An update on the classification of phyllodes tumours of the breast

Published:January 06, 2022DOI:


      Phyllodes tumour (PT) is a rare fibroepithelial neoplasm of the breast, histologically categorized into 3 grades, namely benign, borderline and malignant; each with distinct clinical behaviour and implications for management. This article addresses challenges in the diagnosis, grading and management of PT in excisional and core needle biopsy specimens, with a brief review of recent molecular findings.


      To read this article in full you will need to make a payment


      Subscribe to Diagnostic Histopathology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Tan P.H.
        • Thike A.A.
        • Tan W.J.
        • et al.
        Predicting clinical behaviour of breast phyllodes tumours: a nomogram based on histological criteria and surgical margins.
        J Clin Pathol. 2012; 65
        • WHO Classification of Tumours Editorial Board
        WHO classification of tumours. 5th Edition.
        in: Breast tumours. 5th ed. 2019
        • Pacioles T.
        • Seth R.
        • Orellana C.
        • John I.
        • Dhaliwal R.
        • Panuganty V.
        Malignant phyllodes tumor of the breast presenting with hypoglycemia: a case report and literature review.
        Cancer Manag Res. 2014; (Published online December)
        • Landrum M.L.
        • Ornstein D.L.
        Hypertrophic osteoarthropathy associated with metastatic phyllodes tumor.
        Am J Clin Oncol. 2003; 26
        • Kalambo M.
        • Adrada B.E.
        • Adeyefa M.M.
        • et al.
        Phyllodes tumor of the breast: ultrasound-pathology correlation.
        Am J Roentgenol. 2018; 210
        • Tan P.H.
        Fibroepithelial lesions revisited: implications for diagnosis and management.
        Mod Pathol. 2021; 34
        • Tan B.Y.
        • Acs G.
        • Apple S.K.
        • et al.
        Phyllodes tumours of the breast: a consensus review.
        Histopathology. 2016; 68
        • Lyle P.L.
        • Bridge J.A.
        • Simpson J.F.
        • Cates J.M.
        • Sanders M.E.
        Liposarcomatous differentiation in malignant phyllodes tumours is unassociated with MDM2 or CDK4 amplification.
        Histopathology. 2016; 68
        • Jara-Lazaro A.R.
        • Akhilesh M.
        • Thike A.A.
        • Lui P.C.-W.
        • Tse G.M.-K.
        • Tan P.H.
        Predictors of phyllodes tumours on core biopsy specimens of fibroepithelial neoplasms.
        Histopathology. 2010; 57
        • Tan B.Y.
        • Tan P.H.
        A diagnostic approach to fibroepithelial breast lesions.
        Surgical Pathology Clinics. 2018; 11
        • Lee A.H.S.
        • Hodi Z.
        • Ellis I.O.
        • Elston C.W.
        Histological features useful in the distinction of phyllodes tumour and fibroadenoma on needle core biopsy of the breast.
        Histopathology. 2007; 51
        • Jacobs T.W.
        • Chen Y.Y.
        • Guinee D.G.
        • et al.
        Phyllodes tumor (PT) subsequent to a diagnosis of fibroadenoma (FA) on breast core needle biopsy (CNB): frequency and characteristics.
        Mod Pathol. 2014; 27: 34-90
        • Ross D.S.
        • Giri D.D.
        • Akram M.M.
        • et al.
        Fibroepithelial lesions in the breast of adolescent females: a clinicopathological study of 54 cases.
        Breast J. 2017; 23
        • Dunne B.
        • Lee A.H.S.
        • Pinder S.E.
        • Bell J.A.
        • Ellis I.O.
        An immunohistochemical study of metaplastic spindle cell carcinoma, phyllodes tumor and fibromatosis of the breast.
        Hum Pathol. 2003; 34
        • Tan J.
        • Ong C.K.
        • Lim W.K.
        • et al.
        Genomic landscapes of breast fibroepithelial tumors.
        Nat Genet. 2015; 47
        • Piscuoglio S.
        • Ng C.K.
        • Murray M.
        • et al.
        Massively parallel sequencing of phyllodes tumours of the breast reveals actionable mutations, and TERT promoter hotspot mutations and TERT gene amplification as likely drivers of progression.
        J Pathol. 2016; 238
        • Piscuoglio S.
        • Geyer F.C.
        • Burke K.A.
        • et al.
        Massively parallel sequencing analysis of synchronous fibroepithelial lesions supports the concept of progression from fibroadenoma to phyllodes tumor.
        npj Breast Cancer. 2016; 2
        • Ng C.C.Y.
        • Tan J.
        • Ong C.K.
        • et al.
        MED12 is frequently mutated in breast phyllodes tumours: a study of 112 cases.
        J Clin Pathol. 2015; 68
        • Sim Y.
        • Ng G.X.P.
        • Ng C.C.Y.
        • et al.
        A novel genomic panel as an adjunctive diagnostic tool for the characterization and profiling of breast Fibroepithelial lesions.
        BMC Med Genom. 2019; 12
        • Md Nasir N.D.
        • Ng C.C.Y.
        • Rajasegaran V.
        • et al.
        Genomic characterisation of breast fibroepithelial lesions in an international cohort.
        J Pathol. 2019; 249
        • Tan B.Y.
        • Md Nasir N.D.
        • Chang H.Y.
        • et al.
        Morphologic and genetic heterogeneity in breast fibroepithelial lesions—a comprehensive mapping study.
        Mod Pathol. 2020; 33
        • Tan E.Y.
        • Hoon T.P.
        • Yong W.S.
        • et al.
        Recurrent phyllodes tumours of the breast: pathological features and clinical implications.
        ANZ J Surg. 2006; 76
        • Borhani-Khomani K.
        • Talman M.-L.M.
        • Kroman N.
        • Tvedskov T.F.
        Risk of local recurrence of benign and borderline phyllodes tumors: a Danish population-based retrospective study.
        Ann Surg Oncol. 2016; 23
        • Cowan M.L.
        • Argani P.
        • Cimino-Mathews A.
        Benign and low-grade fibroepithelial neoplasms of the breast have low recurrence rate after positive surgical margins.
        Mod Pathol. 2016; 29
        • Moutte A.
        • Chopin N.
        • Faure C.
        • et al.
        Surgical management of benign and borderline phyllodes tumors of the breast.
        Breast J. 2016; 22
        • Rosenberger L.H.
        • Thomas S.M.
        • Nimbkar S.N.
        • et al.
        Contemporary multi-institutional cohort of 550 cases of phyllodes tumors (2007-2017) demonstrates a need for more individualized margin guidelines.
        J Clin Oncol. 2021; 39
        • Koh V.C.Y.
        • Thike A.A.
        • Nasir N.D.M.
        • Yip G.W.C.
        • Bay B.H.
        • Tan P.H.
        Size and heterologous elements predict metastases in malignant phyllodes tumours of the breast.
        Virchows Arch. 2018; 472
        • Chng T.W.
        • Gudi M.
        • Lim S.H.
        • Li H.
        • Tan P.H.
        Validation of the Singapore nomogram for outcome prediction in breast phyllodes tumours in a large patient cohort.
        J Clin Pathol. 2018; 71
        • Ogunbiyi S.
        • Perry A.
        • Jakate K.
        • Simpson J.
        • George R.
        Phyllodes tumour of the breast and margins: how much is enough?.
        Can J Surg. 2019; 62
        • Tay T.K.Y.
        • Chang K.T.E.
        • Thike A.A.
        • Tan P.H.
        Paediatric fibroepithelial lesions revisited: pathological insights.
        J Clin Pathol. 2015; 68