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Why are Phyllodes tumors called 'phyllodes'? Delve deeper into the morphological characteristics of this mysterious tumor!
Phyllodes tumors, also known as phyllodes tumors, are derived from the Greek word "phullon", which means "leaf". This tumor forms in breast tissue and is a rare type of biphasic fibroepithelial tumor. According to statistics, this tumor accounts for less than 1% of all breast tumors. According to historical data, the term was first proposed by Johannes Müller in 1838, when it was called cystosarcoma phyllodes. It was not until 2003 that the World Health Organization renamed it Phyllodes tumor.
The inclusion of leaf-like projections is one of the key features of this tumor and is clearly visible on histological examination. Typically, this tumor appears as a firm, mobile, and painless mass, and the texture of the mass can vary depending on its size and may be smooth or nodular. During an outpatient examination, patients may feel abnormal lymph nodes or obvious lumps in the breast. Of note, tumor size ranged from 0.8 to 40 cm, with most averaging between 4 and 8 cm. The tumor can grow quickly or slowly, but specifically, it rarely regresses, unlike fibroadenoma, which can change in size with a woman's menstrual cycle.
"The diagnosis of Phyllodes tumors mainly relies on core needle biopsy, which is the main tool to provide a confirmed diagnosis."
Discussion on the causes
As for the exact cause of Phyllodes tumors, there is still no clear conclusion. Some experts say that Li-Fraumeni syndrome and BRCA1/BRCA2 gene mutations may be related to the high incidence of this tumor. Notably, men with a history of gynecomastia also showed higher rates of Phyllodes tumors.
Mechanism analysis
Expert exploration of the pathological development of Phyllodes tumors shows that while some studies suggest possible genetic factors, other literature also emphasizes the influence of hormone and growth factor receptors, cell signaling pathways, and cell cycle markers. Studies have pointed out that receptors associated with Phyllodes tumors include estrogen/progesterone, glucocorticoids and HER2. The Wnt signaling pathway is considered the most intensively studied cell signaling mechanism, and it is a conserved operating channel across species. When B-catenin is deregulated due to mutations in certain proteins such as c-myc, c-jun and cyclin D1, it may lead to the rapid growth of this type of tumor.
Diagnosis and Classification
Phyllodes tumors are diagnosed primarily through imaging studies. Although these tumors often grow rapidly and may affect surrounding breast tissue, in approximately 20% of cases, the tumors may appear nonpalpable. In addition to ultrasound and magnetic resonance imaging, core needle biopsy remains the main method for confirming diagnosis. Phyllodes tumors are classified according to histological criteria into benign, borderline, and malignant tumors. According to research from MD Anderson Cancer Center, reports show that benign tumors account for 58%, borderline tumors account for 12%, and malignant tumors account for 30%.
Treatment and prognosis
For the management of Phyllodes tumors, the best hands-on approach is wide surgical excision with margins exceeding 1 cm. There is no clear treatment other than surgery, as chemotherapy and radiotherapy are not very effective. Generally speaking, Phyllodes tumors have a good prognosis after appropriate surgical resection, with an overall ten-year survival rate of 87%. However, the prognosis is poor if it is in the advanced stage, especially for malignant tumors.
Epidemiology
Phyllodes tumors make up only 1% of all breast tumors, but they occur more frequently in women between 40 and 50 years of age than in women with the more common fibroadenomas. Of note, younger women are more likely to develop benign tumors, while as they age, high-grade tumors are more likely. Further research on this type of tumor will help to gain a deeper understanding of its pathogenesis and improve treatment strategies.
What profound implications does this complex tumor have for our daily health? Is this a question worth thinking about?
