Predominantly affect pre-menopausal women, with peak incidence in the fifth decade of life
Exact aetiology of malignant phyllodes tumours remains unclear
They do not appear to be strongly linked with typical breast cancer risk factors, such as family history or hormonal influences
Some genetic mutations have been suggested, but further research is needed
Clinical features
Usually presents as a rapidly enlarging, smooth, hard, palpable breast mass, sometimes visible as a smooth bulge under the breast skin
In advanced stages, an ulcer may form on the breast
Despite their potential for rapid and aggressive growth, malignant phyllodes tumours rarely metastasise
Investigations
Mammography: malignant phyllodes tumours can appear as round lesions with well-defined borders on mammography.
Biopsy: a biopsy of the tumour tissue is crucial to distinguish between benign and malignant phyllodes tumours, as well as to differentiate from other breast conditions
Management
Surgical
Management strategies are largely dependent on the size of the tumour
Prone to local recurrence if not adequately excised
Small tumours (<2cm) are typically managed with wide local excision, ensuring clear margins
Larger tumours may require mastectomy
Radiotherapy/chemotherapy
Currently, there is limited data supporting the routine use of adjuvant chemotherapy or radiotherapy
However, in certain high-risk or advanced cases, these modalities may be considered