Phyllodes Tumor vs. Fibroadenoma

Spero

Hi everyone,

I recently had my 6-month breast scan via mammogram (we alternate between MRI and mammo every 6 months) and they found a solid mass. I have a history of breast cancer (invasive ductal carcinoma), but I've been clear for almost 16 years! The initial mammo diagnosis was "probably fibroadenoma" because it was a circumscribed oval mass. However, because it doubled in size in a matter of 6 months (it was on my MRI in May, which they thought was a probable fibroadenoma) the radiologist suggested we do a biopsy just to be sure. We went ahead and did a core needle biopsy and the results were: "Fibroepithelial tumor with cellular stroma and rare stromal mitotic figures. The differential diagnosis could be fibroadenoma and benign phyllodes tumor. Lumpectomy highly recommended and to be scheduled." I meet with the surgeon in January to discuss.

Obviously, I am beyond relieved that it does not appear to be malignant. I've been reading up on Phyllodes tumors and have a fair understanding about them. But I am still worried. I believe the chances between fibroadenoma and phyllodes tumor are almost 50/50. Anyone else have a biopsy diagnosis like mine? And I'm also wondering if a benign appearing phyllodes tumor on core needle biopsy could turn out to be borderline (or even malignat) upon lumpectomy biopsy?

Happy Holidays to all, and for a healthy, peaceful and happy New Year!

LivinLife

I really am unable to answer your questions, Spero... I don't have that knowledge. I want to welcome you. I am glad you posted and am hoping someone will come along who can respond to your questions. I've been diagnosed with two fibroadenomas and they've never recommended any more than biopsy to confirm that is what they were (in the first case - not the 2nd). So it sounds like they really do want to know for sure what they are dealing with. I do not know if phyllodes tumor puts one at greater risk for cancer or not.

Spero

LivinLife, thank you for your response. I found it very comforting, which is just what we need sometimes. Thanks again.

Beesy_The_Other_One

Spero,

In 1996 I had a Phyllodes Tumor which presented as a fibroadenoma and just like yours, it grew significantly in six months (from peanut to lime sized). When MD Anderson did the biopsy, they did it without Ultrasound (not standard at the time), so it was a guess at best. The pathologist called it a giant fibroadenoma. It was removed because it was growing so quickly (would have taken over my breast if left alone) and when the pathologist examined it, there were parts that turned out to be a Phyllodes.

All those years ago, standard of care was wide excision/partial mastectomy. The new standard is lumpectomy with good margins. Twenty-two years later I developed breast cancer in the other breast, but completely unrelated.

There are a few of us on here who've had Phyllodes tumors, but not many. Three docs at MD Anderson have told me that they see only 1 case yearly, which is astounding. Obviously, I'm not an expert on Phyllodes, but it is not anything like you've been through with IDC, based on my experience with both. I can direct you to some threads about Phyllodes tumors if you're interested (I've bookmarked them since they appear rarely) and am happy to answer any questions as I'm able.

Wishing all the best for you, Spero!

ddfair

Welcome to BC.org Spero

To answer your questions, any of the possible outcomes you propose could happen. There's no way to know until the lump is out and pathology done.

I've had a borderline phyloides tumour that kept returning and got more aggressive becoming malignant over time. I had 6 lumpectomies over10 years. Two of those turned out to be abnormal scar tissue. The other 4 were phyloides. It's very hard to tell preop. Both phyloides and fibroids grow very large very quickly.

So sorry you have to deal with this uncertainty at Christmas time. Happy to answer any questions for you.

De

Spero

Thank you for your responses, it's just comforting to connect with others on this topic, especially who have experienced this uncertainty and possible outcome. Yes, my radiologist said that the only the way to know is via surgery. I meet with the surgeon on 1/7, so we'll see how that goes. Beesy_The_Other_One, yes, I'd love for you to direct me to the other threads.

Hope you're all having a great holiday season, and I'll be back with more questions tomorrow!

ddfair

Hey Spero,

Did you get any answers from the surgeon appointment yet?

De

Spero

Hi, thank you for checking in. Yes, I saw my surgeon a couple of days ago. She said it could be either - fibroadenoma OR phyllodes. And that it needs to be removed via Lumpectomy, because there's a 10% chance it's malignant. Although she's leaning more on the side of benign, but there's no way to tell. But either way, she said we should remove it. So we scheduled the surgery and at that point we'll confirm the mystery. I hate not knowing. But it won't change anything. She said no matter what it is, there's really nothing more to be done. Maybe a follow up surgery if the margins aren't clear, or if it keeps coming back. But surgery is all there is. No hormonal therapy, etc. I was hoping to discuss the pathology from the biopsy, but she said we need to wait until the surgery to really discuss pathology.

Was your initial diagnosis borderline phyllodes, that came back malignant at some point? she mentioned that they can recur, which is the biggest pain of phyllodes.

Beesy_The_Other_One

Spero,

I was so glad to see that ddfair was so thoughtful to ask you how you are doing--what a great community! In my experience, everything your doctor said was correct, and they will be able to do an accurate pathology once it's removed. My initial diagnosis was borderline phyllodes, but they went back in and took half my breast (standard of care then) and it never grew back. Ten years after surgery, MD Anderson declared it would not come back.

If MD Anderson sees only two phyllodes tumors a year, they are rare. A malignant phyllodes is VERY rare.

Spero, looking at my response above, I said I would send you links and I realize that in the hubbub of Christmas, I did not follow through! I apologize! In the two years I've been here, these are the threads that I've seen:

https://community.breastcancer.org/forum/137/topic...

https://community.breastcancer.org/forum/5/topics/...

https://community.breastcancer.org/forum/137/topic...

https://community.breastcancer.org/forum/137/topic...

https://community.breastcancer.org/forum/137/topic. . ..

https://community.breastcancer.org/forum/83/topics...

https://community.breastcancer.org/forum/5/topics/.. . .

Let us know how things go!

ddfair

Spero,

Thanks so much for posting an update. Have they set a surgery date for you? I'm sure you will be glad to have this behind you regardless of the outcome. If the surgeon takes wide margins, that should be the end of it for you. My first lumpectomy the surgeon didn't take wide margins. When the pathology report showed borderline phyllodes they had to do a re-excision surgery to get clear margins.

You might want to educate yourself on what to expect with a lumpectomy surgery. There are many threads here with a wealth of information and helpful hints to prepare for surgery. Sending hugs.

De

Spero

They scheduled my lumpectomy for January 25. They're going to use the Radioactive Seed Localization (scheduled a couple of days before my surgery). With my first lumpectomy 15 years ago, they did the wire localization. I'm told the seed is less barbaric, but who knows. Anyone have any experience with it? Other than that, just going through the typical pre-surgery protocols (e.g. pre-surgery testing, COVID-19 testing, and the See Localization).

LivinLife

I do not have experience with that.... Just want to wish you well!! That is just around the corner... please let us know how things go....

ddfair

I'm really confused on the radioactive seed location you mentioned. What is the purpose of that? Is it radiation therapy or is it to locate the tumour?

MelissaDallas

It’s a radioactivelocator for the surgery instead of having to have a wire placed

ddfair

Thanks for the explanation Melissa.