by darkfairy

Phyllodes tumours are very rare tumours of the breast and phyllodes metastases is even rarer but it can and does happen. Metastases have only been reported after diagnosis of a malignant phyllodes – ie no cases have been reported of metastases with benign or borderline phyllodes – and they seem to be more prolific in cases where the original malignant tumour had a high mitotic count and/or was found to have stromal overgrowth. Metastases can also occur if clear margins were not taken when the original malignant phyllodes was removed thus leaving a residue of cells behind.

Symptoms of metastases can include weight loss, fever, pain, shortness of breath or there may be no symptoms at all. It is for this reason that regular follow-ups should be conducted in the case of malignant phyllodes with a high mitotic count.

When phyllodes metastasize, they usually form soft tissue sarcomas. Favoured sites are the lungs, liver, brain and bones. Phyllodes tumours contain something called spindle cells and the fact that these spindle cells have been discovered within the phyllodes metastases raises the question of how they got there.

Unlike common breast cancer, phyllodes spread through the blood stream rather than the lymphatic system. The author of this article would question the safety of tissue reconstructions (eg LD, DIEP, TRAM, SGAP) after mastectomy to remove phyllodes tumours – should any spindle cells remain in the breast area after surgery, would transplanting fresh tissue from another part of the body not form an easy network for spindle cells to travel to a new site? Such a theory has yet to be tested scientifically.

Once phyllodes metastases has been discovered, treatment must be carried out quickly to prevent further spread. In cases where the tumour can be removed surgically, this will be recommended as a first option – again, clear margins must be obtained to ensure no recurrence. Radiotherapy and chemotherapy may be recommended but both are experimental as there have not been enough trials to assess their effectiveness.

There are no long-term reports on patients who have managed phyllodes metastases. For this reason, prognosis is considered to be rather poor – in some cases the patient will have as little as a few months to live after diagnosis.