title: Phyllodes tumours of the breast: a consensus review.
abstract: Phyllodes tumours constitute an uncommon but complex group of mammary fibroepithelial lesions. Accurate and reproducible grading of these tumours has long been challenging, owing to the need to assess multiple stratified histological parameters, which may be weighted differently by individual pathologists. Distinction of benign phyllodes tumours from cellular fibroadenomas is fraught with difficulty, due to overlapping microscopic features. Similarly, separation of the malignant phyllodes tumour from spindle cell metaplastic carcinoma and primary breast sarcoma can be problematic. Phyllodes tumours are treated by surgical excision. However, there is no consensus on the definition of an appropriate surgical margin to ensure completeness of excision and reduction of recurrence risk. Interpretive subjectivity, overlapping histological diagnostic criteria, suboptimal correlation between histological classification and clinical behaviour and the lack of robust molecular predictors of outcome make further investigation of the pathogenesis of these fascinating tumours a matter of active research. This review consolidates the current understanding of their pathobiology and clinical behaviour, and includes proposals for a rational approach to the classification and management of phyllodes tumours.
authors.affiliation: Department of Pathology, Singapore General Hospital, Singapore.
authors.forename: Benjamin Y
authors.initials: BY
authors.lastname: Tan
authors.affiliation: Women's Pathology Consultants, Ruffolo Hooper & Associates, Tampa, FL, USA.
authors.forename: Geza
authors.initials: G
authors.lastname: Acs
authors.affiliation: Department of Pathology, UCLA Medical Center, Santa Monica, CA, USA.
authors.forename: Sophia K
authors.initials: SK
authors.lastname: Apple
authors.affiliation: Departments of Pathology and Internal Medicine, Clarian Pathology Laboratory of Indiana University, Indianapolis, IN, USA.
authors.forename: Sunil
authors.initials: S
authors.lastname: Badve
authors.affiliation: Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Ira J
authors.initials: IJ
authors.lastname: Bleiweiss
authors.affiliation: Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Edi
authors.initials: E
authors.lastname: Brogi
authors.affiliation: Servicio de Anatomía Patológica, Hospital Universitario Ramón y Cajal, Madrid, Spain.
authors.forename: José P
authors.initials: JP
authors.lastname: Calvo
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Dabbs
authors.affiliation: Department of Histopathology, Nottingham City Hospital NHS Trust, Nottingham University, Nottingham, UK.
authors.forename: Ian O
authors.initials: IO
authors.lastname: Ellis
authors.affiliation: Sezione Anatomia e Istologia Patologica, 'M. Malpighi' Università di Bologna, Bologna, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Eusebi
authors.affiliation: BreastScreen SA, Discipline of Medicine, Adelaide University and Directorate of Surgical Pathology, SA Pathology, Adelaide, South Australia.
authors.forename: Gelareh
authors.initials: G
authors.lastname: Farshid
authors.affiliation: Pathology Department, Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, Vic., Australia.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Fox
authors.affiliation: Department of Pathology, Nagoya Medical Center, Nagoya, Japan.
authors.forename: Shu
authors.initials: S
authors.lastname: Ichihara
authors.affiliation: School of Medicine and Pathology Queensland, The Royal Brisbane & Women's Hospital, University of Queensland Centre for Clinical Research, Brisbane, Qld, Australia.
authors.forename: Sunil R
authors.initials: SR
authors.lastname: Lakhani
authors.affiliation: Department of Histopathology, Nottingham City Hospital NHS Trust, Nottingham University, Nottingham, UK.
authors.forename: Emad A
authors.initials: EA
authors.lastname: Rakha
authors.affiliation: Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Jorge S
authors.initials: JS
authors.lastname: Reis-Filho
authors.affiliation: Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Richardson
authors.affiliation: Department of Pathology, Division of Pathology/Laboratory Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Aysegul
authors.initials: A
authors.lastname: Sahin
authors.affiliation: Laboratoire national de santé, Luxembourg city, Luxembourg.
authors.forename: Fernando C
authors.initials: FC
authors.lastname: Schmitt
authors.affiliation: Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Schnitt
authors.affiliation: Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA.
authors.forename: Kalliopi P
authors.initials: KP
authors.lastname: Siziopikou
authors.affiliation: Department of Anatomic Pathology, A. C. Camargo Cancer Centre, São Paulo, Brazil.
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Soares
authors.affiliation: Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Gary M
authors.initials: GM
authors.lastname: Tse
authors.affiliation: Pôle Pathologie-Génétique-Immunologie, Institut Curie, Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Vincent-Salomon
authors.affiliation: Department of Pathology, Singapore General Hospital, Singapore.
authors.forename: Puay Hoon
authors.initials: PH
authors.lastname: Tan
mesh_terms: D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000473:pathology*; D002277:Carcinoma / Q000473:pathology*; D032921:Consensus; D003937:Diagnosis, Differential; D005260:Female; D018226:Fibroadenoma / Q000473:pathology*; D006801:Humans; D003557:Phyllodes Tumor / Q000473:pathology*; D012509:Sarcoma / Q000473:pathology*
keywords: classification; fibroadenoma; malignant; metastasis; phyllodes