Iranian Journal of Pathology

Phyllodes Tumor, A Cytomorphologic Study of 17 Cases with Histologic Correlation

Document Type : Original Research

Authors

Savita Agarwal 1
Pinki Pandey 1
Megha Sawhney 2
Alka Yadav 1
Sunita Kumari Meena 1

1 Department of Pathology, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, India

2 Department of Pathology, Post Graduate Institute of Child Health Noida, Uttar Pradesh

https://doi.org/10.30699/ijp.2024.2033852.3322
Abstract
Background & Objective: Phyllodes tumor (PT) is a rare fibroepithelial tumor of the breast exhibiting varied clinicopathologic behavior, ranging from benign to borderline to frankly malignant,based on the presence of infiltrative margins, stromal overgrowth, stromal atypia, cellularity, and mitotic activity. A detailed cytomorphological study of cases of PT was performed, with clinical and histological correlation.
Methods: A cytomorphological study of 17 cases of histologically proven PT diagnosed between Jan 2014 and July 2021 was done retrospectively. Relevant data were obtained, including age at the time of diagnosis, the duration of illness, presenting symptoms, personal and family history, tumor size, tumor localization, and surgical procedure. A detailed cytomorphological assessment of stromal and epithelial components was performed, and further histological correlation was obtained for each case.
Results: The age of the patients ranged from 25 to 65 years old. The chief complaint was a palpable breast mass in all patients. The mean size of the lump was 11.86 cm. A complete cytohistological concordance was achieved among malignant cases. Stromal metaplasia was observed in only one case of benign phyllodes tumor, which was chondroid differentiation, and malignant heterologous component as fibrosarcomatous differentiation in one of the malignant PTs. Each of the benign and malignant phyllode tumors ductal carcinoma in situ (DCIS) of its epithelial component was seen in one case.
Conclusion: Phyllodes must be considered in differential diagnosing a rapidly growing breast lump. Breast imaging has little role in diagnosing phyllode tumors. FNAC or trucut biopsy is mandatory in preoperative diagnosis. An extended follow-up is needed in all cases.

Keywords

Cytohistologic correlation
fibroepithelial tumor
FNAC
Phyllodes

Subjects

  1.  

