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Phyllodes Tumor: Benign
Nicole S. Winkler, MD; Wei Tse Yang, MBBS
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Synonyms

                • Periductal stromal tumor
                • Benign phyllodes tumor (PT) = low-grade PT
              • Definitions

                • Fibroepithelial neoplasm with proliferation of stromal cells with epithelial lining creating leaf-like structures
                • Histopathology may vary within given mass resulting in spectrum of findings and sampling issues on core biopsy
                  • Fibroadenoma (FA) ↔ benign PT ↔ borderline PT ↔ malignant PT
                  • Distinguish based on cellularity and overgrowth of stroma, margins, mitotic figures

              IMAGING

              • General Features

                • Mammographic Findings

                  • Ultrasonographic Findings

                    • MR Findings

                      • CT Findings

                        • Nuclear Medicine Findings

                          • Image-Guided Biopsy

                            DIFFERENTIAL DIAGNOSIS

                              PATHOLOGY

                              • General Features

                                • Staging, Grading, & Classification

                                  • Gross Pathologic & Surgical Features

                                    • Microscopic Features

                                      CLINICAL ISSUES

                                      • Presentation

                                        • Demographics

                                          • Natural History & Prognosis

                                            • Treatment

                                              DIAGNOSTIC CHECKLIST

                                              • Consider

                                                • Image Interpretation Pearls

                                                  Selected References

                                                  1. Chang J et al: Trends in the Diagnosis of Phyllodes Tumors and Fibroadenomas Before and After Release of WHO Classification Standards. Ann Surg Oncol. ePub, 2018
                                                  2. Choi N et al: Malignant and borderline phyllodes tumors of the breast: a multicenter study of 362 patients (KROG 16-08). Breast Cancer Res Treat. 171(2):335-344, 2018
                                                  3. Kalambo M et al: Phyllodes Tumor of the Breast: Ultrasound-Pathology Correlation. AJR Am J Roentgenol. 210(4):W173-W179, 2018
                                                  4. Krings G et al: Fibroepithelial lesions; The WHO spectrum. Semin Diagn Pathol. ePub, 2017
                                                  5. Moo TA et al: Association between recurrence and re-excision for close and positive margins versus observation in patients with benign phyllodes tumors. Ann Surg Oncol. 24(10):3088-3092, 2017
                                                  6. Shaaban M et al: Benign phyllodes tumours of the breast: (Over) treatment of margins - A literature review. Eur J Surg Oncol. 43(7):1186-1190, 2017
                                                  7. Borhani-Khomani K et al: Risk of local recurrence of benign and borderline phyllodes tumors: a Danish population-based retrospective study. Ann Surg Oncol. 23(5):1543-8, 2016
                                                  8. Cowan ML et al: Benign and low-grade fibroepithelial neoplasms of the breast have low recurrence rate after positive surgical margins. Mod Pathol. 29(3):259-65, 2016
                                                  9. Duman L et al: Differentiation between Phyllodes Tumors and Fibroadenomas Based on Mammographic Sonographic and MRI Features. Breast Care (Basel). 11(2):123-7, 2016
                                                  10. Marcil G et al: Fibroepithelial breast lesions diagnosed by core needle biopsy demonstrate a moderate rate of upstaging to phyllodes tumors. Am J Surg. ePub, 2016
                                                  11. Ouyang Q et al: Benign Phyllodes Tumor of the Breast Diagnosed After Ultrasound-Guided Vacuum-Assisted Biopsy: Surgical Excision or Wait-and-Watch? Ann Surg Oncol. 23(4):1129-34, 2016
                                                  12. Tan BY et al: Phyllodes tumours of the breast: a consensus review. Histopathology. 68(1):5-21, 2016
                                                  13. Kamitani T et al: Differentiation between benign phyllodes tumors and fibroadenomas of the breast on MR imaging. Eur J Radiol. 83(8):1344-9, 2014
                                                  14. Lawton TJ et al: Interobserver variability by pathologists in the distinction between cellular fibroadenomas and phyllodes tumors. Int J Surg Pathol. 22(8):695-8, 2014
                                                  15. Eusebi V et al. Fibroepithelial tumors In: Lakhani SR et al. WHO Classification of Tumours of the Breast. 4th Edition Lyon, France: IARC; 2012
                                                  16. Tan H et al: Imaging findings in phyllodes tumors of the breast. Eur J Radiol. 81(1):e62-9, 2012
                                                  17. Yoo JL et al: Can MR Imaging contribute in characterizing well-circumscribed breast carcinomas? Radiographics. 30(6):1689-702, 2010
                                                  18. Chung EM et al: From the archives of the AFIP: breast masses in children and adolescents: radiologic-pathologic correlation. Radiographics. 29(3):907-31, 2009
