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From Water Cyst to Complex Cyst now Phyllodes tumour do we need to get ...
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From Water Cyst to Complex Cyst now Phyllodes tumour do we need to get a surgical biopsy done?

My wife (29 years old) had a lump and was told it was a water cyst 6 months ago, but it has slightly gotten bigger (6 cm) and thouht she would get it checked out at the hospital. They did a needle biopsy and said it was a complex cyst, as there was a water bubble with a clot in the centre. On the result day we were told that they could not work out what it was ans said it could be benign or not and required a mammogram which is only recommneded for women over 35 as tissue below this age is too dense to view!. Anyhow, the took the mammogram and last week they informed us it is a Borderline Phyllode tumour and due to the size it would need a masectomy as they would need a margin using an industry guidline in order to remove normal tissue, just confused at the moment as i have read these are very rare and can easily be mixed up with fibrosoama (apologise for the spelling), so would it be better to get a sugical biospy done and as one of your replies (Aug 16 suggests), these tumours only require a wide excisionas they are not multicentric. Anyhelp from anyone would be very helpful as were are all very stressed. get back to me via email.
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587083_tn?1327123862
Hi,
I think that the best thing for you to do, is that you and your wife consult with a Breast/Surgeon Specialist for more advice and see what he/she recommends concerning this lump.
Take with you all the films and reports when you'll see the specialist.
On a mammogram, a Phyllodes tumor will have a well-defined edge. Neither a mammogram nor a breast ultrasound, however, can distinguish clearly between fibroadenomas and benign,borderline or malignant Phyllodes tumors. Cells from a needle biopsy can be tested in the lab but seldom give a clear diagnosis, because the cells can resemble carcinomas and fibroadenomas. An open surgical biopsy, which results in a slice of tissue, will provide a better sample of cells and will result in a proper diagnosis for a Phyllodes tumor.
Hoping that when you get more informed,you and your wife can decide what is best for her.
Best wishes to you both.
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Avatar_n_tn
Hi Zouzi,
I greatly thank your quick response, the case is being handled by a breast consultant/surgeon who has suggested a masectomy. However, if it is a fibradenoma/carcinoma why would she have said that it is borderline? and in which case can these be removed without the need of a masectomy?
I have managed to view a report done accross 4/5 hospitals using data from 40 women, all who had benign/borderline/malignant tumours and it states that these tumours only one metacentre and very rarely metasize (spread) regardless of their character, and over a period of 5 years review only 2 had reoccured, and it suggests that a 1cm margin is sufficient rather than a masectomy, obviously this also depends on the tumour size/breast size as it may be worth to have a masectomy done if there is not much breast tissue left over after the masectomy.

Do you suggest that i request a surgical biopsy and just to confirm what experiance do you have within this field, personal/occupation?

Any guidance would be greatly appreciated.
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962875_tn?1314213636
Hi and welcome to our community,

I am sorry you and your young wife are suddenly having to deal with this confusing and cascading medical situation!

In response to some of the  specific questions you posed: an open surgical biopsy is considered the standard of care for suspected phyllodes tumors; a  wide (2 cm) clear margin  for benign tumors and a wider-yet margin for malignant ones (possibly necessitating mastectomy in either some case) is recommended; and although metastases for borderline phyllodes tumors is not as common as with malignant ones, it can be a very serious matter when it does occur.

I am providing some additional information about phyllodes tumors, whichI hope will be helpful to you,  below:

"Diagnosis

The diagnosis of a phyllodes tumor may be made when the patient notices a rapidly growing mass in her breast and consults her doctor. After palpating (feeling) the mass and evaluating the appearance of the overlying skin, the doctor will order imaging studies and an open breast biopsy. Although a mammogram or ultrasound study may be useful in evaluating the size and location of the tumor, these tests are not reliable in distinguishing among benign phyllodes tumors, fibroadenomas, and malignant phyllodes tumors. In addition, fine-needle aspiration does not usually confirm the diagnosis; an open biopsy is considered the definitive diagnostic test as of the early 2000s.

Staging

Phyllodes tumors are not staged in the usual sense; they are classified on the basis of their appearance under the microscope as benign, borderline (or indeterminate), or malignant. The pathologist makes the decision on the basis of the cells' rate of division (mitosis) and the number of irregularly shaped cells in the biopsy sample. In one series of 101 patients with phyllodes tumors, 58 percent were identified as benign, 12 percent as borderline, and 30 percent as malignant.

Treatments

Surgical excision (removal) is the usual treatment for phyllodes tumors, whether benign or malignant. In the case of benign tumors, the surgeon will usually try to spare as much breast tissue as possible, generally removing about 1 in (2 cm) of normal breast tissue from the area around the tumor as well as the tumor itself. If the tumor is very large, however, the doctor may remove the entire breast.

In the case of malignant tumors, the surgeon will remove a wider area of normal tissue along with the tumor—a technique known as wide local excision (WLE)—or perform a complete mastectomy.

Although radiation therapy has been tried as follow-up treatment after surgery, phyllodes tumors do not respond well to either radiotherapy or chemotherapy if they recur or metastasize. In addition, malignant phyllodes tumors do not respond to hormone therapy.

Prognosis

The prognosis for benign phyllodes tumors is good following surgical removal, although there is a 20–35 percent chance of recurrence, particularly in patients over the age of 45. Recurrence is usually treated with further surgery, either another local excision or a complete mastectomy.

