Borderline Phyllodes Tumor of Breast

Borderline Phyllodes Tumor of Breast

Article
Women's Health
Diseases & Conditions
+1
Contributed byMaulik P. Purohit MD MPHNov 15, 2019

What are the other Names for this Condition? (Also known as/Synonyms)

  • Borderline Mammary Phyllodes Tumor
  • Borderline Phyllodes Tumour of Breast
  • Borderline Phylloides Tumor of Breast

What is Borderline Phyllodes Tumor of Breast? (Definition/Background Information)

  • Borderline Phyllodes Tumor of Breast is a rare tumor of the breast, which is observed in middle-aged individuals (mostly women). The most common site of phyllodes tumor is the breast
  • In general, phyllodes tumor may be classified as benign, malignant, or borderline tumor based on their behavior. Rarely, some tumors show both indolent (non-cancerous) and aggressive (cancerous) features and are classified as borderline phyllodes tumors
  • The cause of Borderline Phyllodes Tumor of Breast is unknown, but the general risk factors may include gender (women are affected more than men), the use of birth control pills, obesity, and one’s reproductive history
  • The signs and symptoms of Borderline Phyllodes Tumor of Breast may include the presence of a rapidly-growing solitary tumor in the breast. Large-sized tumors may break the skin and cause an ulceration
  • Borderline Phyllodes Tumor of Breast is treated through a surgical excision, per the healthcare provider’s recommendation. The prognosis of the tumor is excellent with appropriate treatment; but due to an increased risk for malignancy, periodic/regular checkups and screening mammograms are advised 

Who gets Borderline Phyllodes Tumor of Breast? (Age and Sex Distribution)

  • Borderline Phyllodes Tumor of Breast are rare tumors affecting individuals over a wide age range
  • Generally, it affects women between the age of 40 and 50 years (prior to or around menopause)
  • All racial and ethnic groups are affected and no specific predilection is seen
  • Studies inform that much less than 1% of all primary breast tumors constitute Phyllodes Tumor of Breast

What are the Risk Factors for Borderline Phyllodes Tumor of Breast? (Predisposing Factors)

The definitive risk factors for Borderline Phyllodes Tumor of Breast are not well-understood. However, the following risk factors increase one’s chances of getting benign breast tumors, and these include:

  • Gender: Women have a higher risk for developing the condition than men
  • Obesity: Being overweight or obese increases the risk
  • Alcohol consumption
  • Menstrual cycle: Women who got their period before the age of 12 years, and those who reached menopause after age 55 have a higher risk. The longer the duration between menarche and menopause, the greater is the risk. This is due to hormonal influences during the reproductive period on the breast tissue
  • Postmenopausal hormone therapy: Women taking hormone replacement therapy medications containing both estrogen and progesterone for menopause, have a higher risk
  • Reproductive history: Having the first child after the age of 35, or never having a child
  • Birth control pills
  • Physical inactivity: A lack of physical exercise (leading a sedentary life) can increase one’s risk 
  • Not breastfeeding the child

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Borderline Phyllodes Tumor of Breast? (Etiology)

  • The exact cause of development of Borderline Phyllodes Tumor of Breast is currently not clearly understood
  • Studies have shown that such tumors may be caused by hormonal influence

What are the Signs and Symptoms of Borderline Phyllodes Tumor of Breast?

The signs and symptoms of Borderline Phyllodes Tumor of Breast may include:

  • The presence of a rapidly growing lump in the breast; the tumors may develop over few weeks to months
  • Most tumors are solitary, well-defined, and range in size between 2-3 cm; unlike benign tumors, the boundaries of malignant tumors are ill-defined
  • Generally, the tumors are painless to touch
  • If left untreated, the rapidly-growing tumors may cause breast skin ulceration resulting in an open wound
  • Ulceration of skin can lead to pain and discomfort
  • The presence of multiple tumors are rarely observed

It is important to note that both benign and malignant phyllodes tumors are known to grow rapidly.

How is Borderline Phyllodes Tumor of Breast Diagnosed?

