A 34-year-old woman presents with a right breast lump that has grown rapidly over four months and now measures 7 cm. It is firm and mobile. Excision biopsy shows a biphasic tumour with a leaf-like architecture, marked stromal hypercellularity, stromal overgrowth and 12 mitoses per 10 high-power fields. What is the correct management?

• A Neoadjuvant chemotherapy followed by re-excision
• B Simple enucleation of the lump
• C Modified radical mastectomy with axillary clearance
• D Wide local excision aiming for a margin of at least 1 cm ✓

Explanation

Leaf-like architecture with stromal overgrowth, hypercellularity and more than 10 mitoses per 10 high-power fields defines a malignant phyllodes tumour. Treatment is wide local excision with a margin of at least 1 cm; mastectomy is needed only when the tumour-to-breast ratio prevents a clear margin. Axillary clearance is not performed because phyllodes tumours spread haematogenously and involve axillary nodes in under 5 percent of cases. Enucleation is inadequate even for benign phyllodes and invites local recurrence.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.