Second Surgery phyllodes tumor

[vpareja]

About a month ago I had a surgery to get a breast lump removed  and after the biopsy both my doctor and the pathologist are suggesting me to have a second surgery.  The following is the Diagnosis:
Breast Lumpectomy (Left):
Bening phyllodes tumor, and breast tissue showing fibrocystic and fibroadenomatoid changes.
COMMENT: The specimen has been embedden in toto. Sections show a 2.6 diameter fibroepthelial clefting, and leaf-like processes. While generally well circumscribed, the border of the lesion is focally irregular and multinodular.  There are no areas of stromal overgrowth, and the stromal cells show only mild cytologic atypia with minimal mitotic activity (ie. Maximal mitotic count of 2/10 hpf in block 1H. There are no heterologous elements or areas of necrosis noted.  The histologic features are those of a phyllodes tumor, and as this tumor does not appear to exhibit any histologic features that would place it at a significant risk for malignant behavior, it is classified as a benign phyllodes tumor.  Although margin assessment is hampered by the fact that the specimen was recived from the operating room already incised, the tumor appear to be present very close to, and probably at the margin of the specimen and reexcision to clear margins is suggested. This tumor may recur if it has been incompletely excised.

I would like to wait for at least 3 months to see if it develops and if so have the second surgery. Is that the right decision to make?

[vpareja]

First of all, thank you so much for your prompt response. This forum is excellent. Now I saw the tumor and base in the diagnosis he got it fully around it, however I'm going to ask him if his suggestion is based in the way it was cut.
The two reasons why I don't want to have the surgery right away are: 1- I would like to give my breast a time (at least three months) to heal completely from the first surgery, 2-I've been reading Deepak Chopra and I believe in many things he explains in his books, plus I've always been very optimistic and positive and I want to try the Simonton techniques among others to get a better health.
I'm a woman -34-I've always been very healthy and have an excellent healthy way of living, still I know I can improve it spiritually. This is the first illness I've ever had and hopefully I will heal completely from it and avoid any other from happening. Thanks again for your helpful answers and I will keep you posted.

[jays67]

I had a benign phyllodes tumor removed in November.  Since they didn't know it was a PT until removal no margins were removed.  My doctor suggested that we don't do any further surgery and wait 3 months and do another ultrasound to look for changes.  I had a follow up US last month and it showed a 2 CM "area to watch".  I am scheduled for another US in May.  It's just a waiting game at this point.

[surgeon]

If the surgeon feels he/she got fully around it, and that the suggestion that it's near the edge has to do with the way it was cut, and given that the pathology report is quite clear that it's not malignant, and given the slowness of growth of phyllodes tumors, then waiting 3 months isn't really dangerous, nor would it have predicable negative impact. However, 3 months really isn't enough to know it's not coming back. The balance is between undergoing surgery now to give a high rate of comfort that it won't come back, versus waiting to see and possibly avoiding another operation, while worrying to some extent that it will.

[CCF-RN,MSN-rf]

Dear vpareja:  Benign phyllodes tumors are generally cured by complete excision (by complete, it means that the margins are without evidence of the tumor).  If the margins are not clean, there is reasonable probability that the tumor could recur.  Phyllodes tumors can also be malignant.  The right thing to do is have re-excision - not wait and see.