                                                  19. Rosen PP: Rosen's Breast Pathology, 3rd ed. Philadelphia: Wolters Kluwer Lippincott Williams & Wilkins. 202-26, 2009
                                                  20. Bode MK et al: Ultrasonography and core needle biopsy in the differential diagnosis of fibroadenoma and tumor phyllodes. Acta Radiol. 48(7):708-13, 2007
                                                  21. Lee AH et al: Histological features useful in the distinction of phyllodes tumour and fibroadenoma on needle core biopsy of the breast. Histopathology. 51(3):336-44, 2007
                                                  22. Kersting C et al: Amplifications of the epidermal growth factor receptor gene (egfr) are common in phyllodes tumors of the breast and are associated with tumor progression. Lab Invest. 86(1):54-61, 2006
                                                  23. Yabuuchi H et al: Phyllodes tumor of the breast: correlation between MR findings and histologic grade. Radiology. 241(3):702-9, 2006
                                                  24. Chen WH et al: Surgical treatment of phyllodes tumors of the breast: retrospective review of 172 cases. J Surg Oncol. 91(3):185-94, 2005
                                                  25. Franceschini G et al: Phyllodes tumor of the breast: magnetic resonance imaging findings and surgical treatment. Breast J. 11(2):144-5, 2005
                                                  26. Franceschini G et al: Surgical treatment and MRI in phyllodes tumors of the breast: our experience and review of the literature. Ann Ital Chir. 76(2):127-40, 2005
                                                  27. Goel NB et al: Fibrous lesions of the breast: imaging-pathologic correlation. Radiographics. 25(6):1547-59, 2005
                                                  28. Tan PH et al: p53 and c-kit (CD117) protein expression as prognostic indicators in breast phyllodes tumors: a tissue microarray study. Mod Pathol. 18(12):1527-34, 2005
                                                  29. Tse GM et al: Stromal nitric oxide synthase (NOS) expression correlates with the grade of mammary phyllodes tumour. J Clin Pathol. 58(6):600-4, 2005
                                                  30. Kinoshita T et al: Magnetic resonance imaging of benign phyllodes tumors of the breast. Breast J. 10(3):232-6, 2004
                                                  31. Tse GM et al: Stromal expression of vascular endothelial growth factor correlates with tumor grade and microvessel density in mammary phyllodes tumors: a multicenter study of 185 cases. Hum Pathol. 35(9):1053-7, 2004
                                                  32. Gordon PB et al: Solid breast masses diagnosed as fibroadenoma at fine-needle aspiration biopsy: acceptable rates of growth at long-term follow-up. Radiology. 229(1):233-8, 2003
                                                  33. Komenaka IK et al: Core needle biopsy as a diagnostic tool to differentiate phyllodes tumor from fibroadenoma. Arch Surg. 138(9):987-90, 2003
                                                  34. Tavassoli FA and Devilee P: World Health Organization (WHO) Classification of Tumors: Pathology and Genetics of Tumours of the Breast and Female Genital Organs. Lyon: IARC Press. 100-103, 2003
                                                  35. Tse GM et al: Tumour angiogenesis and p53 protein expression in mammary phyllodes tumors. Mod Pathol. 16(10):1007-13, 2003
                                                  36. Barth RJ Jr: Histologic features predict local recurrence after breast conserving therapy of phyllodes tumors. Breast Cancer Res Treat. 57(3):291-5, 1999
                                                  37. Liberman L et al: Benign and malignant phyllodes tumors: mammographic and sonographic findings. Radiology. 198(1):121-4, 1996
                                                  38. Koller R et al: Counseling the coronary patient on sexual activity. Postgrad Med. 51(4):133-6, 1972
                                                  Related Anatomy
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                                                  Related Differential Diagnoses
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                                                  References
                                                  Tables

                                                  Tables

                                                  KEY FACTS

                                                  • Terminology

                                                    • Imaging

                                                      • Top Differential Diagnoses

                                                        • Pathology

                                                          • Clinical Issues

                                                            • Diagnostic Checklist

                                                              TERMINOLOGY

                                                              • Synonyms

                                                                • Periductal stromal tumor
                                                                • Benign phyllodes tumor (PT) = low-grade PT
                                                              • Definitions

