Phyllodes Tumor of Breast – Complete Surgical Guide
Phyllodes tumor is a rare but high-yield breast tumor frequently tested in NEET SS and MRCS. It is a fibroepithelial tumor with unpredictable behavior and high recurrence if not treated correctly.
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Golden Rule: All phyllodes tumors require wide local excision with ≥1 cm margin.
Pathology & Classification
Phyllodes tumors are biphasic tumors composed of epithelial and stromal components. The stromal component determines malignancy.
- Benign → minimal atypia
- Borderline → moderate atypia
- Malignant → stromal overgrowth, high mitosis
Key exam point: malignancy is based on stroma, NOT epithelium.
Clinical Features
- Rapidly growing breast lump
- Painless
- Large size
- Previously diagnosed fibroadenoma increasing in size
Investigation
- Ultrasound → solid lesion
- Core biopsy → diagnostic
- FNAC → unreliable
Management (VERY IMPORTANT)
Small / Benign
- Wide local excision ≥1 cm margin
- Enucleation ❌ wrong
Borderline
- Wide excision + follow-up
Malignant
- Wide excision or mastectomy
- Margins critical
Radiotherapy
- Used in recurrence
- Close margins
Chemotherapy
- No routine role
Axillary Dissection
- NOT required
- Spread is hematogenous
High Yield Summary:
- Margin ≥1 cm mandatory
- No enucleation
- No axillary clearance
- Recurrence depends on margins
NEET SS 2025 MCQ
Asked in NEET SS 2025
A 32-year-old woman presents with a 2 cm breast lump. Enucleation done and biopsy shows phyllodes tumor. Next step?
A. Observation
B. Wide local excision with margins
C. Mastectomy
D. Radiotherapy