Phyllodes Tumor

• The term Phyllodes originates from Greek word "phullon" which means a leaf.
• It is also called as Cystosarcoma phyllodes.
• Here is a picture of a Phyllodes tumor recently operated by us. 
• The patient was a 38 year old female with complaints of swelling in Left breast of 6 months duration which was fast growing in size.
• The tumor was excised through a submammary incision
• Phyllodes tumors are a fibroepithelial tumor composed of an epithelial and a cellular stromal component. 
• They may be considered benign, borderline, or malignant depending on histologic features including stromal cellularity, infiltration at the tumor's edge, and mitotic activity
• Predominantly a tumor of adult women
• Very fast-growing, and can increase in size in just a few weeks
• 10% of patients with phyllodes tumours can develop distant metastases 
• Commonest sites for distant metastases are the lung, bone, and abdominal viscera.
• Treatment : Wide Local Excision

6/24/2020 07:03:00 PM

Case History

A 32 year old female came with multiple lumps in her right breast which have been there from past 7 years and are increasing in size and number. Initially she was advised conservative management and observation. But the lesions were growing in size and she had started having occasional pain. So she decided to go for surgical removal.

Discussion: What is the best incision if multiple fibroadenomas have been identified?

Having multiple fibroadenomas in a single breast is a rare occurrence.

There are various available incision approaches like: 

• Periareolar
• Inframammary
• Radial
• Curvilinear. 

Each of these having their advantages and disadvantages. Utilising the mobility of the fibroadenomas, allows them to be excised through a single cosmetic circumareolar incision in each breast. Periareolar incision is not suitable when the diameter of the tumor is >5 cm or when the distance between the tumor and the areola is >3–4 cm, since the surgery would cause significant damage to the lactiferous ducts (Zhao XY).

Traditional surgical incision often chooses radial incision or curvilinear incision on the surface of the tumor. It is very favorable for the exposure and resection of the tumor, and the treatment effect is also good, but the postoperative scar is obvious and affects the cosmesis.

References

http://journals.sagepub.com/doi/abs/10.4137/BCBCR.S9512

https://onlinelibrary.wiley.com/doi/full/10.1046/j.1524-4741.2001.007003189.x

http://file.scirp.org/Html/5-2101137_57749.htm

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5103926/

Zhao XY. Application value of areola incision at the edge of the benign breast tumor resection. Zhongguo Shiyong Yiyao. 2010;5:57–58

5/04/2018 11:01:00 AM

What is Aberration of Normal Development and Involution (ANDI) ?

Aberrations in the Normal Development and Involution of the breast (ANDI) is an all encompassing term that is used to describe a wide spectrum of the benign breast diseases. As the name suggests, it is based on the theory that most of the encountered benign breast disorders are essentially minor aberrations in the normal development process, hormonal response and involution of the breast.

How does the incidences across years of life varies for Fibroadenoma, Simple Cyst, Nodularity and Breast Ca ?

From which structure does a Fibroadenoma arise?

Arises from a single lobule and is composed of epithelial and fibrous components. Check out the anatomical origin of various breast pathologies in the figure below.

What is the relative risk of breast cancer in case of Proliferative breast disease with atypia?

Moderate Risk. (Relative risk >2)

6/17/2016 05:23:00 PM

What is Skin Involvement or T4b ?

Edema (including peau d’ orange) or ulceration of the skin of the breast or satellite skin nodules confined to the breast.

What is not Skin Involvement or T4b ?

Dimpling of the skin and nipple retraction is not considered skin involvement.

Skin involvement in breast showing a skin nodule 

surrounded by edema (peau d orange)

How does peau d’ orange appearance develop?

Localised edema (peau d’orange) develops when drainage of lymph fluid from the skin is disrupted by infiltration of lymphatics by metastatic cells.

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Read more about Ca Breast:

WHAT IS THE REASON FOR PUCKERING OR SKIN RETRACTION IN BREAST CANCER?
http://www.worldsurgeryforum.net/2016/05/what-is-reason-for-puckering-or-skin.html

SKIN PUCKERING AND PEAU D ORANGE APPEARANCE IN BREAST CANCER
http://www.worldsurgeryforum.net/2016/05/skin-puckering-and-peau-d-orange.html

WHAT IS THE ACCURACY OF CLINICAL DETERMINATION OF AXILLARY LYMPH NODE METASTASIS IN CA BREAST?
http://www.worldsurgeryforum.net/2016/06/what-is-accuracy-of-clinical.html

MECHANISM OF METASTASIS FROM CA BREAST TO BATSON'S PLEXUS AND LIVER
http://www.worldsurgeryforum.net/2016/06/mechanism-of-metastasis-from-ca-breast.html

6/12/2016 02:39:00 PM

How does metastatic lesion from Ca Breast reach vertebrae?

• The malignant cells from the breast reaches vertebrae via the intercostal veins.
• The intercostal vein will join the vertebral plexus of the veins. This is also called Batson’s plexus of veins. 
• The peculiarity of this plexus is that there are no valves and therefore the malignant cells can freely reach all the vertebrae from the base of the skull to the sacrum.
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How does a metastatic lesion from Ca Breast reach the liver ?

• The liver is involved in 2 ways. 
• The most important route is bloodstream spread. 
• The liver also can be involved by lymphatic route. 
• The lymphatics from the lower inner quadrant of the breast traverse the plexus in the rectus sheath and reach the subperitoneal plexus. From their along the falciform ligament it will reach the liver. 

6/10/2016 07:16:00 PM