                                                                • Fibroepithelial neoplasm with proliferation of stromal cells with epithelial lining creating leaf-like structures
                                                                • Histopathology may vary within given mass resulting in spectrum of findings and sampling issues on core biopsy
                                                                  • Fibroadenoma (FA) ↔ benign PT ↔ borderline PT ↔ malignant PT
                                                                  • Distinguish based on cellularity and overgrowth of stroma, margins, mitotic figures

                                                              IMAGING

                                                              • General Features

                                                                • Mammographic Findings

                                                                  • Ultrasonographic Findings

                                                                    • MR Findings

                                                                      • CT Findings

                                                                        • Nuclear Medicine Findings

                                                                          • Image-Guided Biopsy

                                                                            DIFFERENTIAL DIAGNOSIS

                                                                              PATHOLOGY

                                                                              • General Features

                                                                                • Staging, Grading, & Classification

                                                                                  • Gross Pathologic & Surgical Features

                                                                                    • Microscopic Features

                                                                                      CLINICAL ISSUES

                                                                                      • Presentation

                                                                                        • Demographics

                                                                                          • Natural History & Prognosis

                                                                                            • Treatment

                                                                                              DIAGNOSTIC CHECKLIST

                                                                                              • Consider

                                                                                                • Image Interpretation Pearls

                                                                                                  Selected References

                                                                                                  1. Chang J et al: Trends in the Diagnosis of Phyllodes Tumors and Fibroadenomas Before and After Release of WHO Classification Standards. Ann Surg Oncol. ePub, 2018
                                                                                                  2. Choi N et al: Malignant and borderline phyllodes tumors of the breast: a multicenter study of 362 patients (KROG 16-08). Breast Cancer Res Treat. 171(2):335-344, 2018
                                                                                                  3. Kalambo M et al: Phyllodes Tumor of the Breast: Ultrasound-Pathology Correlation. AJR Am J Roentgenol. 210(4):W173-W179, 2018
                                                                                                  4. Krings G et al: Fibroepithelial lesions; The WHO spectrum. Semin Diagn Pathol. ePub, 2017
                                                                                                  5. Moo TA et al: Association between recurrence and re-excision for close and positive margins versus observation in patients with benign phyllodes tumors. Ann Surg Oncol. 24(10):3088-3092, 2017
                                                                                                  6. Shaaban M et al: Benign phyllodes tumours of the breast: (Over) treatment of margins - A literature review. Eur J Surg Oncol. 43(7):1186-1190, 2017
                                                                                                  7. Borhani-Khomani K et al: Risk of local recurrence of benign and borderline phyllodes tumors: a Danish population-based retrospective study. Ann Surg Oncol. 23(5):1543-8, 2016
                                                                                                  8. Cowan ML et al: Benign and low-grade fibroepithelial neoplasms of the breast have low recurrence rate after positive surgical margins. Mod Pathol. 29(3):259-65, 2016
                                                                                                  9. Duman L et al: Differentiation between Phyllodes Tumors and Fibroadenomas Based on Mammographic Sonographic and MRI Features. Breast Care (Basel). 11(2):123-7, 2016
                                                                                                  10. Marcil G et al: Fibroepithelial breast lesions diagnosed by core needle biopsy demonstrate a moderate rate of upstaging to phyllodes tumors. Am J Surg. ePub, 2016
                                                                                                  11. Ouyang Q et al: Benign Phyllodes Tumor of the Breast Diagnosed After Ultrasound-Guided Vacuum-Assisted Biopsy: Surgical Excision or Wait-and-Watch? Ann Surg Oncol. 23(4):1129-34, 2016
                                                                                                  12. Tan BY et al: Phyllodes tumours of the breast: a consensus review. Histopathology. 68(1):5-21, 2016
                                                                                                  13. Kamitani T et al: Differentiation between benign phyllodes tumors and fibroadenomas of the breast on MR imaging. Eur J Radiol. 83(8):1344-9, 2014
