Phyllodes tumor - why remove?

[SKB]

My biopsy says:  "The lesion seen here is a fibroepithelial lesion.  There is more stromal cellularity and more leaf-like configuration than in a typical fibroadenoma and there is some infiltration of the stromal tissue seen into the surrounding breast parenchyma.  These findings favor a phyllodes tumor.  The lesion should be removed in its entirety with adequate margins and examined histologically. Focally, the interface is somewhat irregular in character with a more cellular fibrous connective tissue seen between the adipose tissues. There is no significant cytologic atypia"

Would this be considered a benign phyllodes tumor?  If benign and malignant phyllodes tumors are treated alike, and they don't usually metastasize or cause health problems, why do I need to have it removed?  Does it make any difference that this tumor is actually in my axilla, rather than in my breast?

[CCF-RN,MSN-rf]

Dear SKB:  Phyllodes tumors are not staged in the same manner as breast cancer. The following information regarding phyllodes tumor is directly from the textbook “Cancer: Principles and Practice of Oncology” 6th edition, edited by DeVita,V., Hellman,S., and Rosenberg, S. I hope it is of some help to you. Beyond this, in terms of your individual case, you would need to discuss any additional interpretations with your physician.
“The term phyllodes tumor includes a group of lesions of varying malignant potential ranging from completely benign (non-cancerous) to fully malignant sarcomas.
Phyllodes tumors are classified as benign, borderline, or malignant based on the nature of the tumor margins (pushing or infiltrative) and presence of cellular atypia, mitotic activity, and overgrowth in the stroma. There is disagreement about which of these criteria is most important, although most experts favor stromal overgrowth. The percentage of phyllodes tumors classified as malignant ranges from 23% to 50%. Axillary metastases are reported in less than 5% of cases, but are a poor prognostic sign when present. Metastases more commonly follow the pattern seen with sarcomas (with lung as the most common site) and histologically resemble sarcomas. Approximately 20% of phyllodes tumors recur locally if excised with no margin or a margin of a few millimeters of normal breast tissue, regardless of whether they are benign or malignant. A wide excision with a 2cm margin of normal breast tissue is appropriate therapy for benign and borderline phyllodes tumors unless they are so large that this is not cosmetically feasible. In the past, many authors have advocated mastectomy for the management of malignant phyllodes tumors. Since phyllodes tumors are not multicentric, there is no clear-cut biologic rationale for mastectomy, and series have reported the successful treatment of malignant phyllodes tumors with wide excision. The use of systemic therapy for malignant phyllodes tumors is based on guidelines for treating sarcomas.”

Part of the reason for removing the tumor is to examine it more carefully to discover if it is benign, borderline or if it has any malignant features.  The treatment, regardless, is surgery.  To leave it there may, in the future, cause health problems, including metastasis, if it has any malignant features.  If it is in your axilla, the important question is whether this is a primary lesion (in breast tissue) or whether it is metastatic (includes lymph nodes).

[wickedwaters]

I am a malignant phyllodes and my doctor referred to it as "fingers".  I had a lumpectomy w/out clear margins, hence, the "fingers".

There are some of us starting a phyllodes e-mail list.  If interested write ***@****

[lbells]

A related discussion, Benign Phyllodes Tumor reoccurance was started.

[ranam2009]

A related discussion, after lumpectomy was started.