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Imaging
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TERMINOLOGY
Abbreviations
- Phyllodes tumor (PT)
Synonyms
- Cystosarcoma phyllodes (older term, out of favor)
Definitions
- PT: Hypercellular fibroepithelial neoplasm with characteristic leaf-like architecture
- Biphasic tumor composed of stromal and epithelial elements
- Characterized by leaf-like stromal projections into epithelium-lined clefts
- Phyllodes: "Leaf-like" in Greek
- Clefts between projections form distinctive "cystic" spaces
- Phyllodes tumors can be benign, borderline, or malignant
- Cannot reliably distinguish with imaging
- Graded at histopathology based on: Mitoses, stromal cellularity, stromal overgrowth and borders
- Benign PT
- < 5 mitoses per 10 HPF
- Low stromal cellularity, no stromal overgrowth, circumscribed margins
- Recurrence rate: 5-17%; distant metastasis < 1%
- Borderline PT (low-grade malignant)
- 5-9 mitoses per 10 HPF
- Stromal overgrowth present, may be focal
- Recurrence rate: 14-25%; distant metastasis 2%
- Malignant PT (high-grade)
- ≥ 10 mitoses per 10 HPF (WHO criteria)
- Marked stromal cellularity, extensive stromal overgrowth, invasive margins
- Recurrence rate: 23-30%; distant metastasis 17%
- PT: Hypercellular fibroepithelial neoplasm with characteristic leaf-like architecture
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
MR Findings
CT Findings
Image-Guided Biopsy
Imaging Recommendations
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
- 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
- Kalambo M et al: Phyllodes Tumor of the Breast: Ultrasound-Pathology Correlation. AJR Am J Roentgenol. 210(4):W173-W179, 2018
- Li J et al: Expression of biomarkers in AKT pathway correlated with malignancy and recurrence in phyllodes tumors of the breast. Histopathology. ePub, 2018
- Tan BY et al: A Diagnostic Approach to Fibroepithelial Breast Lesions. Surg Pathol Clin. 11(1):17-42, 2018
- Krings G et al: Fibroepithelial lesions; The WHO spectrum. Semin Diagn Pathol. ePub, 2017
- Strode M et al: Update on the diagnosis and management of malignant phyllodes tumors of the breast. Breast. 33:91-96, 2017
- Adesoye T et al: Current Trends in the Management of Phyllodes Tumors of the Breast. Ann Surg Oncol. 23(10):3199-205, 2016
- Liu SY et al: Genomic profiling of malignant phyllodes tumors reveals aberrations in FGFR1 and PI-3 kinase/RAS signaling pathways and provides insights into intratumoral heterogeneity. Mod Pathol. 29(9):1012-27, 2016
- Tan BY et al: Phyllodes tumours of the breast: a consensus review. Histopathology. 68(1):5-21, 2016
- Roberts N et al: Aggressive malignant phyllodes tumor. Int J Surg Case Rep. 8C:161-5, 2015
- Yom CK et al: Reappraisal of conventional risk stratification for local recurrence based on clinical outcomes in 285 resected phyllodes tumors of the breast. Ann Surg Oncol. 22(9):2912-8, 2015
- Cimino-Mathews A et al: A Subset of Malignant Phyllodes Tumors Express p63 and p40: A Diagnostic Pitfall in Breast Core Needle Biopsies. Am J Surg Pathol. 38(12):1689-96, 2014
- McCarthy E et al: Phyllodes tumours of the breast: radiological presentation, management and follow-up. Br J Radiol. 87(1044):20140239, 2014
- Tan H et al: Imaging findings in phyllodes tumors of the breast. Eur J Radiol. 81(1):e62-9, 2012
- Tse GM et al: Phyllodes tumor of the breast: an update. Breast Cancer. 17(1):29-34, 2010
- Yoo JL et al: Can MR Imaging contribute in characterizing well-circumscribed breast carcinomas? Radiographics. 30(6):1689-702, 2010
- 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
- Pezner RD et al: Malignant phyllodes tumor of the breast: local control rates with surgery alone. Int J Radiat Oncol Biol Phys. 71(3):710-3, 2008
- 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
- Morales-Vásquez F et al: Adjuvant chemotherapy with doxorubicin and dacarbazine has no effect in recurrence-free survival of malignant phyllodes tumors of the breast. Breast J. 13(6):551-6, 2007
- 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
- Yabuuchi H et al: Phyllodes tumor of the breast: correlation between MR findings and histologic grade. Radiology. 241(3):702-9, 2006
- 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
- Franceschini G et al: Phyllodes tumor of the breast: magnetic resonance imaging findings and surgical treatment. Breast J. 11(2):144-5, 2005
- 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
- Goel NB et al: Fibrous lesions of the breast: imaging-pathologic correlation. Radiographics. 25(6):1547-59, 2005
- 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
- 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
- Kinoshita T et al: Magnetic resonance imaging of benign phyllodes tumors of the breast. Breast J. 10(3):232-6, 2004
- 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
- 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
- Komenaka IK et al: Core needle biopsy as a diagnostic tool to differentiate phyllodes tumor from fibroadenoma. Arch Surg. 138(9):987-90, 2003
- Tse GM et al: Tumour angiogenesis and p53 protein expression in mammary phyllodes tumors. Mod Pathol. 16(10):1007-13, 2003
- Liberman L et al: Benign and malignant phyllodes tumors: mammographic and sonographic findings. Radiology. 198(1):121-4, 1996
