Abstract

Phyloid tumors are complex and rare mammary fibroepithelial lesions, of uncertain biological behavior, accurate and reproducible classification is a challenge, due to the need to evaluate multiple histopathological parameters, which hinder their interpretation by pathologists; mainly to differentiate benign phyloid tumors from cellular fibroadenomas, or malignant phyloid tumors from spindle cell metaplastic carcinoma and primary breast sarcoma. Graduation of phyllodes tumors is achieved with accuracy and consistency at the ends of the spectrum from benign to malignant; although, using the term benign fibroepithelial lesion/neoplasia is recommended for diagnosis. They are presented as smooth, multinodular, asymptomatic mass; similar to fibroadenomas; but it is suspected by its rapid growth in tumor size, or typical mammography (MMG) or smooth, polylobulated mass appearance; in ultrasound (US), they are solid, hypoechoic, well-circumscribed lesions, the presence of cystic areas within the mass increases suspicion; Only thick needle biopsy is useful. The therapeutic management is surgical, with no consensus on the ideal definition of the appropriate surgical margin to reduce the risk of recurrence; but, wide local excision (ALS) is recommended, a surgical margin of> 1cm is necessary; and it is considered in relation to factors such as tumor and aesthetic size, its risk of metastasis and death, are infrequent. Axillary lymphadenectomy (LDN); it is not performed routinely, nor adjuvant radiotherapy (Rt) in the benign ones; only, for borderline or malignant, to reduce the recurrence rate. Adjuvant chemotherapy (Qt) is reserved in patients at higher risk, or recurrent malignancies and hormonal therapy is not recommended. Conclusion: the phyloid tumor presents challenges related to interpretation, histopathological diagnostic criteria, correlation between histopathological classification, clinical behavior, lack of adequate molecular predictors; hindering the understanding of its pathophysiology; Preoperative diagnosis and correct management are important.