Expert: Claes-Gustaf Nordquist, M.D. - 2/21/2006

Question
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Followup To
Question -
I recently underwent a major duct excision for findings noted on an ultrasound - which was thought to be an intraductal papilloma - and nipple discharge.  The findings from the excision were as follows "consistent with fibroadenoma with associated intraluminal microcalcification. No evidence of malignancy."  further comments from the report noted "foci of mild ductal hyperplasia....many of the breast ducts present within the fibroadenoma shows a slightly cellular myxoid stroma raising the possibility of a benign phyllodes tumor. However, other features in favor of phyllodes tumor are lacking. Appropriate clinical follow-up is suggested."
Based on these results and the limited conversation I had with my physician, I think that the plan is to monitor this area for future changes. She stated that sometimes they recommend a wide margin on excision, but she would not recommend that we go back and take any further breast tissue out as this was all within a duct.  Do you have any thoughts on these results or the plan that is in place?  I have read varying articles on phyllodes tumors and I am wondering if they need to be watched closer and/or if they have a propensity to change towards malignancy.

Thank you in advance for your response.
Answer -
The diagnosis here of a phyllodes tumour seems most uncertain to me so I would agree with your dr. provided she will follow up your case closely. In the case of a CLEAR phyllodes tumour (not the case here based on the material at hand) a VERY wide margin or even a mastectomy should be recommended as the local relapse rate is 20-35% and the risk of metastatic disease 10-20%. I hope this answers your question.



*** I just have a follow-up question to your response.  Would you recommend getting a second opinion on the pathology results that I currently have?  Are even benign phyllodes treated with the wide excision and continued to be watched carefully?  If I do not change anything, do you think that watching it every 6 months or yearly with ultrasound or other method will be the treatment of choice?  Thank you so much for taking the time to consider my questions.  I really appreciate it!

Answer
Well, real phyllodes tumours should be treated as sarcomas (Cystosarcoma phyllodes , a malignant soft tissue tumour). There very wide surgery margins are a necessity but mastectomy is even better, but in your case there just is not any basis for such treatment. I think that follow ups including X-ray mammography, MRI-mammography and ultrasound are sufficient. In the beginning every 6 months and later on if everything looks stable and ok just yearly. Good luck! You are welcome!