Phyllodes Tumor vs. Cellular Fibroadenoma Poster

I did a study with nine breast pathology colleagues of mine on how breast pathologists distinguish cellular fibroadenomas from phyllodes tumor.  Our abstract was accepted at the 100th annual USCAP meeting in San Antonio this year.  I have attached a pdf version of our poster below:

FEL_poster

Please feel free to comment or ask questions about this study.

© 2011 Seattle Breast Pathology Consultants, LLC. All rights reserved.

3 Responses

  1. Hi,
    Thanks for posting a link to your poster. It is very helpful.
    I think I spoke to one of your colleagues recently at Mayo in regards to this study. Id be interested in hearing more about it and your criteria used to distinguish the two. Everytime I get a case that I think could be a benign phyllodes, it gives me a headache because I know the diagnosis is subjective and I know somebody else (ie a second opinion) is going to call it a fibroadenoma. Recently, my sister had an intermediate grade phyllodes that I saw on core biopsy. The pathologist called it a fibroadenoma. So, I warned her that it was a phyllodes tumor and gave her a letter to take to her surgeon to do the appropriate surgery. The surgeon ignored my letter and said that phyllodes are so rare in us and that he never saw one before…basically ignoring my second opinion letter and her fear. He enucleated her lesion with no attempt at clear margins and the resection came back as a fibroadenoma. I could not believe the surgeon did this and I could not believe my eyes reviewing the final path report. It was intermediate grade by my eyes on the core (and I only had a tiny fraction of her lesion to review). So, I asked for it to be re-reviewed and it was done by an expert breast pathologist..and the institution still claimed it was a fibroadenoma. So, I told my sister to send the slides out of the institution to another big hospital…And, the final consult report was phyllodes, intermediate grade. So, my point is that there is plenty of subjectivity in the benign phyllodes vs fibroadenoma and we need better criteria. And, as my sisters case demonstrates there can be subjectivity with intermediate grade phyllodes vs benign fibroadenomas. Thats scary.
    Garrey

  2. I understand your frustration and I share it! This was the main reason I chose to do this study with my colleagues. As you can see from the poster, diagnoses from breast pathologists ranged from fibroadenoma to borderline phyllodes tumor in 9 of the twenty-one cases that we all reviewed. We are hoping to get the paper finished and submitted for publication soon.

  3. I had a fast growing tumour in 96 and they said it was a fibroadenoma – exact same spot there were two more in 99 and again same pathologist and same diagnosis. My surgeon with my agreement suspecting PT took a very wide margin just in case. 2012 – it was back again same spot and post mental pause time. Pathology and second opinion Borderline PT. Second surgery for margins as not clear. PT growth means compression and when released it expands and pushes on margins. They pulled the old slides and it was PT all along. My tumours always caused pain due to rapid growth and all three times I insisted they be taken out. If I had not pushed the buttons and been a squeaky wheel I may not be here to write this. Sadly we hear the it is rare and so many misdiagnosed. There are lives we are dealing with and education and research is needed.

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