    1. Limaiem F, Kashyap S. Phyllodes Tumor of the Breast. 2023 Jan 1. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan. [NBK] [PMID]
    2. Tummidi S, Kothari K, Agnihotri M, Naik L, Sood P. Fibroadenoma versus phyllodes tumor: a vexing problem revisited! BMC Cancer. 2020;20(1):648. [DOI:10.1186/s12885-020-07129-0] [PMID]
    3. Foxcroft LM, Evans EB, Porter AJ. Difficulties in the pre-operative diagnosis of phyllodes tumours of the breast: a study of 84 cases. Breast. 2007;16:27-37. [DOI:10.1016/j.breast.2006.05.004] [PMID]
    4. Krishnamurthy S, Ashfaq R, Shin HJ, Sneige N. Distinction of phyllodes tumor from fibroadenoma: a reappraisal of an old problem. Cancer. 2000;90:342-9. [DOI:10.1002/1097-0142(20001225)90:63.0.CO;2-I] [PMID]
    5. Bhattarai S, Kapila K, Verma K. Phyllodes tumor of the breast: a cytohistologic study of 80 cases. Acta Cytol. 2000;44:790-6. [DOI:10.1159/000328563] [PMID]
    6. Maritz RM, Michelow PM. Cytological criteria to distinguish phyllodes tumour of the breast from fibroadenoma. Acta Cytol. 2017;61:418-24. [DOI:10.1159/000477573] [PMID]
    7. Fiks A. Cystosarcoma phyllodes of the mammary gland - Müller's tumor. For the 180th birthday of Johannes Müller. Virchows Arch A Pathol Anat Histol. 1981;392:1-6. [DOI:10.1007/BF00430543] [PMID]
    8. Shimizu K, Korematsu M. Phyllodes Tumor of the Breast. A cytomorphologic approach based on evaluation of epithelial cluster architecture. Acta Cytol. 2002;46:332-6. [DOI:10.1159/000326730] [PMID]
    9. Kaufman Z, Shiptz B, Shapiro M, Rona R, Lew S, Dinbar A. Triple approach in the diagnosis of dominant breast mass: combined physical examination, mammography, and fine needle aspiration. J Surg Oncol. 1994;56:254-7. [DOI:10.1002/jso.2930560413] [PMID]
    10. Jackin RK, Fridgway PF, Ziprin P, Healy V, Hadjiminas A, Darzi A. Optimizing preoperative diagnosis in phyllodes tumour of the breast. J Clin Pathol. 2006;59:454-9. [DOI:10.1136/jcp.2005.025866] [PMID]  
    11. El Hag IA, Aodah A, Kollur SM, Attallah A, Mohamed AAE, Hussaini HA. Cytological clues in the distinction between phyllodes tumor and fibroadenoma. Cancer Cytopathol. 2010;118:33-40. [DOI:10.1002/cncy.20057] [PMID]
    12. World Health Organization. Histologic typing of breast tumors. 2nd ed. Geneva: WHO; 1981.
    13. Scolyer RA, McKenzie PR, Achmed D, Lee CS. Can phyllodes tumours of the breast be distinguished from fibroadenomas using fine needle aspiration cytology? Pathology. 2001;33:437-43. [DOI:10.1080/00313020120083151] [PMID]
    14. Veneti S, Manek S. Benign phyllodes tumour vs fibroadenoma: FNA cytological differentiation. Cytopathology. 2001;12:321-8. [DOI:10.1046/j.1365-2303.2001.00334.x] [PMID]
    15. Jayaram G, Sthaneshwar P. Fine-needle aspiration cytology of phyllodes tumors. Diagn Cytopathol. 2002;26:222-7. [DOI:10.1002/dc.10085] [PMID]
    16. Bandyopadhyay R, Nag D, Mondal SK, Mukhopadhyay S, Roy S, Sinha SK. Distinction of phyllodes tumor from fibroadenoma: cytologists' perspective. J Cytol. 2010;27:59-62. [DOI:10.4103/0970-9371.70739] [PMID]  
    17. Simi U, Moretti D, Iacconi P, Arganini M, Roncella M, Miccoli P, et al. Fine needle aspiration cytopathology of phyllodes tumor: differential diagnosis with fibroadenoma. Acta Cytol. 1988;32:63-6.
    18. Rao CR, Narasimhamurthy NK, Jaganathan K, Mukherjee G, Hazarika D. Cystosarcoma phyllodes: diagnosis by fine needle aspiration cytology. Acta Cytol. 1992;36:203-7.
    19. Shimizu K, Masawa N, Yamada T, Okamoto K, Kanda K. Cytologic evaluation of phyllodes tumours as compared to fibroadenomas of the breast. Acta Cytol. 1994;38:891-7.
    20. Hadju SI, Espinosa MH, Robbins GF. Recurrent cystosarcoma phyllodes: a clinicopathologic study of 32 cases. Cancer. 1976;38:1402-6.   [DOI:10.1002/1097-0142(197609)38:33.0.CO;2-9] [PMID]
    21. Reinfuss M, Mitus J, Duda K, Stelmach A, Rys J, Smolak K. The treatment and prognosis of patients with phyllodes tumor of the breast: an analysis of 170 cases. Cancer. 1996;77:910-6. [DOI:10.1002/(SICI)1097-0142(19960301)77:53.0.CO;2-6]
    22. Ashfaq R, Sneige N, Staerkel G. Cytologic features distinguishing phyllodes tumours from fibroadenomas in fine needle aspirates of the breast: a review of 48 cases. Mod Pathol. 1993;7:27A.
    23. Deen SA, McKee GT, Kissin MW. Differential cytological features of fibroepithelial lesions of the breast. Diagn Cytopathol. 1999;20:53-6. [DOI:10.1002/(SICI)1097-0339(199902)20:23.0.CO;2-T]
    24. Chao TC, Lo YF, Chen SC, Chen MF. Sonographic features of phyllodes tumors of the breast. Ultrasound Obstet Gynecol. 2002;20:64-71. [DOI:10.1046/j.1469-0705.2002.00736.x] [PMID]
    25. Chatura KR, Deeparani T, Patil SB. A revisit of cytological features in phyllodes tumors. J Med Radiol Pathol Surg. 2018;5(6):3-8. [DOI:10.15713/ins.jmrps.147]
    26. Kumar PV, Mokhtari M. Cytological findings in benign phyllodes tumors. Acta Cytol. 2019;63(1):23-7. [DOI:10.1159/000493677] [PMID]
    27. Lissidini G, Mulè A, Santoro A, Papa G, Nicosia L, Cassano E, et al. Malignant phyllodes tumor of the breast: a systematic review. Pathologica. 2022;114(2): 111. [DOI:10.32074/1591-951X-754] [PMID]
    28. Kuppusamy DA, Jinkala S, Thambiraj P, Stephen N, Gochhait D, Siddaraju N, et al. Malignant phyllodes tumor with liposarcomatous differentiation: diagnosed on cytology. Diagn Cytopathol. 2021;49(6):E226-30. [DOI:10.1002/dc.24681] [PMID]
    29. Li JJ, Chan WC, Chau HH, Wu C, Tse GM. Cytologic diagnosis of metastatic malignant phyllodes tumor of the breast in pleural effusion. Diagn Cytopathol. 2019;47(6):599-602. [DOI:10.1002/dc.24151] [PMID]
    30. Rayzah M. Phyllodes tumors of the breast: a literature review. Cureus. 2020;12(9):e10211. [DOI:10.7759/cureus.10288] [PMID]  
    31. Bennett IC, Saboo A. The evolving role of vacuum-assisted biopsy of the breast: a progression from fine-needle aspiration biopsy. World J Surg. 2019;43(4): 1054-61. [DOI:10.1007/s00268-018-04892-x] [PMID]
Iranian Journal of Pathology
Volume 20, Issue 1
Winter 2025
Pages 90-97

  • Receive Date 05 July 2024
  • Revise Date 03 August 2024
  • Accept Date 07 December 2024

Home

Guide for Authors

Submit Manuscript

Contact Us