The phyllodes tumors of the breast are a rare type of breast cancer and take its name from its structure. The tumor cells in this cancer appear in a leaf like pattern and in greek phyllodes means leaf like. This type of tumor is also referred to as phylloides tumor and cystosarcoma phyllodes. These cells show aggressive multiplication and growth but are predominantly confined and restricted to the breast. these tumors are not necessarily malignant or benign, they can be in both type of growths and some are in between the two ( malignant cells and benign cells), these are called borderline phyllodes tumors. These may be of any type but show a quick growth and can affect women at any age; they are known to be quite rare in men. The non cancerous tumour in women is commonly detected at a younger age as compared to cancerous tissue which is diagnosed much later after 40s. Cancers are recurrent in nature and the phyllodes tumor necessitates surgical removal to prevent their recurrence.
Fibroadenoma is a breast condition in which there are bulges in the breast. de to striking similarity with phyllodes tumors, the diagnosis may be little difficult to make. Also as the phyllodes cancer is a rare incidence the diagnosis may be wrong. A fibroadenoma is nothing but in younger women there is a solid, growing lump of normal breast cells referred to as fibroadenoma. The major distinguishing feature between the two being that phyllodes have aggressive growth as compared to fibroadenoma. Also fibroadenoma affects women in their 30s and phyllodes affects women in their 40s
The usual symptom is a breast lump in a phyllodes tumor. As these are quick to grow and multiply, these can be of a 2-3cm size in weeks. These cells tend to push the tissue and thus in advanced stages they may become visible as a bulge. If not diagnosed in time an open wound or ulcer may also result in phyllodes tumors. But a quick growth does not imply that the growth is malignant or cancerous in nature.
The step by step diagnosis process involves a basic initial physical examination of the breasts for detecting any lumps or firm tissue in the breast.
This is followed by imaging tests. First a mammogram is done to visibly detect the accumulation of cancerous cells. In this imaging tests the cells of phyllodes tumor have well defined edges and have oval / round shape and mass. Tiny speckles of calcium – micro calcifications can also be seen in a mammogram film. Rounded lobes like structures appear in the tumor in the film. Imaging tests are also used to detect tumor growths in the surrounding tissue. Ultra sound imaging or an MRI is also done for the same purpose with better and clear distinctive results. On a ultrasound (sonic wave images), this type of phyllodes tumors appear to be have some cysts in a well-defined mass.
Biopsy is a conclusive test and the only way to detect the type of cancer and its malignancy status. And as such, it is important that a biopsy of the tissue is done to obtain specific information of the tumor cells. In this a tissue sample is removed from the breast for pathological tests. The biopsy may a simple core needle biopsy to remove small tissue from breast or an excision biopsy wherein the whole cancer tissue is removed from the breast.
The advantage with excisional biopsy is that that the whole tissue is examined for better diagnosis. In a biopsy of a benign tissue, it appears to have well defined edges with slow dividing cells. The connective tissue cells appear normal with no overgrowth. Also the epithelial cells are also present. In cancerous tissue the cells show rapid division with irregular edges. Also the connective tissue or the stromal appear abnormal and the epithelial cells may also not be present in malignant tissue. For borderline phyllodes the pathological findings are mixed. The benign cells may not damage the healthy tissue but the growth as mentioned earlier may cause external bulges or even eruption of skin in stromal overgrowth.