariate analysis
was performed on a subset of 146 patients for whom there was no missing data and all variables could be analyzed.
Patients with benign tumors had improved local control and disease-free survival compared to patients with
borderline and malignant lesions [31].
Stromal overgrowth is consistently associated with aggressive (metastatic) behavior [2,32]. Most clinically
malignant/metastatic phyllodes tumors reported have had overgrowth of one or several sarcomatous elements.
These include liposarcoma, undifferentiated/unclassified sarcoma (formerly included within the terms ”malignant
fibrous histiocytoma [MFH]” and “undifferentiated pleomorphic sarcoma [UPS]”, and now a separate soft tissue
sarcoma category with an undifferentiated pleomorphic variant [33]), rhabdosarcoma, and chondrosarcoma [34,35].
Close examination of the stroma is imperative as the sarcomatous component may be present in only a small portion
of the phyllodes tumor [24]. (See "Clinical presentation, histopathology, diagnostic evaluation, and staging of soft
tissue sarcoma", section on 'Histopathology'.)
Evaluation of tumor markers such as p53, Ki-67, epidermal growth factor receptors, c-kit, platelet-derived growth
factor and others in phyllodes tumors has failed to adequately predict outcomes [24]. The expression of estrogen
and progesterone receptors is common in the epithelial component but uncommon in the stromal component of
phyllodes tumors [12]. On a molecular level, genetic heterogeneity has been observed intratumorally, with increasing
numbers of aberrations coinciding with increased malignant potential [36].
TREATMENT — Given the small number of patients with phyllodes tumors, treatment principles are based mainly on
retrospective series and case reports. Because of their clinical behavior and prognosis, phyllodes tumors should be
treated as primary breast sarcomas rather than infiltrating ductal carcinomas [37].
Surgical resection — A complete surgical excision is the standard of care for a phyllodes tumor [13,38,39]. Based
upon a retrospective review of 164 patients, surgical approach should include a wide local excision with histologic
margins negative for malignant cells [38]. Other studies suggest a histologic margin of at least 1 cm, which is much
larger than what is required for invasive or in situ breast cancer [2,4,40]. Unfortunately, local excision without
attention to margins is often performed, particularly since phyllodes tumors are often misdiagnosed as
fibroadenomas preoperatively. Recurrence rates are unacceptably high following either local excision or enucleation
without negative margins [30,41]. In a multivariate survival analysis that included 172 patients with phyllodes tumors,
a positive surgical margin was associated with an almost fourfold risk of a tumor-related event (eg, local recurrence,
distant disease) (hazard ratio [HR] 3.9, 95% CI 1.1-14.3) [39].
Breast conserving therapy is appropriate for nonmalignant as well as malignant lesions as long as adequate margins
can be achieved [2,4,13]. Reexcision is indicated when necessary to ensure acceptable margins
[4,5,13,14,25,30,31,37,40-43].
Several reports indicate that wide excision yields local recurrence rates of 8 percent for benign phyllodes tumors and
21 to 36 percent for borderline and malignant tumors [30,40]. When appropriate margins are not obtained the
recurrence rates are much higher. In a retrospective review of 48 women with high-grade malignant phyllodes
tumors, 10 patients were treated with local excision (margins <1 cm), 14 with wide local excision (margins ≥1 cm)
and 24 with mastectomy [41]. Average tumor size was 7.8 cm and median follow up was 9 years. The recurrence
rates were 60 percent for those treated with local excision only as compared with 28 percent for those who were
treated with wide local excision with appropriate margins. Local recurrence and cancer-specific survival were related
to tumor size and excision margins.
Even large tumors may be effectively treated with breast conservation without compromising cancer-specific survival
[13]. In data from the Surveillance, Epidemiology and End Results (SEER) database on 821 women being treated for
malignant phyllodes tumors, mastectomy and wide excision were performed in 52 percent and 48 percent of women
respectively. Wide excision was associated with equivalent or improved cause-specific survival relative to
mastectomy, regardless of tumor size.
Axillary dissection is usually not required since axillary lymph node involvement is only rarely reported, even with
malignant tumors [5,7,13,42,44]. In the SEER database cited above, only eight of 498 women with known lymph
node status had involved nodes [13].
Radiation therapy — Radiotherapy is unnecessary for benign phyllodes tumors that are widely excised. However,
adjuvant RT decreases local recurrences after breast conserving surgery with negative margins for borderline or