                                                                                                  14. Lawton TJ et al: Interobserver variability by pathologists in the distinction between cellular fibroadenomas and phyllodes tumors. Int J Surg Pathol. 22(8):695-8, 2014
                                                                                                  15. Eusebi V et al. Fibroepithelial tumors In: Lakhani SR et al. WHO Classification of Tumours of the Breast. 4th Edition Lyon, France: IARC; 2012
                                                                                                  16. Tan H et al: Imaging findings in phyllodes tumors of the breast. Eur J Radiol. 81(1):e62-9, 2012
                                                                                                  17. Yoo JL et al: Can MR Imaging contribute in characterizing well-circumscribed breast carcinomas? Radiographics. 30(6):1689-702, 2010
                                                                                                  18. Chung EM et al: From the archives of the AFIP: breast masses in children and adolescents: radiologic-pathologic correlation. Radiographics. 29(3):907-31, 2009
                                                                                                  19. Rosen PP: Rosen's Breast Pathology, 3rd ed. Philadelphia: Wolters Kluwer Lippincott Williams & Wilkins. 202-26, 2009
                                                                                                  20. Bode MK et al: Ultrasonography and core needle biopsy in the differential diagnosis of fibroadenoma and tumor phyllodes. Acta Radiol. 48(7):708-13, 2007
                                                                                                  21. Lee AH et al: Histological features useful in the distinction of phyllodes tumour and fibroadenoma on needle core biopsy of the breast. Histopathology. 51(3):336-44, 2007
                                                                                                  22. Kersting C et al: Amplifications of the epidermal growth factor receptor gene (egfr) are common in phyllodes tumors of the breast and are associated with tumor progression. Lab Invest. 86(1):54-61, 2006
                                                                                                  23. Yabuuchi H et al: Phyllodes tumor of the breast: correlation between MR findings and histologic grade. Radiology. 241(3):702-9, 2006
                                                                                                  24. Chen WH et al: Surgical treatment of phyllodes tumors of the breast: retrospective review of 172 cases. J Surg Oncol. 91(3):185-94, 2005
                                                                                                  25. Franceschini G et al: Phyllodes tumor of the breast: magnetic resonance imaging findings and surgical treatment. Breast J. 11(2):144-5, 2005
                                                                                                  26. Franceschini G et al: Surgical treatment and MRI in phyllodes tumors of the breast: our experience and review of the literature. Ann Ital Chir. 76(2):127-40, 2005
                                                                                                  27. Goel NB et al: Fibrous lesions of the breast: imaging-pathologic correlation. Radiographics. 25(6):1547-59, 2005
                                                                                                  28. Tan PH et al: p53 and c-kit (CD117) protein expression as prognostic indicators in breast phyllodes tumors: a tissue microarray study. Mod Pathol. 18(12):1527-34, 2005
                                                                                                  29. Tse GM et al: Stromal nitric oxide synthase (NOS) expression correlates with the grade of mammary phyllodes tumour. J Clin Pathol. 58(6):600-4, 2005
                                                                                                  30. Kinoshita T et al: Magnetic resonance imaging of benign phyllodes tumors of the breast. Breast J. 10(3):232-6, 2004
                                                                                                  31. Tse GM et al: Stromal expression of vascular endothelial growth factor correlates with tumor grade and microvessel density in mammary phyllodes tumors: a multicenter study of 185 cases. Hum Pathol. 35(9):1053-7, 2004
                                                                                                  32. Gordon PB et al: Solid breast masses diagnosed as fibroadenoma at fine-needle aspiration biopsy: acceptable rates of growth at long-term follow-up. Radiology. 229(1):233-8, 2003
                                                                                                  33. Komenaka IK et al: Core needle biopsy as a diagnostic tool to differentiate phyllodes tumor from fibroadenoma. Arch Surg. 138(9):987-90, 2003
                                                                                                  34. Tavassoli FA and Devilee P: World Health Organization (WHO) Classification of Tumors: Pathology and Genetics of Tumours of the Breast and Female Genital Organs. Lyon: IARC Press. 100-103, 2003
                                                                                                  35. Tse GM et al: Tumour angiogenesis and p53 protein expression in mammary phyllodes tumors. Mod Pathol. 16(10):1007-13, 2003
                                                                                                  36. Barth RJ Jr: Histologic features predict local recurrence after breast conserving therapy of phyllodes tumors. Breast Cancer Res Treat. 57(3):291-5, 1999
                                                                                                  37. Liberman L et al: Benign and malignant phyllodes tumors: mammographic and sonographic findings. Radiology. 198(1):121-4, 1996
                                                                                                  38. Koller R et al: Counseling the coronary patient on sexual activity. Postgrad Med. 51(4):133-6, 1972