TUMOR FILOIDES

ANATOMI

Molecular basic
tumor

TUMOR FILOIDES
Phyllodes tumor are rare fibroepithel lesion
They make up 0,3-0,5% of female breast and
have incidence of about 2,1 per million
Most of tumor arises in women aged 35-55
years
Peak of which occurs in women aged 45 49
years
Few cases have been reported in men and
these have invariably been associated with
the presence of gynaecomastia

Etiologi
Unknown but its relationship with
fibroadenoma

Patogenesis
Unlike carcinoma breast, this tumor
start outside of ducts and lobules in
the breast connective tissue
stroma include the fatty tissue and
ligament that surround the ducts,
lobule and blood and lymph vessels
in the breast

CLASSIFICATION WHO
Criteria

Benign

Borderline

Malignant

Stroma
cellularity and
atypia

Minimal

Moderate

Marked

Stroma
overgrowth

Minimal

Moderate

Marked

Mitoses/10 high
power fields

04

59

>10

Tumor margins

Well
circumscribed
with pushing
tumor margins

Zone of
microscopic
invasion around
tumor margins

Infiltrative
tumor margins

Clinical Presentation
The skin over large tumors may have dilated veins and blue
discoloration but nipple retraction is rare
Fixation to skin and pectoralis muscle has been reported, but ulceration
is uncommon
More commonly found in upper outer quadrant with an equal propensity
to occur in either breast
Rarely presentation may be bilateral
The median size phyllodes tumor is around 4 cm. 20% of tumor grow
larger than 10 cm. these tumor can reach sizes up to 40 cm in diameter
A significant proportion of patient have history of fibroadenoma and in a
minority these have been multiple
Palpable axillary lymphadenopathy can be identified in up to 10-15% of
patients but <1% had pathologcal positive nodes

Ultrasonography
Lobulated shape well circumscribed with
smooth margins,echogenic rim, and low
level homogenous internal echoes.

Mammography

It show well circumscribed oval or

lobulated mass with rounded border
A radioucent halo may be seen around
the lesion due to compression of the
surrounding
Coarse calcification may be present

Histological Assesment

Histological Assesment
Benign

Borderline

Malignan

The stromal
compound,
represented by
stromal fragment,
isolated stroma cells,
and naked stroma
nuclei are found t be
more numerous than
the epithelial one in
most of the cases

-There is
predominance of the
stroma component as
compared to the
epithelial one
- frequent
hypercellular stroma
fragments, an
average of 2 in each
microscopical field
-Frequent large
spindle cells and
monomorphic naked
stroma nuclei

-Stroma frsgments of
variable dimension
with moderate
cellularity, made of
discohesive spindle
cells with atypical
nuclei
-minimal/ no epitheial
element found on the
smears
-Presence of atypical
multinucleated giant
cells

Metastasis

Lungs (66%)
Bones (28%)
Brain (9%)
Liver and heart (rare)

Prognostik

Inadequate local excision

Histological characteristic
Size
location