Phyllodes tumours are uncommon (less than 1% of breast tumours) but important. They can be benign, borderline or malignant — and they have a tendency to come back locally if not removed with a clear margin. Early recognition is the key to a clean cure.
What is a phyllodes tumour
A fibroepithelial breast tumour that arises from the connective (stromal) tissue of the breast. Unlike fibroadenomas, phyllodes lesions have a higher cellular stromal content and can show a spectrum from benign (60–75%) to borderline (15–20%) to malignant (10–25%).
Symptoms
A firm, smooth, mobile, painless breast lump — often noticed during routine self-exam. The classic feature is rapid growth: a lump that was small a few months ago is now several centimetres. The overlying skin may stretch and become shiny but is rarely red or ulcerated.
Diagnosis
Triple assessment: clinical exam + ultrasound (sometimes mammogram) + core-needle biopsy. Fine-needle aspiration cytology (FNAC) cannot reliably distinguish phyllodes from fibroadenoma — a core-needle biopsy is mandatory.
Treatment — surgery is the cornerstone
Wide local excision with a minimum 1 cm margin of normal tissue around the tumour. This is the single most important factor in preventing local recurrence. For very large or recurrent malignant phyllodes, mastectomy may be needed. Lymph nodes are very rarely involved and are usually not removed.
Recovery
Day-care surgery for most lesions. Return to desk work in 3–5 days, full activity in 2–3 weeks. Final histology guides the follow-up plan: benign phyllodes need clinical review at 6 months and 12 months; borderline and malignant lesions need imaging follow-up for 5 years.
Prognosis
Excellent with clear margins. Benign phyllodes have a less than 10% local recurrence rate. Malignant phyllodes carry a small risk of haematogenous spread (lungs, bone) — careful surveillance protects you.