Phyllodes tumour
Fibroepithelial breast tumour (benign → malignant spectrum)
Overview
A fibroepithelial breast tumour on a spectrum from benign to malignant — typically a rapidly growing, large lump in women in their 40s–50s. Resembles a giant fibroadenoma but grows fast and can recur or (rarely) metastasise (haematogenous). Treated with WIDE local excision (not enucleation).
Recognise
- Rapidly enlarging, often large, smooth firm mobile breast lump, usually women aged ~40–50
- Can stretch/ulcerate overlying skin; benign, borderline or malignant on histology
- Resembles fibroadenoma but bigger and faster-growing
Red flags
- Rapid growth of a fibroepithelial lesion → excise (don't just observe as fibroadenoma)
- Malignant phyllodes → haematogenous spread (lungs)
Differentials & how to tell them apart
Investigations
Triple assessment; core biopsy (may under-sample — excisional histology often needed); imaging.
Management
Wide local excision with clear margins
- 1Suspect with a rapidly growing fibroepithelial lump; triple assessment (core biopsy may under-grade). Treat with WIDE local excision aiming for clear margins.Gate: Excise widely (not enucleate like a fibroadenoma) because of recurrence risk; malignant phyllodes spreads haematogenously (lung) — node clearance is not routinely needed
- 2Mastectomy for large/recurrent/malignant tumours; surveillance for recurrence; radiotherapy in selected malignant cases.
Key points
Rapidly enlarging 'giant fibroadenoma' in a 40-50-year-old = phyllodes → wide local excision. Spreads via the bloodstream (lungs), not lymphatics.
Monitor & prognosis
Recurrence; chest imaging if malignant.
Good (benign); recurrence/metastasis if malignant.
Source: NICE NG101; StatPearls