Phyllodes Tumors of the Breast

Rodrigo Arrangoiz MS, MD, FACS, FSSO
Palpable right subareolar mass
Ultrasound from 6-month follow-up
Ultrasound from 6-month follow-up
  • The rapid growth of this lesion:
    • Suggests that it is a phyllodes tumor:
      • Although a giant fibroadenoma is another possibility
  • The most recent ultrasound image shows:
    • An isoechoic, heterogeneous mass that contains cystic, fluid filled spaces, and is vascular on Doppler examination
  • In most cases, benign phyllodes tumors:
    • Have margins that are well-circumscribed, and a thin, echogenic capsule is demonstrable
    • The doubling time for a:
      • Benign phyllodes tumor:
        • Is about four months
      • Malignant phyllodes tumor:
        • Is a little over a month
    • Rapidly growing phyllodes tumors:
      • Whether benign or malignant:
        • Often cause prominent veins on the skin:
          • From the developing vascularity
    • Phyllodes tumors are more common in women of Mexican descent:
      • Latin American women with phyllodes tumors tend to be diagnosed at an earlier age than other women
  • A malignant phyllodes tumor:
    • Would in all likelihood have a less distinct border than the lesion shown above
  • A core needle biopsy:
    • Cannot reliably distinguish phyllodes tumors from fibroadenomas:
      • It is therefore not sufficient for a definitive diagnosis
  • The correct management is excision:
    • With or without a pre-operative core biopsy:
      • With care to completely excise the tumor
  • Phyllodes tumors can also be difficult to distinguish from giant juvenile fibroadenomas:
    • But they should also be treated by surgical excision
  • The rapid growth of this lesion suggests a phyllodes tumor, not a fibroadenoma
  • References:
    • Guillot E, Couturaud B, Reyal F, Curnier A, Ravinet J, Lae M, et al. Management of phyllodes breast tumors. Breast J. 2011;17(2):129-137.
    • Plaza MJ, Swintelski C, Yaziji H, Torres-Salichs M, Esserman LE. Phyllodes tumor: review of key imaging characteristics. Breast Dis. 2015;35(2):79-86.
    • Rajan PB, Cranor ML, Rosen PP. Cystosarcoma phyllodes in adolescent girls and young women: a study of 45 patients. Am J Surg Pathol. 1998;22(1):64-69.
    • Sosin M, Pulcrano M, Feldman ED, Patel KM, Nahabedian MY, Weissler JM, et al. Giant juvenile fibroadenoma: a systematic review with diagnostic and treatment recommendations. Gland Surg. 2015;4(4):312-321.
    • Stavros AT. Atypical, high-risk, premalignant, and locally aggressive lesions. In: Stavros AT. Breast Ultrasound. Philadelphia, PA: Lippincott Williams & Wilkins; 2004:689-711.
#Arrangoiz #BreastSurgeon #CancerSurgeon #Surgeon #SurgicalOncologist #Doctor #Miami #MountSiniaMedicalCenter #MSMC #BreastCancer #Phyllodes Tumor
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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