malignant phyllodes tumors [26,27,29,31,40,44,45]. The following studies and reviews illustrate the benefit of
adjuvant RT:
● A large retrospective study of patients with malignant phyllodes tumors treated with surgical resection alone
revealed suboptimal five-year local control rates (79 percent in 169 patients treated with wide excision and 91
percent in 207 patients treated with mastectomy) [45]. The authors concluded that for patients with malignant
phyllodes tumors, particularly over 2 cm in diameter and treated with wide excision alone, adjuvant RT should
be strongly considered. One important limitation of this study is the lack of information about margin status.
● In a study of 443 women treated for phyllodes tumor, RT was associated with a superior local control rate at 10
years, from 59 percent to 86 percent for borderline and malignant phyllodes tumors [31].
● In a prospective study of 46 women with malignant (n = 30) or borderline tumors undergoing a resection with
histologic negative margins and adjuvant RT, none had developed a local recurrence at a median follow-up of
56 months [40]. Two patients with malignant phyllodes tumor died of metastatic disease.
For some tumors, a 1 cm margin may not be possible even with a total mastectomy location. In such patients,
radiation may be indicated even after a mastectomy. There is less agreement about the role of adjuvant RT when
wide margins ≥1 cm can be obtained. Available data indicate that RT will substantially reduce recurrence for these
patients [40]. We suggest RT in this setting but recognize that this is not uniformly recommended by others. Further
studies are needed to determine when adjuvant RT should be advised in the treatment of phyllodes tumors. (See
"Adjuvant radiation therapy for women with newly diagnosed, non-metastatic breast cancer".)
However, utilization of adjuvant RT appears to be modest. In a retrospective review of the National Cancer Database
that included 3120 patients with malignant phyllodes tumor, only 14 percent received adjuvant RT [46]. Patients were
more likely to receive radiation therapy if they were diagnosed later in the study, were 50 to 59 years old, had tumors
>10 cm, or had lymph nodes removed. In adjusted models, adjuvant radiation reduced local recurrence but did not
impact disease-free or overall survival with a median follow-up of 53 months.
Chemotherapy — The benefit of adjuvant chemotherapy is controversial. There have been no randomized studies
of adjuvant therapy specifically in phyllodes tumors. An observational study included 28 patients with malignant
phyllodes tumors treated over a 10-year period (1993-2003) with either adjuvant doxorubicin plus dacarbazine or
observation alone after surgical resection. Treatment was based upon patient preference [47]. There was no
difference in relapse-free survival between the two groups. However, the study was small, retrospective, and
uncontrolled, and did not utilize ifosfamide in combination with doxorubicin (which is superior to dacarbazine plus
doxorubicin in other soft tissue sarcomas). The likely bias is that patients with more aggressive disease would opt for
treatment while those with more favorable disease might choose observation.
Based on limited data and experiences in soft tissue sarcoma, adjuvant chemotherapy should be administered only
for a minority of patients with large (>5 cm), high-risk or recurrent malignant tumors, and only after a thorough
discussion about the risks and benefits of treatment. Patients with benign or borderline phyllodes tumors should not
be offered chemotherapy. Guidelines for treating sarcomas rather than adenocarcinomas of the breast should be
followed. (See "Adjuvant and neoadjuvant chemotherapy for soft tissue sarcoma of the extremities".)
Hormone therapy — Hormone therapy is not effective for phyllodes tumors despite the presence of positive
hormone receptors in the epithelial component of some of these tumors [12,48]. The stromal component is the
principle neoplastic cell population responsible for the metastatic behavior in these tumors and expresses primarily
estrogen receptor beta as opposed to the alpha receptor expressed in adenocarcinomas of the breast [49,50].
PROGNOSIS — The majority of patients with benign and borderline phyllodes tumors are cured with surgery. The
survival rate for malignant phyllodes tumors is reported as approximately 60 to 80 percent at 5 years [2,13,37].
The impact of histology on survival was explored in the SArcoma and PHYllode Retrospective (SAPHYR) Study, a
retrospective study of 70 patients with primary breast sarcomas and phyllodes tumors treated from 1966 to 2004
[37]. The overall three year survival rate for combined benign and borderline tumors was 100 percent. The overall
three year survival rate for malignant phyllodes tumors was 54 percent, similar to that of nonangiosarcoma primary
breast sarcomas (60 percent).
Similarly, in a retrospective study of 101 patients treated between 1944 and 1998, the overall survival for patients
