What are phyllodes tumors of the breast?
Phyllodes tumors of the breast, also called phyllodes tumors and cystosarcoma phyllodes, are rare breast tumors that grow in a leaf-like pattern throughout the breast tissue. These tumors tend to grow quickly within breast tissue, but it is rare for them to spread to other areas of the body.
Phyllodes tumors account for about one percent of all breast tumors. Most of them are not cancerous, but some are cancerous, and some are considered borderline, which means they have characteristics of both benign (non-cancerous) tumors and malignant (cancerous) tumors. All phyllodes tumors grow quickly regardless of whether they are cancerous, and they must be removed with surgery to prevent them from coming back.
Phyllodes tumors do not develop inside milk ducts or milk-producing glands, but instead develop outside these areas in the connective tissue in the breast (called stroma). The stroma is made up of fatty tissue and ligaments that basically holds together the ducts, glands, and blood and lymph vessels. Phyllodes tumors are usually made up of stromal cells and may contain cells from the ducts and lobules.
What causes phyllodes tumors of the breast?
Experts do not know what causes phyllodes tumors to develop. There is some evidence that they develop as people age.
What are the risks for phyllodes tumors of the breast?
There are several factors that may lead to phyllodes tumors developing, including:
- injury to the nipple and areola
- breastfeeding and pregnancy
- increased estrogen levels
There is a rare, inherited genetic syndrome called Li-Fraumeni syndrome that puts women at higher risk for developing phyllodes tumors of the breast. If you have Li-Fraumeni syndrome or a family history of this syndrome, talk to your doctor about how often you should have breast exams, mammograms, and other imaging studies.
What are the signs and symptoms of phyllodes tumors?
The most common symptom of phyllodes tumor of the breast is a lump in the breast. The tumor may be 2 to 3 centimeters or even larger. You may be able to see the lump as the tumor pushes against the skin of your breast. Some people get ulcers or open wounds on the breast.
Phyllodes tumors of the breast are not usually painful.
How do you diagnose phyllodes tumors?
Phyllodes tumors are sometimes difficult for doctors to diagnose because they are rare, so doctors aren’t used to seeing them. They can look like fibroadenomas, a non-cancerous breast growth that is a solid lump of breast cells, which can also lead to misdiagnosis. However, fibroadenomas tend to occur in women in their 30s, while phyllodes tumors of the breast usually develop in women in their 40s. Fibroadenomas also tend to grow slower than phyllodes tumors of the breast. These two factors may help doctors make an accurate diagnosis.
To make an official diagnosis of phyllodes tumors, doctors will usually order several exams, tests, and procedures, including:
To make an accurate diagnosis of phyllodes tumor of the breast, it may be necessary for a doctor to examine the entire tumor. For this reason, an excisional biopsy may be the best choice.
There are three classifications for phyllodes tumors:
- Benign
- Borderline
- Malignant
Benign tumors have:
- well-defined edges
- cells that grow slower
- stromal cells that look very similar to normal cells
- no overgrowth of stromal cells, and the tumor contains the same type of cells that line the ducts and lobules (epithelial cells)
A tumor is considered malignant if:
- it doesn’t have well defined edges
- the cells are dividing and growing quickly
- the stromal cells look abnormal
- there is an overgrowth of stromal cells, and normal epithelial cells may not be present
A tumor is considered borderline if the tumor cells have features of both non-cancerous and cancerous tumors.
How do you treat phyllodes tumors of the breast?
The main treatment for phyllodes tumors of the breast is lumpectomy, regardless of whether the tumor is benign, borderline, or cancerous. This type of surgery is done to conserve as much breast tissue as possible. During a lumpectomy, surgeons remove the tumor and some of the normal, healthy tissue surrounding it. If there is not enough normal breast tissue after the tumor is removed, the surgeon may have to perform a mastectomy. If the phyllodes tumor is cancerous, the surgeon will remove a larger area of healthy tissue surrounding the tumor.
Cancerous phyllodes tumors of the breast do not respond to hormone therapy, and radiation therapy and chemotherapy aren’t as likely to work either.
After surgery, it’s important to follow up with frequent breast exams and imaging tests for as long as your doctor recommends.
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