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Breast-nonmalignant
Benign tumors / changes
Phyllodes Tumor - Benign
Reviewer: Hind Nassar, M.D. in January 2009 (see Authors page)
Revised: 17 April 2010, 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
Cleft like spaces and condensation of Adipose tissue differentiation of stroma
stroma beneath epithelium
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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