2017 Resarch Forum

OB/GYN: C-1

A pplicant: Sherryann Taylor-Santos MD Principal Investigator: Sally Nalesnik,MD

Phyllodes tumor of the vulva: a case report and review of the literature Sherryann Taylor-Santos MD, Nathan Abdelsayed MS IV, Sally Nalesnik, MD

INTRODUCTION Phyllodes tumors are fibroepithelial tumors of the breast which are uncommon. Phyllodes tumors account for less than 0.5% of all breast malignancy 1,2 . Characteristic histopathological appearance shows papillary projections and cystic characteristics 5,6 . PURPOSE In this case report, we report a 46-year old African American female with benign phyllodes tumor of the vulva. She presented with an approximately 6 cm slow growing mass located on the right vulva. The mass was removed with wide local excision. DISCUSSION Phyllodes tumors are known for their characteristic histological appearance of leaf like structures. Phyllodes tumors are usually found in the breast; they account for approximately 1% of primary breast tumors 1,2 . Phyllodes of the breast can be classified in three different groups: benign, malignant or borderline. WHO classification uses stromal cellularity, degree of cellular pleomorphism, number of mitosis, infiltration of margins, and heterologous differentiation to help classify the lesion 1 . Those of benign behavior have low mitoses and those of malignant concern are thought to have sarcomatous stroma and prominent mitoses. Cases of phyllodes tumor are much more frequently found in the breast but to date, the review of the literature found 14 cases that have shown phyllodes tumors in the vulva. Differential diagnosis includes fibroadenoma, papillary hidradenoma and chondroid syringoma. In comparison, the stroma of fibroadenoma is generally less cellular without cytologic atypia and more homogenous compared to phyllodes. 1 The initial thought was that is a supernumerary breast tissue that is derived from the milk line. This was disputed by van der Putte stating that the lesions may have come from mammary like anogenital glands, that are part of normal anogenital epithelium 5,6 . Phyllodes tumor usually presents as painless unilateral mass, often being found in the labia majora, minora and interlabial cleft. Patients can present with an enlarging mass or stable vulvar mass or cyst 1,3, 4 . Histologically the tumors contain the identifiable epithelial and stromal features of the breast mass 1,2 . Using WHO guidelines for the phyllodes tumor of the breast, there has been one case of a malignant mass in the vulva 7 , and multiple cases of borderline or benign masses 1-4 . Phyllodes tumor of the vulva are very rare and have similar morphology of fibroadenoma which suggest they may be of common source. A wide local excision was done and noted to be an adequate form of treatment with clear margins. It has been shown that recurrence can occur if incompletely excised 7,8,14 . CONCLUSION We present this case to describe a very rare tumor and its occurrence in a rare location. We will also discuss the pathogenesis and histopathology of this tumor as well as, a review of the literature.