Description

Phyllodes tumours (PT) of the breast ares an uncommon fibroepithelial neoplasm classified as benign (BPT), lowgrade (borderline) and high-grade malignant (MPT). These tumours occur at a mean age of 45 years and are less common in women under 30 years of age. The aetiology of PT remains unclear. Molecular and cellular studies suggest no apparent histogenetic relationship between PT and its analogous counterpart, the fibroadenoma (FA). No specific clinical features readily distinguish FA from BPT or MPT, although rapid growth in a preexisting breast mass or a tumour larger than 4 cm are more likely to indicate PT. Triple assessment may have a limited diagnostic accuracy in identifying subtypes of PT pre-operatively compared to surgical excision biopsy.

Primary surgical excision for complete tumour extirpation and achievement of clear margins is the treatment of choice for PT. Adjuvant chemotherapy and radiotherapy may also be indicated for MPT. Local recurrence (LR) is associated with incomplete excision of BPT, borderline and MPT, while distant metastasis (DM) is usually a feature of MPT. Multivariate analysis identifies histologic subtype and surgical margins as the main predictive factor for recurrence. The treatment of distant relapse is not well defined, with limited gains in survival despite the combination of radiotherapy and chemotherapy.