Phyllodes tumors of the breast
Phyllodes tumors are rare lesions in the breast. They account for about 1% of all breast tumors. Phyllodes is a term that means "leafy" in the ancient Greek language and has been named in this way because of the leaf-like extension of phyllodes tumors. In contrast to breast cancers, phyllodes tumors originate from connective tissue, not from milk ducts (ducts) or milk glands (lobules). Therefore, they are called "cystosarcoma phyllodes" because they resemble sarcoma tumors from the connective tissue at the naked eye.
Phyllodes tumors can be benign, malignant, or borderline. This distinction can be made by pathological evaluation, not by imaging findings. Most of the phyllodes tumors are benign, about 1/4 borderline, and 10% malignant. Malignant tumors can sometimes metastasize to tissues such as lungs and bones.
Clinically, phyllodes tumors may be confused with fibroadenomas, a benign tumor of the breast. It is not possible to reliably differentiate these two by ultrasound, mammography and MRI. However, fibroadenomas are more common in 20-30 years of age while phyllodes tumors are more common in 40-50 years of age. In addition, phyllodes tumors grow much faster than fibroadenomas. Some phyllodes tumors may reach a size of 2-3 cm in a few weeks. In conclusion, if a mass which is thought to be fibroadenoma on ultrasound shows a rapid growth, phyllodes tumor should be considered and a trucut needle biopsy should be performed.
How are they treated?
Classical treatment of phyllodes tumors is surgical removal of the tumor. However, recurrence rates after surgery can range from 10% to 40%. Recurrent tumors are repeatedly removed and in some cases, even mastectomy may be required. During the surgery, the mass should be removed as large as possible to decrease the recurrence rate. But this may cause severe depression and deformation of the breast and requires a long incision that may also compromize breast aesthetics. And despite this agressive approaches, phyllodes tumors may still recur. Due to these limitations of surgery, treatment options such as cryoablation have emerged.
Cryoablation is a method that is successfully applied in both fibroadenomas and breast cancer. This treatment is performed under local anesthesia and under ultrasound guidance. Depending on the size of the mass, one or several cryoneedles are inserted into the mass through the skin under ultrasound guidence. Then, the device is activated and a large iceball is formed that completely engulf the phyllodes tumor and surrounding tissue. During the procedure, the temperature in the iceball reaches -140 degrees, that kills all the phyllodes tumor cells. The cryoablation process takes about 1 hour. Because of the local anesthetic effect of cold, the patient does not have any pain during the procedure. After treatment, the patient can go home and return to normal life immediately.
The superiority of cryoablation therapy in phyllodes tumors is as follows.
1. Treatment can be done in the clinic, with local anesthesia. After approximately 1 hour of treatment, the patient may return to daily life.
2. Treatment is done through a few pinholes, there is no incision and scarring does not occur.
3. Phyllodes tumor is killed in the breast, the body gradually shrinks this tissue over the years. Therefore, no deformation occurs in the breast.
4. Since cryoablation does not cause deformation of the breast, a much wider tissue can be frozen around the mass and the risk of recurrence may be further reduced.
5. If there is recurrence in the phyllodes tumor, cryoablation can easily be repeated in the same way.
Interventional oncology in cancer management
Prof Saim Yilmaz, MD