Borderline phyllodes tumor – A saga of recurrences and malignant transformation

• Author Details:   
• Neelam Sood ^*
• Ruhi .

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Background: Phyllodes tumors (PTs) of the breast are rare fibroepithelial neoplasms with variable biological behaviour. While most cases are benign, some recur with increasing aggressiveness and histologic transformation. This study evaluates a case series of borderline phyllodes tumors from last 10 years records and their morphological evolution.

Materials and Methods: A retrospective cohort study was conducted on recurrent phyllodes tumors, which were initially diagnosed as either benign or borderline. The records of last 10 years were retrieved. Out of total number of 30 diagnosed phyllodes tumors, 5 were recurrent. Their slides were reviewed and morphological parameters were evaluated. The clinical demographic parameters, clinical parameters including interval between the first diagnosis and recurrence and surgical margins were also evaluated.

Results: Among these five cases, three showed transformation to sarcoma, over a period of 1-5years, one of them in first recurrence itself,another in second recurrence and third in third recurrence. One case has heterologous elements in form of well differentiated liposarcoma. With each recurrence, there was a progressive reduction in the epithelial component. One case remained borderline phyllodes even after three recurrences, and one of them transformed from benign to borderline Phyllodes tumors. In four out of five cases the stromal hypercellularity was seen in the first presentation. Extent of surgical margins had no bearing on recurrence; however infiltrative margins were seen in two cases, on initial presentation.

Conclusion: Phyllodes tumors may evolve into more aggressive histologic subtypes upon recurrence, often with diminishing epithelial elements. Early recognition of these changes is essential for prognosis and management planning with close follow ups.