Phylloides Tumour

Breast

Clinicals - History

Fact Explanation
Breast Lump Phyllodes tumors usually present as a painless,
rapidly growing but clinically benign smooth breast lump. The median size of phyllodes tumors is around 4 cm.It can acquire any size and is sometimes even massive. Translucency of the overlying skin of an large tumor will allow visualization of veins which will lead to bluish discoloration of the skin.They can be found as a breast lump at any age including adolescence. The peak incidence of this tumor in women is between 35 and 55 years of age, with only a few cases reported in men. Phyllodes tumors are rare fibroepithelial lesions, they should be regarded as a spectrum of fibroepithelial neoplasms.At one extreme are malignant phyllodes tumors, then borderline tumors and
at the other extreme benign phyllodes tumors.
Breast Lump
Phyllodes tumors usually present as a painless,
rapidly growing but clinically benign smooth breast lump. The median size of phyllodes tumors is around 4 cm.It can acquire any size and is sometimes even massive. Translucency of the overlying skin of an large tumor will allow visualization of veins which will lead to bluish discoloration of the skin.They can be found as a breast lump at any age including adolescence. The peak incidence of this tumor in women is between 35 and 55 years of age, with only a few cases reported in men. Phyllodes tumors are rare fibroepithelial lesions, they should be regarded as a spectrum of fibroepithelial neoplasms.At one extreme are malignant phyllodes tumors, then borderline tumors and
at the other extreme benign phyllodes tumors.
Necrosis of the skin This is due to pressure necrosis of the overlying skin of a large tumor. Necrosis of the skin
This is due to pressure necrosis of the overlying skin of a large tumor.

Clinicals - Examination

Fact Explanation
Breast lump Size of the lump is usually greater than 2 cm.It has a spherical or ovoid shape, smooth surface and rubbery consistency. It is freely mobile and not fixed or tethered to skin.They are found more commonly in the upper outer quadrant. It usually takes over a quarter or half of the affected breastThe skin over large tumors may have dilated veins and a blue discoloration but nipple retraction is rare.The diagnosis of a Phyllodes tumor should be considered in all women, particularly over the age of 35 years, who present with a rapidly growing but clinically benign breast lump. Breast lump
Size of the lump is usually greater than 2 cm.It has a spherical or ovoid shape, smooth surface and rubbery consistency. It is freely mobile and not fixed or tethered to skin.They are found more commonly in the upper outer quadrant. It usually takes over a quarter or half of the affected breastThe skin over large tumors may have dilated veins and a blue discoloration but nipple retraction is rare.The diagnosis of a Phyllodes tumor should be considered in all women, particularly over the age of 35 years, who present with a rapidly growing but clinically benign breast lump.
Necrosis of the skin This is due to pressure necrosis of the overlying skin. Necrosis of the skin
This is due to pressure necrosis of the overlying skin.
Palpable axillary lymph nodes. Palpable axillary lymphadenopathy can be
identified in up to 20% of patients but nodal
metastases are uncommon
Palpable axillary lymph nodes.
Palpable axillary lymphadenopathy can be
identified in up to 20% of patients but nodal
metastases are uncommon

Investigations - Diagnosis

Fact Explanation
Mammography Phyllodes tumours are mammographically well defined with a smooth and occasionally lobulated border.A radiolucent “halo” may be seen around the lesion, due to compression of the surrounding breast stroma. No mammographic indicators have been identified that allow for differentiation between benign and malignant tumors Mammography
Phyllodes tumours are mammographically well defined with a smooth and occasionally lobulated border.A radiolucent “halo” may be seen around the lesion, due to compression of the surrounding breast stroma. No mammographic indicators have been identified that allow for differentiation between benign and malignant tumors
Ultrasound scan On ultrasound examination,
phyllodes tumors often show smooth contours
with low level homogenous internal echoes,
intramural cysts, and the absence of posterior
acoustic enhancement.
Ultrasound scan
On ultrasound examination,
phyllodes tumors often show smooth contours
with low level homogenous internal echoes,
intramural cysts, and the absence of posterior
acoustic enhancement.
Fine Needle Aspiration Cytology (FNAC) Cytologically, it is often easier to
differentiate benign from malignant phyllodes
tumours than to separate benign phyllodes
tumours from fibroadenomas
Fine Needle Aspiration Cytology (FNAC)
Cytologically, it is often easier to
differentiate benign from malignant phyllodes
tumours than to separate benign phyllodes
tumours from fibroadenomas
Core biopsy This is require to differentiate phyllodes tumors from the fibroadenomas which is difficult in fine needle aspiration cytology. Core biopsy
This is require to differentiate phyllodes tumors from the fibroadenomas which is difficult in fine needle aspiration cytology.

