Phyllodes tumor

benign breast diseases

1. Phyllodes tumor:Management Dr Shambhavi Sharma Resident 1 st year

2. I ntroduction Also known as serocystic disease of Brodie or cystosarcoma phyllodes Greek word Phyllon = leaf Sarcoma = fleshy tumor

3. Epidemiology Age: over the age of 40 Sex: almost exclusively on females Occurrence: 1% of tumors of breast, 2.5% of fibroepithelial tumors Mostly benign Average annual incidence rate of malignant phyllodes tumor is 2.1/million women May be associated with Li F reumani syndrome

4. Clinical presentation Large, sometimes massive tumor (Average size: 5cm) Unilateral Rapidly growing mass Ulceration of overlying skin

5. Examination Stretched,red,dilated veins Smooth ,non tender, fluctuant necrosis and hence cystic areas Warmer,notfixed to skin or deeper muscles or chest wall No nipple retraction Lymph nodes palpaple (20%) (mostly reactive

6. Malignant phyllodes More aggressive Metastasize hematogenously Lung , skeleton, heart, and liver – most common metastatic site Mortality rate: 30% May present with dyspnea, fatigue, and bone pain

7. Malignant phyllodes Malignant phyllodes tumor represent anywhere from 10–30% of all phyllodes tumors.

8. ultrasonography well-circumscribed, lobulated masses, heterogeneous internal echo patterns, and a lack of microcalcifications Mammography:

9. Invetsigations CT scan : chest Excisional biopsy(cut section) histopathlogy Invading chest wall Cystic areas expansion and increased cellularity of the stromal component a leaf-like pattern

10. Classification

11. Differential diagnosis

12. TREATMENT: SURGERY Complete Excision 2cm margin for small tumors 5cm margin for large tumor Lumpectomy/Wide Local Excision /Mastectomy depending on Size Axillary Lymph Node Dissection : usually not necessary

13. Postoperative adjuvant therapy  ADJUVANT CHEMOTHERAPY ? role is Controversial ! Should be considered for Malignant Phyllodes tumour

14. Adjuvant radiotherapy •Not indicated for tumours that are Widely Excised • Indicated for Borderline or Malignant Phyllodes tumours • Reduces Local Recurrence but does not impact Survival. • Rarely indicated following Mastectomy

15. Adjuvant hormone therapy   No place for Hormonal therapy in Phyllodes Tumours

16. Post op complications   Infection Seroma formation Local or distant recurrence

17. Follow up Most recurrence occur within first 2 years Clinical Follow-Up: Every 6 months in the First 2 years Then Annually Annual Mammography: for Lumpectomy & Wide Local Excision cases Chest X-ray/Chest Computed Tomography: 6 Monthly For Large (≥5 cm) or Malignant Phyllodes Tumours

18. Prognosis majority of patients with Benign and Borderline Phyllodes Tumours Cured by Surgery The 5 Year Survival Rate for Malignant Phyllodes Tumours approximately 60-80 %

19. complications Emotional distress due to the presence of breast cancer Ulceration of overlying skin may lead to secondary bacterial and/or fungal infections Metastasis of the tumor to local and regional sites including to lymph nodes and skin Recurrence of the tumor on incomplete surgical removal Side effects of chemotherapy: nausea , vomiting, hair loss, decreased appetite, mouth sores, fatigue, low blood cell counts, and a higher chance of developing infections

20. Side effects of radiation therapy : sunburn-like rashes, red or dry skin, heaviness of the breasts, general fatigue Lymphedema (swelling of an arm ) may form weeks to years after treatment that involves radiation therapy to the axillary lymph node

21. THANK YOU