with combined benign and borderline tumors was 91 percent at 5 years. The five year survival rate for malignant
phyllodes tumors was 82 percent [2]. Eight patients in this series developed distant metastases (seven of whom had
tumors classified as histologically malignant, and one benign); all of these had stromal overgrowth, and six were ≥ 5
cm in size.
In another retrospective review of 293 phyllodes tumors, treated between 1954 and 2005, five patients developed
distant disease, all of these had infiltrative borders, marked stromal overgrowth, marked stromal cellularity, high
mitotic count, and necrosis and were ≥7 cm in size. [8]. Of note, six of the locally recurrent benign phyllodes tumors
recurred as malignant.
There are several case reports documenting the ability of benign tumors to undergo malignant transformation, which
points to the dilemma that there are no absolute predictive factors for these rare tumors [2,8,29,51]. However, in the
majority of cases, when strict adherence to established histological classification criteria are followed and adequate
surgical margins are obtained, benign and borderline phyllodes tumors rarely recur [24,30].
ADVANCED AND RECURRENT DISEASE
Local recurrence — When tumors recur, they typically recur locally within two years of initial excision [4,12]. Some
series have found that time to local recurrence is shorter for patients with malignant phyllodes compared with
patients with benign and borderline phyllodes [4].
Locally recurrent disease is best treated with re-excision with wide margins or mastectomy followed by RT to help
avoid the morbidity of yet another recurrence and the need for additional aggressive surgical intervention [20]. For
patients with locally unresectable tumors, another option would be palliative radiation alone. In a case of a patient
with high-grade tumor recurrence that could not be excised, radiation treatment resulted in local control for 84
months after recurrence [14]. There are no prospective randomized trial data regarding the best treatment for
recurrent phyllodes tumors.
Metastatic disease — Metastatic disease has been reported in 13 to 40 percent of patients. [1,2,4,18]. Metastases
most frequently involve the lungs. After the development of metastases, mean overall survival is 30 months [52].
As with other soft tissue sarcomas, resection of pulmonary metastases is indicated when technically feasible. (See
"Surgical treatment and other localized therapy for metastatic soft tissue sarcoma".)
For patients with unresectable disease, chemotherapy is based upon treatment guidelines for soft tissue sarcoma
[4,53]. The regimen typically consists of doxorubicin and/or ifosfamide, or a combination of gemcitabine and
docetaxel, or dacarbazine. Ifosfamide appears to be a particularly active agent, with two of four patients achieving a
complete response in one report [53]. Others suggest benefit with cisplatin plus either etoposide [48] or doxorubicin
[51]. (See "Systemic treatment of metastatic soft tissue sarcoma".)
SURVEILLANCE AFTER THERAPY — Given the small number of patients with malignant phyllodes tumors of the
breast, there are no evidence based recommendations for surveillance after therapy [54,55]. Follow-up guidelines
are adapted from those for soft tissue sarcoma. (See "Local treatment for primary soft tissue sarcoma of the
extremities and chest wall", section on 'Posttreatment cancer surveillance'.)
Most recurrences occur in the first two years after treatment [40] and most frequently involve the lungs. Since
isolated limited metastatic tumor to the lung is often asymptomatic and amenable to resection, we follow patients
closely for at least two years:
● History and physical examination and chest x-ray every six months for two years, then annually. If suspicious
findings are found on breast examination, mammography with focused ultrasound and/or MRI of the breast is
useful for evaluation.
● Patients who have had breast conservation should resume surveillance with mammography annually. If
suspicious findings are found on mammography, focused ultrasound and/or MRI is useful for evaluation.
● For patients at higher risk for metastatic disease (eg, tumors >5 cm), surveillance may be performed more
frequently. Follow-up should be performed as per NCCN guidelines for soft-tissue sarcomas by chest
radiographs and/or chest CT scans [56].
SUMMARY AND RECOMMENDATIONS
● Phyllodes tumors are uncommon fibroepithelial breast tumors that are capable of a diverse range of biologic
behavior. (See 'Introduction' above.)
● Most phyllodes tumors present as smooth, multinodular, painless breast lumps. While they can be confused
with fibroadenomas, suspicion for a phyllodes tumor should be increased with large tumor size and rapid
growth. (See 'Clinical presentation and diagnosis' above.)
● The typical appearance of a phyllodes tumor on mammography is a smooth, polylobulated mass. On