The prognosis for patients diagnosed with borderline or malignant phyllodes tumors is more guarded. About 4 percent of borderline tumors will eventually metastasize. A Mayo Clinic study of 50 patients with malignant tumors found that 32 percent had a recurrence within two years after surgery; 26 percent developed metastases, and 32 percent of the group died from their malignancy. The most common sites for metastases from malignant phyllodes tumors are the lungs, bones, liver, and chest wall, although metastases to the lymph nodes have also been reported. Most patients with metastases from a malignant phyllodes tumor die within three years of their first treatment."

Pleased keep us posted regarding how things turn out, by adding any additional comments to this same post--we care!

Best wishes to both you and your wife,
bluebutterfly
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962875_tn?1314213636
p.s. Typo correction: In my 3rd paragraph, 4th line, it should have read: "(possibly necessitating mastectomy in either  case)."

bb
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587083_tn?1327123862
Hi again,
First of all,most of us,members in the Breast Cancer Community Forum, are not medical professional,but we try to help newcomers the best way we can,because we have read and learned quite a bit about breast cancer issues from other well informed members.
All I can tell you is that a needle biopsy does not always give a clear diagnosis, as would an open surgical biopsy would.However,all forms of phyllodes tumors, are considered as breast cancer.Even the benign form is regarded as having malignant potential and needs to be surgically removed.
Since your wife's mammogram report stated that the lump is a borderline Phyllodes tumor,and the Breast Specialist recommended a mastectomy,I would,if I were your wife, seek a second opinion to see if an open surgical biopsy is necessary to provide a more accurate diagnosis,before a mastectomy is even considered.
Having 2 Breast Specialist opinions will definitely guide your wife in the right direction.
A wide excision and a clean margin of normal breast tissue is the usual appropriate therapy for benign and borderline phyllodes tumors"unless" they are so large that this is not cosmetically feasible.
Hoping that your wife will do just fine regardless on how things will proceed.
Again best wishes to you and your wife.
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Avatar_n_tn
Thanks for all your help, As you suggest, a second opinion is recommended but my wife has said that the initial lump which was tiny may have been 2-3 years ago, and is not painfull. When i looked at the ultrasound it was a bubble with a centre which was a smaller and hard, and the radiographer said that it was a complex cyst and she could not just drain it. Why not drain the bubble and then cut the lump out?

Anyhow, butterfly2222 has given some information, but a lot more reports state that this is not considered as cancer as it does not have multi-centres as does cancer and only metases in very rare cases as it only has a single metacentre.

Regards
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Avatar_n_tn
Thanks for all your help, As you suggest, a second opinion is recommended but my wife has said that the initial lump which was tiny may have been 2-3 years ago, and is not painfull. When i looked at the ultrasound it was a bubble with a centre which was a smaller and hard, and the radiographer said that it was a complex cyst and she could not just drain it. Why not drain the bubble and then cut the lump out?

Anyhow, as you have given some information regarding types etc, but a lot more reports state that this is not considered as cancer as it does not have multi-centres as does cancer and only metases in very rare cases as it only has a single metacentre.

Regards
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Avatar_n_tn
Just to confirm they (consultants etc) have told me that once a masectomy has been done then there is no chance for it to return and the patient can leed a normal life, and after keeping the patient under review for 2-3 years they are given an all clear. As my wife is only 29 it perhaps is better that it has been pickeup early and hence she can get this sorted and continue enjoying life.
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Avatar_n_tn
we have also deciced to leave the reconstruction till later, as now we just want to get rid of this 'thing' and let my wife get her normal health back. Is that what most ladies do, as we have been told that it depends on the individual as some people get it out of the way?

But they have said tha the muscle in the mammagram has appeared very healthy and they have said that they are 99.9% sure that the muscle has not been affected at all, which is a brialliant relief and her blood tests have all come back excellent.
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587083_tn?1327123862
I am glad that you and your wife have reached a decision by consulting her doctors.
Whatever is best for her,then it's the right decision.
Good luck to your wife and I really admire you for being such a good husband!
Best of wishes to both of you.
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962875_tn?1314213636
I am not sure where you got the idea that a tumor could not be cancer unless it has "multicenters."  Many breast cancers present as a unifocal abnormality.

Also, the true nature of any  lesion, including a phylodes tumor, cannot be determined with certainty until  the cells are examed under a miccroscope by a pathologist.

There is some disagreement among specialists regarding the number of phyllodes tumors that prove to be malignant. Although figures of 16–30 percent are commonly given, some doctors think that the actual incidence may be higher, as more cases of malignant tumors have been reported in the early 2000s.

In any case, we truly hope everything will turn out fine for your wife, and would appreciate an update on her case once more is known.

Warm regards,
bluebutterfly




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Avatar_n_tn
Thanks to you and bluebutterfly, and i trying my best to find the ideal solution to this testing time in both of our lives. Hopefully they have said that the drain come off in a week and then the scare should start to heal and infection is very rare as statistics say it is less than 5%, the sugeon has an excellent record of no infections in her career over 20 years.

I have said to her that people who have worse conditions and diseases end up all clear and lead normal lives so you ar lucky that we have the resources available and excellent care and above all there is the Almighty who cures all and everything.
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