Investigations - Management

Fact Explanation
Mammography 15% of patients develop local recurrence. Local
recurrence usually occurs within the first few
years of surgery. So women who undergo surgery for removal of a phyllodes tumor require close surveillance with a follow-up mammogram and physical examination at regular intervals.
Mammography
15% of patients develop local recurrence. Local
recurrence usually occurs within the first few
years of surgery. So women who undergo surgery for removal of a phyllodes tumor require close surveillance with a follow-up mammogram and physical examination at regular intervals.
Full blood count This is a slandered preoperative investigation for any patient who wish to undergo surgical treatment. Can asses Hb level, platelet counts and blood cell counts which will help to identify anemia, thrombocytopenia. Full blood count
This is a slandered preoperative investigation for any patient who wish to undergo surgical treatment. Can asses Hb level, platelet counts and blood cell counts which will help to identify anemia, thrombocytopenia.
ECG Done as a routine investigation to find out any cardiac compromise. if there any ECG changes exercise ECG will be indicated. ECG
Done as a routine investigation to find out any cardiac compromise. if there any ECG changes exercise ECG will be indicated.
Blood urea and electrolyte Not routinely done, but if patient has any underlying disease such as hypertension, cardiac diseases, renal disease, diabetes mellitus or if age is more than 65 years. Blood urea and electrolyte
Not routinely done, but if patient has any underlying disease such as hypertension, cardiac diseases, renal disease, diabetes mellitus or if age is more than 65 years.
Echocardiogram Only indicated if there any ECG changes or in diagnosed cardiac disease patient. Echocardiogram
Only indicated if there any ECG changes or in diagnosed cardiac disease patient.
Chest x ray. To asses respiratory functions. this will also indicated in malignant phylloides tumors to asses complications like plural effusions, bone deposits etc. Chest x ray.
To asses respiratory functions. this will also indicated in malignant phylloides tumors to asses complications like plural effusions, bone deposits etc.
Fasting Blood Sugar To asses to preoperative blood sugar control as uncontrolled diabetes will give rise to lot of surgical complications. Fasting Blood Sugar
To asses to preoperative blood sugar control as uncontrolled diabetes will give rise to lot of surgical complications.

Management - Supportive

Fact Explanation
Non surgical watchful waiting The natural history of fibroadenomas has
recently been clearly defined.With the negligible
increased risk of malignancy and the recognition
that 40% of fibroadenomas reduce in
size over a two year period, non-operative
management has been widely adopted. But many patients wish lump to be removed even after informing that it is benign.
Non surgical watchful waiting
The natural history of fibroadenomas has
recently been clearly defined.With the negligible
increased risk of malignancy and the recognition
that 40% of fibroadenomas reduce in
size over a two year period, non-operative
management has been widely adopted. But many patients wish lump to be removed even after informing that it is benign.

Management - Specific

Fact Explanation
Wide local excision wide excision with a
margin of at least 1 cm of normal breast tissue
is required, particularly for borderline and
malignant tumours to prevent local recurrence. If recurred,re-excision of borderline and
malignant phyllodes tumours identified after
local excision should be considered.
Wide local excision
wide excision with a
margin of at least 1 cm of normal breast tissue
is required, particularly for borderline and
malignant tumours to prevent local recurrence. If recurred,re-excision of borderline and
malignant phyllodes tumours identified after
local excision should be considered.
Mastectomy Mastectomy is now not routinely done for phyllodes tumors. It is done if histology shows malignant features. But mastectomy for malignant tumours offers
no survival advantage.
Axillary nodal dissection is not required
Mastectomy
Mastectomy is now not routinely done for phyllodes tumors. It is done if histology shows malignant features. But mastectomy for malignant tumours offers
no survival advantage.
Axillary nodal dissection is not required
Radiotheraphy The role of adjuvant radiotherapy is
unclear.
Radiotheraphy
The role of adjuvant radiotherapy is
unclear.

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