Borderline Phyllodes Tumor of Breast may be diagnosed in the following manner:

  • Complete physical examination with comprehensive medical and family history evaluation
  • Breast exam to check for any lumps or unusual signs in the breasts
  • Mammogram: A mammogram uses X-rays to provide images of the breast. These benign tumors are identified as a mammogram mass, which may or may not be associated with microcalcification. The mammography findings may raise enough suspicion to warrant a tissue biopsy
  • Breast ultrasound scan: Using high-frequency sound waves to produce images of the breast, the type of tumor, whether fluid-filled cyst or solid mass type, may be identified
  • Computerized tomography (CT) or magnetic resonance imaging (MRI) scan of the breast
  • Positron emission tomography (PET) scan to help determine, if the cancer has spread to other organ systems
  • Breast biopsy:
    • A biopsy of the tumor is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis
    • Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The pathologist then decides on additional studies depending on the clinical situation
    • Sometimes, the pathologist may perform additional studies, which may include immunohistochemical stains and molecular studies to assist in the diagnosis

Biopsies are the only methods used to determine whether an abnormality is benign or cancerous. These are performed by inserting a needle into a breast mass and removing cells or tissues, for further examination. There are different types of biopsies:

  • Fine needle aspiration biopsy (FNAB) of breast mass: In this method, a very thin needle is used to remove a small amount of tissue. FNAB cannot help definitively diagnose Phyllodes Tumor of Breast. It only helps determine if the tumor is malignant or benign. This can help the healthcare provider discuss and plan the next steps (with respect to diagnosis and treatment)
  • Core needle biopsy of breast mass: A wider needle is used to withdraw a small cylinder of tissue from an abnormal area of the breast
  • Open tissue biopsy of breast mass: A surgical procedure used less often than needle biopsies, it is used to remove a part or all of a breast lump for analysis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Borderline Phyllodes Tumor of Breast?

The complications of Borderline Phyllodes Tumor of Breast may include:

  • Emotional stress due to concerns of a malignancy
  • Ulceration of overlying skin may lead to secondary bacterial and/or fungal infections
  • A majority of the phyllodes tumors are benign; though in some cases, they may be malignant and can spread to other body sites (such as to the lymph nodes)
  • The tumor is known to recur following incomplete removal through surgery
  • Side effects of chemotherapy and radiation therapy, if employed

How is Borderline Phyllodes Tumor of Breast Treated?

The following treatment methods for Borderline Phyllodes Tumor of Breast may be considered:

  • A simple surgical excision and removal of the entire breast tumor is normally sufficient treatment
    • The surgical procedure performed is known as a breast lumpectomy. It is a surgical procedure to remove the breast lump, which may be done under a general anesthetic
    • During the surgery, a small incision is made in the skin of the breast and a hollow probe that is connected to a vacuum, inserted
    • The breast tissue is sucked through the probe, using vacuum, until the lump has been removed 
  • If malignancy with spread of cancer is noted, then apart from surgery, chemotherapy and radiation therapy may be necessary
  • Follow-up care with frequent breast self-examinations and screening mammograms may be recommended by the healthcare provider

How can Borderline Phyllodes Tumor of Breast be Prevented?

Borderline Phyllodes Tumor of Breast is difficult to prevent. Since prevention is generally not possible, it is important to be aware of the risk factors for breast lumps and take steps to avoid them.

  • The individual must regularly conduct breast self-exams, to ensure that no lumps are present
  • Maintain a healthy body weight and exercise regularly
  • Implement and follow a well-balanced diet; a high intake of fiber via fresh fruits and vegetables helps in a healthy lifestyle
  • Drink alcohol in moderation; limit to one or (maximum) two drinks a day
  • Limit combination hormone therapy used to treat symptoms of menopause. It is advised that individuals be aware of the potential benefits and risks of hormone therapy

What is the Prognosis of Borderline Phyllodes Tumor of Breast? (Outcomes/Resolutions)

  • The prognosis of Borderline Phyllodes Tumor of Breast is generally excellent on a complete surgical excision and removal of the tumor, since in many cases it behaves in a benign fashion
  • Borderline Mammary Phyllodes Tumor is infrequently associated with malignancy. In such cases, the prognosis of the tumor depends on the stage of the tumor, age of the individual, and treatment response, apart from other parameters

Additional and Relevant Useful Information for Borderline Phyllodes Tumor of Breast:

The following DoveMed website links are useful resources for additional information:

http://www.dovemed.com/healthy-living/womens-health/

http://www.dovemed.com/diseases-conditions/cancer/

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Maulik P. Purohit MD MPH picture
Approved by

Maulik P. Purohit MD MPH

Assistant Medical Director, Medical Editorial Board, DoveMed Team

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