Phyllodes tumor

Last updated: June 13, 2023

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Summarytoggle arrow icon

Phyllodes tumor is a rare fibroepithelial breast tumor that typically manifests in individuals between 40–50 years of age as a painless, multinodular breast mass. Unlike fibroadenomas, phyllodes tumors tend to increase in size more rapidly over time. On breast ultrasound, phyllodes tumors appear as a hypoechoic solid mass containing cysts; on mammography, they appear as a hyperdense mass. Biopsy is required for diagnostic confirmation. Histological findings of stromal cellularity and leaf-like architecture distinguish phyllodes from fibroadenoma. Phyllodes tumors are categorized as benign, borderline, and malignant according to the following features: border infiltration, mitotic activity, stromal atypia, and hypercellularity. Malignant or borderline phyllodes tumors can metastasize hematogenously. Surgical excision is recommended for nonmetastatic disease. Metastatic phyllodes tumors carry a poor prognosis; management (e.g., palliative surgery, chemotherapy) should be tailored to the individual. Phyllodes tumors have a high rate of recurrence after surgical excision.

Epidemiologytoggle arrow icon

Epidemiological data refers to the US, unless otherwise specified.

Clinical featurestoggle arrow icon

  • Painless, multinodular lump in the breast, with an average size of 4–7 cm
  • Variable growth rate: may grow slowly over many years, rapidly, or have a biphasic growth pattern

Compared to phyllodes tumors, fibroadenomas tend to be smaller in size, remain the same size or grow slowly, and usually occur in younger (20–30 years) women. [3]

Diagnosticstoggle arrow icon

Follow age-appropriate diagnostic workup for a palpable breast mass. The findings specific to phyllodes tumor are described here.

Phyllodes tumors and fibroadenomas have similar clinical presentations and imaging features. If phyllodes tumor is suspected, a biopsy is necessary to confirm the diagnosis. [3]

Imaging findings

Phyllodes tumors may be indistinguishable from fibroadenomas on imaging, but features such as larger size, the presence of cysts, or a hyperdense mass on mammography should raise concern for phyllodes tumor. [3]


Stromal cellularity and leaf-like architecture are key histological findings that distinguish phyllodes tumors from fibroadenomas. [3]

While phyllodes tumors are typically benign, some are malignant and have the potential to metastasize. Phyllodes tumors should be considered malignant until proven otherwise. [3][4]

Treatmenttoggle arrow icon

Refer all patients with phyllodes tumors to a breast surgeon or surgical oncologist for management.

  • Benign phyllodes tumor: surgical excision
  • Borderline or malignant phyllodes tumor: Assess for metastases (e.g., CT chest).
    • Nonmetastatic disease:
      • Wide excision (1 cm margin), if feasible
      • Adjuvant radiation may be considered to minimize the risk of recurrence.
    • Metastatic disease:

Prognosistoggle arrow icon

  • High risk of recurrence after excision [3]
  • Borderline and malignant phyllodes can metastasize hematogenously.
  • Metastatic phyllodes tumor has a poor prognosis.

Referencestoggle arrow icon

  1. $Contributor Disclosures - Phyllodes tumor. None of the individuals in control of the content for this article reported relevant financial relationships with ineligible companies. For details, please review our full conflict of interest (COI) policy:.
  2. ACOG. Practice Bulletin No. 164 Diagnosis and management of benign breast disorders. Obstetrics & Gynecology. 2016; 127 (6): p.e141-e156.doi: 10.1097/aog.0000000000001482 . | Open in Read by QxMD
  3. Simpson A, Li P, Dietz J. Diagnosis and management of phyllodes tumors of the breast. Ann Breast Surg. 2021; 5: p.8-8.doi: 10.21037/abs-20-99 . | Open in Read by QxMD
  4. Kalambo M, Adrada BE, Adeyefa MM, et al. Phyllodes Tumor of the Breast: Ultrasound-Pathology Correlation. AJR Am J Roentgenol. 2018; 210 (4): p.W173-W179.doi: 10.2214/ajr.17.18554 . | Open in Read by QxMD
  5. Plaza MJ, Swintelski C, Yaziji H, Torres-Salichs M, Esserman LE. Phyllodes tumor: Review of key imaging characteristics. Breast Dis. 2015; 35 (2): p.79-86.doi: 10.3233/bd-150399 . | Open in Read by QxMD
  6. Tan BY, Acs G, Apple SK, et al. Phyllodes tumours of the breast: a consensus review. Histopathology. 2015; 68 (1): p.5-21.doi: 10.1111/his.12876 . | Open in Read by QxMD
  7. Fernández-Ferreira R, Arroyave-Ramírez A, Motola-Kuba D, Alvarado-Luna G, Mackinney-Novelo I, Segura-Rivera R. Giant Benign Mammary Phyllodes Tumor: Report of a Case and Review of the Literature. Case Rep Oncol. 2021; 14 (1): p.123-133.doi: 10.1159/000510741 . | Open in Read by QxMD

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