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1 Department of Radiology, Division of Diagnostic Imaging, The University of
Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX
77030.
2 The University of Texas-Houston Medical School, 6431 Fannin St., Houston, TX
77030.
3 Division of Pathology, The University of Texas M. D. Anderson Cancer Center,
Houston, TX 77030.
Received April 8, 2002;
accepted after revision May 15, 2002.
Address correspondence to G. J. Whitman.
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First described by Johannes Müller in 1838 as cystosarcoma phyllodes, phyllodes tumor is a rare fibroepithelial neoplasm. Phyllodes tumors resemble fibroadenomas, account for 1% of breast malignancies, and usually occur in women from 30 to 70 years old [1]. In a study of 170 patients with phyllodes tumor, the mean age at presentation was 52 years [2].
Phyllodes tumors often present as discrete, palpable masses, most commonly located in the upper outer quadrant of the breast. Phyllodes tumors usually grow slowly and are often painless. Nipple retraction and bloody nipple discharge may occur when the tumor involves the areolar region [2, 3].
Histologically, phyllodes tumors are usually round or oval masses with sharp margins. Phyllodes tumors contain leaflike, epithelial-lined papillary projections penetrating into cystic spaces. Phyllodes tumors are usually distinguished from fibroadenomas by hypercellular stroma with cytologic atypia and increased mitoses [4].
Classification of phyllodes tumors is controversial. In general, phyllodes tumors may be classified as benign, borderline, or malignant; most phyllodes tumors are benign. Benign phyllodes tumors characteristically have smooth, noninfiltrating borders with hypocellular stromal components, minimal nuclear atypia, and low mitotic activity. Factors suggesting malignancy include increased mitotic activity, pronounced proliferation of stromal components relative to glandular structures, cytologic atypia, and invasive peripheral growth with infiltration into adjacent tissues. Approximately 5-25% of phyllodes tumors are described as malignant. Fewer than 20% of the malignant tumors metastasize. When metastatic disease occurs, the metastases usually spread hematogenously to the lungs, pleura, or bone [4].
On mammography, phyllodes tumors appear as lobulated, round, or oval masses. They are usually noncalcified and well circumscribed. On sonography, phyllodes tumors are usually well-defined, solid masses with heterogeneous internal echoes, without posterior acoustic attenuation. A diagnosis of phyllodes tumor should be considered if sonography reveals fluid-filled, elongated spaces or clefts in a solid mass. It is often difficult to differentiate phyllodes tumors from fibroadenomas on sonography or mammography, and it is not possible to distinguish between benign and malignant phyllodes tumors on the basis of sonographic or mammographic findings [3].
On T2-weighted MR images, phyllodes tumors are usually identified as oval, round, or lobulated masses with circumscribed margins and homogeneous high signal intensity. On dynamic contrast-enhanced MR images, phyllodes tumors show rapid enhancement. MR imaging may be used to delineate the full tumor extent and potential satellite lesions before surgical excision [1].
The use of fine-needle aspiration is controversial in the preoperative diagnosis of phyllodes tumors. The accuracy of performing a core biopsy to diagnose phyllodes tumor has not been established. Although the diagnosis of phyllodes tumor may be made with fine-needle aspiration cytology or core biopsy, confidence in correctly diagnosing the lesion is significantly greater with excisional biopsy.
Treatment of phyllodes tumor requires complete surgical excision with wide margins. Wide reexcision should be considered when the margins are involved microscopically or when the tumor shows an invasive growth pattern. Mastectomy is often performed for recurrent phyllodes tumor [5].
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  J. W. T. Leung, M. B. Gotway, and E. A. Sickles Preoperative Embolization of Vascular Phyllodes Tumor of the Breast Am. J. Roentgenol., March 1, 2005; 184(3_supp): S115 - S117. [Full Text] [PDF]
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