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8 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
A phyllodes tumour is a fast-growing, usually painless breast lump of gland and connective tissue that forms leaf-like fronds. Most are benign, some borderline and a few malignant, behaving like a sarcoma and spreading through the blood. Treatment is surgery with a rim of normal tissue; radiotherapy is considered for higher grades, and chemotherapy has little proven role.
Phyllodes tumours are fibroepithelial tumours in which the stroma, not the epithelium, is the neoplastic component; the epithelium is stretched into the leaf-like clefts that give the name. The World Health Organization grades them benign, borderline or malignant on stromal cellularity, nuclear atypia, mitotic count, stromal overgrowth and the character of the border, and most are benign. They present as a smooth, mobile, often large lump that has grown quickly over months, in women a decade older than those with fibroadenoma. Imaging cannot reliably separate the two, and a core biopsy often returns only a fibroepithelial lesion, so any rapidly growing or large fibroepithelial lesion is excised for diagnosis. Benign phyllodes tumours and fibroadenomas share MED12 mutations, and TERT promoter mutations accumulate in borderline and malignant tumours.
Surgery is the treatment for every grade. Wide local excision with clear margins is the aim, and mastectomy is reserved for tumours too large for the breast; the traditional demand for a 1 cm margin has softened, and guidelines now accept any negative margin for benign tumours while recommending re-excision for positive margins in borderline and malignant disease. Lymph node metastases are rare, so sentinel node biopsy and axillary dissection are not performed. Adjuvant radiotherapy has no randomised evidence: a single-arm phase 2 study of 46 borderline and malignant tumours treated with margin-negative breast-conserving surgery and radiotherapy reported no local recurrences, and guidelines list radiotherapy as a consideration after breast conservation for these grades. Adjuvant chemotherapy has no proven benefit and hormone receptors, though often present in the epithelium, do not guide treatment.
| Setting | Approach | Guideline |
|---|---|---|
| Diagnosis | Ultrasound and mammography, core needle biopsy, and excision of any rapidly growing or large fibroepithelial lesion because biopsy cannot reliably separate phyllodes tumour from fibroadenoma. | not mapped |
| Benign phyllodes tumour | Complete excision with clear margins; observation if margins are close after a benign diagnosis. | not mapped |
| Borderline and malignant phyllodes tumour | Wide excision aiming for clear margins or mastectomy for large tumours, no axillary staging, and adjuvant radiotherapy considered after breast conservation. | not mapped |
| Metastatic malignant phyllodes tumour | Treated as a soft-tissue sarcoma with doxorubicin-based chemotherapy; no proven benefit from adjuvant chemotherapy. | not mapped |