Phyllodes tumor

Last updated: November 25, 2022

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Phyllodes tumor is a rare fibroepithelial breast tumor that typically manifests in individuals between 40–50 years of age as a painless, multinodular breast mass. Unlike fibroadenomas, phyllodes tumors tend to increase in size more rapidly over time. On breast ultrasound, phyllodes tumors appear as a hypoechoic solid mass containing cysts; on mammography, they appear as a hyperdense mass. Biopsy is required for diagnostic confirmation. Histological findings of stromal cellularity and leaf-like architecture distinguish phyllodes from fibroadenoma. Phyllodes tumors are categorized as benign, borderline, and malignant according to the following features: border infiltration, mitotic activity, stromal atypia, and hypercellularity. Malignant or borderline phyllodes tumors can metastasize hematogenously. Surgical excision is recommended for nonmetastatic disease. Metastatic phyllodes tumors carry a poor prognosis; management (e.g., palliative surgery, chemotherapy) should be tailored to the individual. Phyllodes tumors have a high rate of recurrence after surgical excision.

Epidemiological data refers to the US, unless otherwise specified.

  • Painless, multinodular lump in the breast, with an average size of 4–7 cm
  • Variable growth rate: may grow slowly over many years, rapidly, or have a biphasic growth pattern

Compared to phyllodes tumors, fibroadenomas tend to be smaller in size, remain the same size or grow slowly, and usually occur in younger (20–30 years) women. [2]

Follow age-appropriate diagnostic workup for a palpable breast mass. The findings specific to phyllodes tumor are described here.

Phyllodes tumors and fibroadenomas have similar clinical presentations and imaging features. If phyllodes tumor is suspected, a biopsy is necessary to confirm the diagnosis. [2]

Imaging findings

Phyllodes tumors may be indistinguishable from fibroadenomas on imaging, but features such as larger size, the presence of cysts, or a hyperdense mass on mammography should raise concern for phyllodes tumor. [2]


Stromal cellularity and leaf-like architecture are key histological findings that distinguish phyllodes tumors from fibroadenomas. [2]

While phyllodes tumors are typically benign, some are malignant and have the potential to metastasize. Phyllodes tumors should be considered malignant until proven otherwise. [2][3]

Refer all patients with phyllodes tumors to a breast surgeon or surgical oncologist for management.

  • Benign phyllodes tumor: surgical excision
  • Borderline or malignant phyllodes tumor: Assess for metastases (e.g., CT chest).
    • Nonmetastatic disease:
      • Wide excision (1 cm margin), if feasible
      • Adjuvant radiation may be considered to minimize the risk of recurrence.
    • Metastatic disease:
  • High risk of recurrence after excision [2]
  • Borderline and malignant phyllodes can metastasize hematogenously.
  • Metastatic phyllodes tumor has a poor prognosis.
  1. ACOG. Practice Bulletin No. 164 Diagnosis and management of benign breast disorders. Obstetrics & Gynecology. 2016; 127 (6): p.e141-e156. doi: 10.1097/aog.0000000000001482 . | Open in Read by QxMD
  2. Simpson A, Li P, Dietz J. Diagnosis and management of phyllodes tumors of the breast. Ann Breast Surg. 2021; 5 : p.8-8. doi: 10.21037/abs-20-99 . | Open in Read by QxMD
  3. Kalambo M, Adrada BE, Adeyefa MM, et al. Phyllodes Tumor of the Breast: Ultrasound-Pathology Correlation. AJR Am J Roentgenol. 2018; 210 (4): p.W173-W179. doi: 10.2214/ajr.17.18554 . | Open in Read by QxMD
  4. Plaza MJ, Swintelski C, Yaziji H, Torres-Salichs M, Esserman LE. Phyllodes tumor: Review of key imaging characteristics. Breast Dis. 2015; 35 (2): p.79-86. doi: 10.3233/bd-150399 . | Open in Read by QxMD
  5. Tan BY, Acs G, Apple SK, et al. Phyllodes tumours of the breast: a consensus review. Histopathology. 2015; 68 (1): p.5-21. doi: 10.1111/his.12876 . | Open in Read by QxMD
  6. Fernández-Ferreira R, Arroyave-Ramírez A, Motola-Kuba D, Alvarado-Luna G, Mackinney-Novelo I, Segura-Rivera R. Giant Benign Mammary Phyllodes Tumor: Report of a Case and Review of the Literature. Case Rep Oncol. 2021; 14 (1): p.123-133. doi: 10.1159/000510741 . | Open in Read by QxMD

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