Phyllodes Tumor-Pathology Report

Hi there,
I had a partial mastectomy to remove a 7.8 phyllodes from my L breast a little over a week ago. I'm trying to break down my pathology report. Below is a summary. My questions follow. Thank you in advance for taking the time to help me.

Microscopic Diagnosis: Phyllodes tumor 7.8cm Narrowly but completely excised
Gross Description: The specimen is 6.5cm superior to inferior, 7.8cm medial to lateral and 4.7cm anterior to posterior with a small ellipse of attached skin which is 3.5cm x 0.7cm to the anterior surface.
Comments: "Although there is focal infarction, no tumor related necrosis or cytologic atypia was seen to suggest a malignant stromal component. Mitotic activity is low. The tumor is surrounded in most parts by a thin pseudocapsule of compressed breast tissue and appears to be completely excised. There is some periductal stromal alteration at the deep margin, a feature which may increase the possibility of local recurrence. Nevertheless, as there are no malignant features in this tumor, clinical surveillance of this area should be adequate."

Questions:
1) Can I determine margins based on the measurements that were given? If not, shouldn't margins be included?
2) The report states there aren't any malignant features in the stromal componnent. Shouldn't the pathologist quantify what led him to this conclusion (ie # of mitosis/rate of stromal growth, infiltrating vs. pushing border etc.)
3) Should there be some definitive grade given?
4)What exactly are "periductal stromal alterations" and how do they relate to phyllodes and rate of recurrence?
5) My initial biopsy was read by 3 pathologists totaling over 70yrs. experience. My surgical path report was read by 1 w/ only 4yrs. experience. Should I be concerned? (I am)
6) Finally, assuming this tumor can be definitively defined as benign, is it acceptable to watch and wait vs.going back in for re-excision or total mastectomy or do the already present periductal stromal alterations change the game?

[japdip]

Your questions all seem to deal with a Malignant Phyllodes and yours was NOT malignant. As far as margins are concerned it stated that it was completely excised and since it was NOT malignant the margins are of little importance. There is no such thing as "staging" or "grading" something that is NOT malignant. Phyllodes certainly can recur and this evidently is the case here ... some factors seem to increase the risk beyond what would be considered "normal". I see little importance here as far as who read the slides. If you would like your slides read by another Pathologist you have but to make that request. I don't quite understand why you would want additional surgery since the tumor was completely excised and the recommendation of normal surveillance seems quite adequate in my opinion.   Regards ....