ultrasound examination, these lesions are solid, hypoechoic and, well circumscribed. The presence of cystic
areas within the mass may increase the level of suspicion for phyllodes tumors. (See 'Clinical presentation and
diagnosis' above.)
● A core biopsy of a suspicious mass should be performed. Fine needle aspiration is not a sufficient diagnostic
test. If the results are indeterminate, excisional biopsy should be completed. (See 'Clinical presentation and
diagnosis' above.)
● Histologically, phyllodes tumors are classified as benign, borderline or malignant. (See 'Pathology' above.)
● We recommend wide local excision, with a margin of at least 1 cm for phyllodes tumors as opposed to
enucleation or local excision alone (Grade 1B). Recurrence rates are unacceptably high following either local
excision or enucleation without adequate margins. Breast conservation does not compromise cancer-specific
survival. Mastectomy can be reserved for cases where breast conservation cannot be achieved with an
acceptable cosmetic result. (See 'Treatment' above.)
● We suggest not performing axillary dissection for phyllodes tumors (Grade 1C). Axillary lymph node
involvement is rarely reported, even with malignant tumors. (See 'Treatment' above.)
● We suggest not performing adjuvant radiotherapy for benign phyllodes tumors that are widely excised (Grade
1C). (See 'Radiation therapy' above.)
● We suggest adjuvant radiotherapy for borderline or malignant phyllodes tumors (Grade 2C). Radiation therapy
substantially reduces the recurrence rate of these tumors. (See 'Treatment' above.)
● We suggest that adjuvant chemotherapy should be reserved for consideration in highly selected patients with
large, high-risk or recurrent malignant tumors (Grade 2C). (See 'Treatment' above.)
● We recommend that hormonal therapy not be used for phyllodes tumors (Grade 1C). (See 'Treatment' above.)
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Topic 793 Version 14.0
GRAPHICS
Cut surface of phyllodes tumor
Graphic 51479 Version 2.0
http://www.uptodate.com.ezproxy.tmc.gov.in:2048/contents/phyllod…oma+phyllodes&selectedTitle=1%7E8&view=print&displayedView=full# Page 10 of 12
Cellular stroma with leaf-like process
Graphic 78624 Version 1.0
Disclosures
Disclosures: Ana M Grau, MD, FACS Nothing to disclose. A Bapsi Chakravarthy, MD Nothing to disclose. Rashmi Chugh, MD
Nothing to disclose. Lori J Pierce, MD Nothing to disclose. Daniel F Hayes, MD Grant/Research/Clinical Trial Support: Janssen R&D,
LLC [Breast cancer (Abiraterone)]; Janssen R&D, LLC [Breast cancer (CellSearch)]; Puma Biotechnology, Inc. [Breast cancer (Neratinib)];
Pfizer [Breast cancer (Palbociclib)]; Astra Zeneca [Breast cancer (Circulating tumor cells)]. Speaker's Bureau: Lilly Oncology (Breast
cancer). Consultant/Advisory Boards: Pfizer [Breast cancer (Palbociclib)]. Other Financial Interest: Janssen R&D, LLC [Breast cancer
(CellSearch)]. Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C) Nothing to disclose. Don S Dizon, MD, FACP Nothing to
disclose.
Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are addressed by vetting through a
multi-level review process, and through requirements for references to be provided to support the content. Appropriately referenced
content is required of all authors and must conform to UpToDate standards of evidence.
Conflict of interest policy

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Phyllodes tumors of the breast 23/05/15 6:48 PM

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Phyllodes tumors of the breast

Authors Section Editors Deputy Editor

of lymph nodes is rare [4,7].

The degree of stromal cellular atypia

● Infiltrative as compared to circumscribed tumor margins

ADVANCED AND RECURRENT DISEASE

SUMMARY AND RECOMMENDATIONS

● The typical appearance of a phyllodes tumor on mammography is a smooth, polylobulated mass. On

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review of 172 cases. J Surg Oncol 2005; 91:185.

Topic 793 Version 14.0

Cut surface of phyllodes tumor

Graphic 51479 Version 2.0

Cellular stroma with leaf-like process

Graphic 78624 Version 1.0

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