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Breast-nonmalignant
Benign tumors / changes
Phyllodes Tumor - Benign
Reviewer: Hind Nassar, M.D. in January 2009 (see Authors page)
Revised: 8 October 2012, last major update April 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Phyllodes features but no/rare mitotic figures, no atypia,
Terminology
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● Also called low grade because even histologically benign appearing tumors may have malignant behavior
Epidemiology
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Sites
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Etiology
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Clinical features
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● Most (75%) phyllodes tumors are benign
● May have benign adipose tissue as primary stromal component (lipophyllodes tumor, Arch Pathol Lab Med 1994;118:91)
● May recur locally, but only rare distant metastases
Prognostic factors
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Case reports
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● Three synchronous tumors (Arch Pathol Lab Med 1990;114:624)
● With DCIS and LCIS (Arch Pathol Lab Med 1987;111:873)
● With same intracytoplasmic inclusion bodies as infantile digital fibromatosis (Am J Surg Pathol 1994;18:506)
Treatment
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● Excision with 1-2 cm margins (Mod Pathol 2001;14:185)
● Breast preservation if possible, particular in young women
Clinical images
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Gross description (Macroscopy)
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● Well circumscribed, firm, gray-white cut surface with cleft-like spaces resembling a leaf
● Variable cysts, hemorrhage, necrosis (more common in larger tumors)
Gross images
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Large, well circumscribed tumors
Multiple polypoid nodules separated
by cleft-like spaces
Micro description (Histopathology)
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● Circumscribed pushing border, stromal hypercellularity (particularly next to epithelial elements) and benign glandular elements with intracanalicular pattern, but ratio is balanced
● Stroma resembles fibroblasts and myofibroblasts
● Epithelial component has luminal epithelial cells resting on myoepithelial layer
● May exhibit hyperplasia, squamous metaplasia
● May have clusters of multinucleated giant cells (Arch Pathol Lab Med 1994;118:912)
● Variable hemorrhage, necrosis, fat, bone, cartilage and skeletal muscle
● 0-4 mitotic figures/10 HPF
● No atypia
Micro images
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Hyperplastic ducts surrounded by cellular fibrous stroma
Circumscribed tumor Leaf like processes Adjacent fibroadenoma
Hyperplastic duct surrounded by Well circumscribed tumor
cellular fibrous stroma with leaf-like ductal epithelium
Apocrine hyperplasia Focal nuclear pleomorphism With LCIS
and mitotic figures
CD117 CD31
Ki-67
Fig A: benign tumor with minimal nuclear staining
Fig B: low grade malignant tumor with increased Ki-67
Fig C: high grade malignant tumor with frequent staining
Virtual Slides
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Videos
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Cytology description
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Cytology images
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Positive stains
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Epithelial cells:
● PR, GCDFP-15
Stromal cells:
● Vimentin, desmin, CD34, bcl2, ER-beta
● S100 (variable)
Negative stains
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Electron microscopy descriptions
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● Fibroblastic features
Electron microscopy images
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Molecular / cytogenetics description
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● No/few chromosome changes (Mod Pathol 2007;20:435)
● DNA content does not predict behavior (Hum Pathol 1992;23:1048)
Molecular / cytogenetics images
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Differential Diagnosis
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● Cellular fibroadenoma: stroma less cellular than phyllodes, less stromal overgrowth, no atypia, fewer mitotic figures, less Ki-67 staining (Am J Clin Path 2005;124:342, Histopathology 2007;51:336)
● Leiomyoma: smooth muscle morphology and immunohistochemistry
Additional references
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End of Breast-nonmalignant > Benign tumors / changes > Phyllodes tumor - benign
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