>>> DR.
JAY HARNESS: Among the benign tumors that I deal with, a phyllodes tumor, which is generally
a benign breast lesion, is one of the more interesting of what is called the biphasic
tumors of the breast.
I have done a fibroadenoma video here at BreastCancerAnswers.com and talked a lot about what are biphasic benign
tumors of the breast.
They are made up of one component of the connective tissue, the other component of the epithelial
cells or the cells that lying ducts.
Interestingly, the fibroadenomas arise out of the terminal ductal lobular units where
actually where breast cancer arises from.
So one of the really unusual kinds of tumors here is called a phyllodes tumor.
One of the old terms for this was cystosarcoma phyllodes.
Phyllodes make up of tiny fraction of all lumps, if you will, in the breast in the neighborhood
of 0.3% and of the fibroadenoma class, if you will, or biphasic class, the phyllodes
tumors only makeup roughly around 2.5%, so they are very very unusual, but why we are
concerned about them?
Well, first of all, if we have a fibroadenoma that is getting bigger and bigger and bigger,
in the back to my mind is, could this be a transition to a phyllodes tumor.
Further, the phyllodes which were general and almost always benign, they cannot go on
to become malignant.
Very very unusual diagnosis, but it can happen.
The other thing that is unique about a phyllodes tumor is the way that they can locally recur,
some estimates are upto 30% chance.
After you take the phyllodes tumor out, that it can reoccur right in the same neighborhood,
so therefore having a rim of some normal tissue around the phyllodes tumor is really really
important.
Generally, we see the phyllodes tumors in the age group of around 45 to 49.
I am looking at some notes just so that I am right up to a snap on this, the question
then becomes how do we differentiate a benign phyllodes tumor from a malignant phyllodes
tumor and further within the malignant phyllodes tumor there are high grade and low grade tumors
and a tiny percent of these malignant phyllodes tumors can actually metastasize elsewhere
in the body, almost exclusively to the lungs
This is again going back to something that I have harped on time and time again about
the multidisciplinary team, about the importance of the breast pathologist and having the experience
to (a) recognize a phyllodes tumor, (b) knowing if it is malignant or not, (c) if it is a
high grade or low grade or even importantly, sending this lesion off to other experts around
the country to help out with the diagnosis.
I worry about phyllodes a lot with big big fibroadenomas.
The core biopsy generally cannot give us a complete answer here.
We really need to take the whole thing out.
We recently received a question from someone concerned about “Gee, why can’t the core
biopsy figure out what is going on here and why does it take so much time to also tell
me what is going on.
That is the nature of the game and that often we need to take the whole lesion out in order
to see in total make multiple multiple slides up of the lesion in order to know exactly
what is going on.
Remember if you are one of those people who has a phyllodes lesion, are the margins negative
because of the chance it can come back, is it by any chance malignant at all and if there
is any question at all in the mind of the pathologist where you are residing, please
ask him, send the slides off to an expert who can give you a bottom-line reading whether
it is completely benign, malignant and the things I have shared with you.
Hi, I am Dr. Jay Harness and I want to share with you important information that I believe
that every newly diagnosed patient with breast cancer needs to know.
Susan Denver: I am a breast cancer survivor.
Katherine Stockton: I am a breast cancer survivor.
Coree: I am a breast cancer survivor.
Susan Denver: And I want every woman to know…
Katherine Stockton: …about personalized breast cancer treatment…
Susan Denver: …and the Genomic Test.
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Katherine Stockton: …to the best treatment options for her.
Susan Denver: Pass it on!