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Year : 2011  |  Volume : 54  |  Issue : 1  |  Page : 191-192
Benign cystic papillary phyllodes tumor: An alarming gross appearance


Department of Pathology, NKP Salve Institute of Medical Sciences and Research Centre, Digdoh Hills, Hingna, Nagpur - 440 019, India

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Date of Web Publication7-Mar-2011
 

How to cite this article:
Maimoon SA, Wilkinson AR. Benign cystic papillary phyllodes tumor: An alarming gross appearance. Indian J Pathol Microbiol 2011;54:191-2

How to cite this URL:
Maimoon SA, Wilkinson AR. Benign cystic papillary phyllodes tumor: An alarming gross appearance. Indian J Pathol Microbiol [serial online] 2011 [cited 2019 Nov 22];54:191-2. Available from: http://www.ijpmonline.org/text.asp?2011/54/1/191/77402


A 58-year-old female attended the surgical clinic with a painless mass in the left breast, measuring 8 × 7 cm, occupying the upper outer quadrant. The mass was mobile with a smooth outer surface. No lymph nodes were palpable. Fine needle aspiration cytology (FNAC) of the mass was advised. Repeated aspirations obtained about 15 ml of serous/hemorrhagic fluid. Cellularity was scanty and showed cytological features suggestive of proliferative breast disease with mild atypia. Mastectomy was done.

Mastectomy specimen with overlying skin, measuring 15 × 13.5 × 6.5 cm was received. Cut sections showed a well-demarcated large cystic cavity measuring 7 × 6 cm. The cavity contained hemorrhagic fluid. A solid mass with papillary processes measuring 6 × 5 cm was seen protruding into the cystic cavity [Figure 1]. Two tiny lymph nodes measuring 0.3 × 0.3 cm each were dissected from the axillary tail.
Figure 1: Gross photograph of mastectomy specimen showing a well-demarcated large cystic cavity, containing a solid mass with papillary processes, protruding into the cavity. Lower right corner inset photomicrograph shows leaf-like papillae composed of stromal connective tissue covered by epithelial cells (H and E, ×400)

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Several sections from different areas of the specimen revealed papillary processes arising from the cyst wall and protruding into the cystic cavity. The leaf-like papillae were composed of stromal connective tissue covered by epithelial cells [[Figure 1], inset]. Other areas revealed numerous irregularly dilated ducts compressed into slit-like spaces by the surrounding fibromyxoid stroma. The stroma was cellular, composed of spindle cells with plump or tapering bland looking nuclei. Other areas were composed of fibrocollagenous or myxoid tissue. Nuclear atypia or mitosis was not seen in the stroma. Sections from the surrounding mammary tissue revealed foci of adenosis, dilated ducts, mononuclear infiltrate and sclerotic connective tissue. Sections from both the lymph nodes revealed sinus histiocytosis.

A histopathological diagnosis of benign cystic papillary phyllodes tumor of breast was given.

Phyllodes tumor is a circumscribed biphasic tumor, analogous to fibroadenoma, and characterized by a double-layered epithelial component arranged in clefts, surrounded by an overgrowing hypercellular mesenchymal component typically organized in leaf-like structures. Depending on the bland or sarcomatous characteristics of their mesenchymal (stromal) components, they display a morphological spectrum lying between fibroadenomas and pure stromal sarcomas. [1] The size of the tumors vary from 1 to 40 cm. Larger tumors may show hemorrhage and necrosis. They frequently contain clefts or cystic cavities; however, the tumor rarely shows intracystic growth. [2] In this case, the tumor showed an intracystic growth morphologically. Due to rapid increase in the size of the mass, degenerative changes might have occurred with hemorrhagic fluid into the cystic cavity. Another case reported from Japan, of a 20-cm ulcerated phyllodes tumor mass, grossly showed a large cystic cavity surrounding a fleshy, hemorrhagic and necrotic mass with a lobulated and trabeculated appearance. [3]

Accuracy of FNAC depends on an adequate and representative sample. Sampling problems can arise because of the heterogeneous nature of these tumors. The characteristic hypercellular fragments may be absent, especially if sampling has been done from the relatively hypocellular myxoid or hyalanized or cystic area. Hence, even if the highest reported diagnostic accuracy results were widely reproducible, a quarter of phyllodes tumor would be undiagnosed by FNAC alone owing to large numbers of false negatives. [4] Histologically, the phyllodes tumor is composed of an extremely cellular stroma, accompanied by the proliferation of benign ductal structures. They typically exhibit an enhanced intracanalicular growth pattern with leaf-like projections into the dilated lumina. Generally, stroma from a malignant phyllodes tumor contains cellular atypia, mitotic activity and tumor margin. [2] Malignant areas are often focal and can be overlooked if multiple samples are not observed. [5]

The preferred initial therapy for a phyllodes tumor is a wide local excision with adequate margin of normal breast tissue. In our case, a mastectomy was done because repeated fine needle aspirations from the large mass showed hemorrhagic fluid which was cytologically reported as proliferative breast disease with mild atypia, indicating that a possibility of malignancy could not be ruled out by cytology. The final diagnosis of benign cystic papillary phyllodes tumor of breast was given on histopathology.

 
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1.Bellocq JP, Magro G. Fibroepithelial tumours. In: Tavassoli FA, Devilee P, editors. World Health Organization Classification of Tumours. Pathology and Genetics. Tumours of the Breast and Female Genital Organs. Lyon: IARC Press; 2003. p. 99-103.   Back to cited text no. 1
    
2.Horiguchi J, Iino Y, Aiba S, Itoh H, Tanahashi Y, Ikeya T, et al. Phyllodes tumor showing intracystic growth: A case report. Jpn J Clin Oncol 1998;11:705-8.  Back to cited text no. 2
    
3.Miyaguni T, Deguchi S, Teruya J, Kuniyoshi S, Tomita S, Soda N, et al. Phyllodes Tumor of the breast with a grossly malignant appearance: A case report. Breast Cancer 1998;5:205-8.  Back to cited text no. 3
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4.Jacklin RK, Ridgway PF, Ziprin P, Healy V, Hadjiminas D, Darzi A. Optimising preoperative diagnosis in phyllodes tumor of the breast. J Clin Pathol 2006;59:454-9.  Back to cited text no. 4
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5.Ellis IO, Punder SE, Lee AH. Tumors of the breast. In: Fletcher CD, editor. Diagnostic Histopathology of Tumors. 3 rd ed, Vol. 1. Philadelphia: Printed in China; 2007. p. 909-10.  Back to cited text no. 5
    

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Correspondence Address:
Anne R Wilkinson
37 Chitnavis Layout, Byramji Town, Nagpur - 440 013, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.77402

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This article has been cited by
1 Cystic Benign Phyllodes Tumor in the Inguinal Region
Jai Hyang Go
Korean Journal of Pathology. 2013; 47(6): 583
[Pubmed] | [DOI]



 

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