Expert: Claes-Gustaf Nordquist, M.D. - 12/18/2009

Question
QUESTION: I had a recent excision of a , now known to be , "benign" phyllode tumor .  In researching how they classify a phyllode as benign, borderline or malignant, I am unclear as to why mine was classified as benign.  My pathology report states:  increased stromal cellularity w / 4 mitosis per fifty high power fields (everything else I read is per 10 hpf) , focal areas of leaf like architecture, focal stromal overgrowth, border well excised except for small area of stroma that interdigitates with adjacent breast tissue.  Is the "histological grade" stated in this report? I'm scheduled for re-excision... is a 1cm or 2 cm margin sufficient?  What is a "wide excision"?

Thank you very much for your expertise and insight?

ANSWER: Hi Nancy, have you given me your WHOLE COMPLETE report here? No grade is mentioned in what you have written. If not complete please let me have the FULL report! You can copy it here.



I have some computer problems so unfortunately my reply is delayed.

You can also reach me on: http://www.lifestylerescue.com/expert/health-fitness-advice/dr-claes-gustaf/128


---------- FOLLOW-UP ----------

QUESTION: Thanks for the clarifying question.  The entire report reads:

FINAL DIAGNOSIS:  Left breast mass, excision (A) Benign phyllodes tumor, see comment.

COMMENT:  Specimen has increased stromal cellularity with 4 mitoses per 50 high power fields.  There are focal areas of leaf-like architecture indentified as well as focal stromal overgrowth.  The border of the lesion appears to be predominantly well circumscribed with the exception of a small area of stroma which interdigitates with the adjacent breast tissue.  A prior biopsy site is identified.  The lesion is incompletely excised with ink and cautery present at one of the edges of the tumor.

GROSS DESCRIPTION:  Recieved in formalin labeled "left breast mass" is an unoriented segment of tan-white soft and rubbery tissue measuring 4.0 x 3.0 x 2.5 cm, and weighing 10.4 grams.  The external surface is distored by multiple, bulging, areas ranging in size from 0.2 to 0.6 cm in greatest dimension.  No skin is identified.  AThe external surface is inked black.  The specimen is serially sectioned.  Sectioning reveals a yellow-white, shiny, variegated cut surface.  Multiple areas of hemorrhage are identified ranging in size from 0.2 to 0.6 cm in greatest dimension.  Representative sections are submitted in formalin A1- A3.  The remainder of the specimen is totally submitted in formalin in A4- A10.

That is all that I received.  I hope this brings clarity or better questions for me to ask my surgeon when I meet with her for re-excision to gain clear margins."

According to a "Stanford Surgical Pathology Criteria" a benign tumor should exhibit NONE of the following 1.Stromal overgrowth ( >1  40power
field) 2. incresed mitotic index ( > 10 per 10 high power field w/out epithelium  3.  stromal nuclear pleomorphism & atypia  4.  infiltrative margins

It looked to me that my path report indicated that I had #'s 1 and 4.  Is that correct and is this criteria a good check list.  

Thanks you so very much for your insight so that I can ensure I make the right decision during this surgery to ensure no recurrance of this tumor.  

Answer
Thanks! It helped by clarifying things. As far as I can see there is only one sure point which differs with certainty from those rules and that is no. 1. No 2 & 3 are certainly and clearly negative and no.4 may be due to not cutting your tumor out with a wide enough margin though that may be somewhat uncertain. Also no.1 MAY (NOT certain) be due to that too narrow margin cut since the report only states overgrowth in singular not plural and the only described overgrowth is that part with unclear margin. However that should be clarified by the pathology report from your follow up surgery. However since there are uncertainties here I do suggest a second opinion with regards to all your pathology reports! I have no problems with those rules! Good luck! Please do keep me posted!


I have some computer problems so unfortunately my reply is delayed.

You can also reach me on: http://www.lifestylerescue.com/expert/health-fitness-advice/dr-claes-gustaf/128


Thanks! You too! You were essentially correct but my prostate cancer treatment (radiation therapy) ended during the spring of this year.

I have some computer problems so unfortunately my reply is delayed.

You can also reach me on: http://www.lifestylerescue.com/expert/health-fitness-advice/dr-claes-gustaf/128