What makes phyllodes tumors different?

Key characteristics include rapid growth pattern, distinct pathology, special surgical needs, specific margin requirements, and regular monitoring needs.

What is the treatment approach?

Treatment includes wide surgical excision, adequate margins, possible reconstruction, regular follow-up, and long-term monitoring.

Phyllodes Tumor Treatment in Lucknow

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Understanding Phyllodes Tumor

Phyllodes tumors are rare fibroepithelial breast tumors that develop in the connective tissue (stroma) of the breast. Unlike more common breast cancers that arise from ducts or lobules, phyllodes tumors grow within the breast’s supportive tissue and can be benign, borderline, or malignant. While they can occur at any age, they are most commonly diagnosed in women between 40 and 50 years old.

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Types of Phyllodes Tumors

Phyllodes tumors are categorized into three types based on their pathological characteristics:

Benign Phyllodes Tumor – Non-cancerous, slow-growing, and less likely to recur after removal.
Borderline Phyllodes Tumor – Intermediate growth potential, with some cellular atypia and a slightly higher risk of recurrence.
Malignant Phyllodes Tumor – Aggressive, fast-growing, with a higher risk of recurrence and, in rare cases, distant spread (metastasis).

Causes ?

Breast cancer’s specific causes is unknown, although a number of factors, such as:

Gender: Female

Increasing Age

Genetic Predisposition

Early Menarche

Late Menopause

Nulliparity

Radiation Exposure

Hormonal Replacement Therapy

Exposure to Estrogen

Radiation Exposure Before 30 Years

Postmenopausal Obesity

Alcohol

Signs and Symptoms

Phyllodes tumors usually present as a painless, firm breast lump that grows rapidly over weeks or months. Other symptoms may include:

A smooth or lobulated lump that can be felt under the skin.
A rapid increase in size compared to other benign breast lumps.
Stretching of the skin over the lump, sometimes causing visible veins.
Occasional pain or tenderness, although many remain painless.

Diagnosis of Phyllodes Tumors

A combination of clinical assessment and imaging is required to diagnose phyllodes tumors accurately. The triple assessment includes:

Clinical Examination

Size Assessment: Measures the lump to monitor growth over time.
Consistency Check: Determines if the lump is firm, soft, or rubbery.
Growth Pattern: Evaluates how quickly the lump is enlarging and any changes in shape.

Imaging Studies

Mammography – May show a well-defined, smooth, or lobulated mass.
Breast Ultrasound – Typically reveals a well-circumscribed solid tumor, often with cystic areas.
MRI (if needed) – Helps assess the extent of the tumor, particularly in larger lesions.

Biopsy

Core Needle Biopsy – Provides a sample of tumor tissue to distinguish between phyllodes tumors and fibroadenomas.
Excisional Biopsy – Complete removal may be required for definitive diagnosis, especially in cases of inconclusive core needle biopsy report.

Treatment Options

Surgical Management

Surgery is the primary treatment for phyllodes tumors, as they do not typically respond to chemotherapy or hormonal therapy. The options include:

Wide Local Excision (Lumpectomy): Removal of the tumor with at least 1–2 cm of healthy tissue around it to reduce recurrence risk.
Mastectomy: Recommended for large tumors or cases where achieving clear margins is difficult.

Management of Malignant Phyllodes Tumors

Radiation Therapy: May be advised in cases of large tumors or inadequate surgical margins to reduce recurrence risk.
Chemotherapy: Generally not effective, but may be considered in rare cases where the tumor has metastasized.

Prognosis and Follow-Up

Benign Phyllodes Tumors: Excellent prognosis after surgical removal, though recurrence may occur if margins are not clear.
Borderline and Malignant Tumors: Require close monitoring due to higher recurrence risk.
Regular Follow-Up: Clinical breast exams and imaging help detect any recurrence early.

Frequently Asked Questions (FAQs)

A: Phyllodes tumors and fibroadenomas are both fibroepithelial tumors, but phyllodes tumors grow faster, can become large, and may recur, whereas fibroadenomas are usually small and slow-growing.

A: Malignant phyllodes tumors are not the same as typical breast cancer (which arises from ducts or lobules). They rarely spread but can grow aggressively within the breast.

A: The exact cause is unknown, but genetic factors and rapid cell growth in breast connective tissue may contribute.

A: Yes, recurrence is possible, particularly in borderline and malignant types. This is why complete excision with clear margins is essential.

A: There is no strong evidence linking phyllodes tumors to inherited genetic mutations like BRCA1 or BRCA2.

A: Yes, because even benign phyllodes tumors can grow rapidly, surgical removal is recommended to prevent complications.

A: If a mastectomy is required, breast reconstruction options can be discussed based on individual preferences and medical suitability.

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Contact: +91-8104598623

Email: dr.harshit.02@gmail.com

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Understanding Phyllodes Tumor