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References
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Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Abbreviations
- Phyllodes tumor (PT)
Synonyms
- Cystosarcoma phyllodes (older term, out of favor)
Definitions
- PT: Hypercellular fibroepithelial neoplasm with characteristic leaf-like architecture
- Biphasic tumor composed of stromal and epithelial elements
- Characterized by leaf-like stromal projections into epithelium-lined clefts
- Phyllodes: "Leaf-like" in Greek
- Clefts between projections form distinctive "cystic" spaces
- Phyllodes tumors can be benign, borderline, or malignant
- Cannot reliably distinguish with imaging
- Graded at histopathology based on: Mitoses, stromal cellularity, stromal overgrowth and borders
- Benign PT
- < 5 mitoses per 10 HPF
- Low stromal cellularity, no stromal overgrowth, circumscribed margins
- Recurrence rate: 5-17%; distant metastasis < 1%
- Borderline PT (low-grade malignant)
- 5-9 mitoses per 10 HPF
- Stromal overgrowth present, may be focal
- Recurrence rate: 14-25%; distant metastasis 2%
- Malignant PT (high-grade)
- ≥ 10 mitoses per 10 HPF (WHO criteria)
- Marked stromal cellularity, extensive stromal overgrowth, invasive margins
- Recurrence rate: 23-30%; distant metastasis 17%
- PT: Hypercellular fibroepithelial neoplasm with characteristic leaf-like architecture
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
MR Findings
CT Findings
Image-Guided Biopsy
Imaging Recommendations
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
- 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
- Kalambo M et al: Phyllodes Tumor of the Breast: Ultrasound-Pathology Correlation. AJR Am J Roentgenol. 210(4):W173-W179, 2018
- Li J et al: Expression of biomarkers in AKT pathway correlated with malignancy and recurrence in phyllodes tumors of the breast. Histopathology. ePub, 2018
- Tan BY et al: A Diagnostic Approach to Fibroepithelial Breast Lesions. Surg Pathol Clin. 11(1):17-42, 2018
- Krings G et al: Fibroepithelial lesions; The WHO spectrum. Semin Diagn Pathol. ePub, 2017
- Strode M et al: Update on the diagnosis and management of malignant phyllodes tumors of the breast. Breast. 33:91-96, 2017
- Adesoye T et al: Current Trends in the Management of Phyllodes Tumors of the Breast. Ann Surg Oncol. 23(10):3199-205, 2016
- Liu SY et al: Genomic profiling of malignant phyllodes tumors reveals aberrations in FGFR1 and PI-3 kinase/RAS signaling pathways and provides insights into intratumoral heterogeneity. Mod Pathol. 29(9):1012-27, 2016
- Tan BY et al: Phyllodes tumours of the breast: a consensus review. Histopathology. 68(1):5-21, 2016
- Roberts N et al: Aggressive malignant phyllodes tumor. Int J Surg Case Rep. 8C:161-5, 2015
- Yom CK et al: Reappraisal of conventional risk stratification for local recurrence based on clinical outcomes in 285 resected phyllodes tumors of the breast. Ann Surg Oncol. 22(9):2912-8, 2015
- Cimino-Mathews A et al: A Subset of Malignant Phyllodes Tumors Express p63 and p40: A Diagnostic Pitfall in Breast Core Needle Biopsies. Am J Surg Pathol. 38(12):1689-96, 2014
- McCarthy E et al: Phyllodes tumours of the breast: radiological presentation, management and follow-up. Br J Radiol. 87(1044):20140239, 2014
- Tan H et al: Imaging findings in phyllodes tumors of the breast. Eur J Radiol. 81(1):e62-9, 2012
- Tse GM et al: Phyllodes tumor of the breast: an update. Breast Cancer. 17(1):29-34, 2010
- Yoo JL et al: Can MR Imaging contribute in characterizing well-circumscribed breast carcinomas? Radiographics. 30(6):1689-702, 2010
- 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
- Pezner RD et al: Malignant phyllodes tumor of the breast: local control rates with surgery alone. Int J Radiat Oncol Biol Phys. 71(3):710-3, 2008
- 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
- Morales-Vásquez F et al: Adjuvant chemotherapy with doxorubicin and dacarbazine has no effect in recurrence-free survival of malignant phyllodes tumors of the breast. Breast J. 13(6):551-6, 2007
- 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
- Yabuuchi H et al: Phyllodes tumor of the breast: correlation between MR findings and histologic grade. Radiology. 241(3):702-9, 2006
- 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
- Franceschini G et al: Phyllodes tumor of the breast: magnetic resonance imaging findings and surgical treatment. Breast J. 11(2):144-5, 2005
- 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
- Goel NB et al: Fibrous lesions of the breast: imaging-pathologic correlation. Radiographics. 25(6):1547-59, 2005
- 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
- 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
- Kinoshita T et al: Magnetic resonance imaging of benign phyllodes tumors of the breast. Breast J. 10(3):232-6, 2004
- 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
- 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
- Komenaka IK et al: Core needle biopsy as a diagnostic tool to differentiate phyllodes tumor from fibroadenoma. Arch Surg. 138(9):987-90, 2003
- Tse GM et al: Tumour angiogenesis and p53 protein expression in mammary phyllodes tumors. Mod Pathol. 16(10):1007-13, 2003
- Liberman L et al: Benign and malignant phyllodes tumors: mammographic and sonographic findings. Radiology. 198(1):121-4, 1996
