Phyllodes Tumors

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  • Phyllodes tumors:
    • Are true fibroepithelial neoplasms:
      • With both epithelial and stromal components
    • They represent less than 1% of all breast tumors:
      • Most commonly occurring in women in their 50s
    • They are rapidly growing:
      • But usually well-defined:
        • Often appear as distinct masses:
          • Indistinguishable from fibroadenomas on mammography and ultrasound

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    • The World Health Organization has divided phyllodes tumors into three categories:
      • Benign
      • Borderline
      • Malignant

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    • The majority are benign:
      • With local recurrence rates of 15% to 20% depending on adequacy of excision
    • Grading is usually based on multiple criteria in the stromal component:
      • Nuclear pleomorphism
      • Mitotic rate
      • Stromal overgrowth
      • Cellularity
      • Tumor margins
    • The distinction between cellular fibroadenomas and phyllodes tumors can be difficult
    • The definition of “optimal” margin varies for various types of phyllodes tumors:
      • Historically, margins of 2 cm to 3 cm have been recommended, but current recommendations are considerably less:
        • With the only “absolute” being that the margin is tumor-free
    • Malignant transformation:
      • Is a rare occurrence
    • Metastases can occur:
      • In a small number of malignant phyllodes tumors and an even smaller number of borderline phyllodes tumors
    • Radiotherapy may be of benefit for local control of malignant phyllodes tumors
    • Differences in grading of phyllodes tumors among pathologists can be substantial

REFERENCES

  1. Barth RJ Jr, Wells WA, Mitchell SE, et al. A prospective, multi-institutional study of adjuvant radiotherapy after resection of malignant phyllodes tumors. Ann Surg Oncol. 2009;16:2288-2294.
  2. Lawton TJ, Acs G, Argani P, et al. Interobserver variability by pathologists in the distinction between cellular fibroadenomas and phyllodes tumors. Int J Surg Pathol. 2014;22:695-698.
  3. O’Malley F, Pinder S, Mulligan A, eds.. Fibroepithelial lesions, including fibroadenoma and phyllodes tumors. In: Breast pathology: a volume in the series: foundations in diagnostic pathology, 2nd ed. Philadelphia, PA: Elsevier Saunders; 2011:121-138.
  4. Pezner RD, Schultheiss TE, Paz IB. Malignant phyllodes tumor of the breast: local control rates with surgery alone. Int J Radiat Oncol Biol Phys. 2008;71:710-713.
  5. Sinn H, Kreipe H. A brief overview of the WHO classification of breast tumors, 4th edition, focusing on issues and updates from the 3rd edition. Breast Care (Basel). 2013;8:149-154.
  6. Spitaleri G, Toesca A, Botteri E, et al. Breast phyllodes tumor: a review of literature and a single center retrospective series analysis. Crit Rev Oncol Hematol. 2013;88 :427-436.

👉Rodrigo Arrangoiz MS, MD, FACS cirujano oncology y cirujano de mamá de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:

  • Es experto en el manejo del cáncer de mama.

👉Es miembro de la American Society of Breast Surgeons:

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

#Arrangoiz

#Surgeon

#Cirujano

#SurgicalOncologist

#CirujanoOncologo

#BreastSurgeon

#CirujanodeMama

#CancerSurgeon

#CirujanodeCancer

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