Grading a phyllodes tumour depends on finding its worst area, and heterogeneity is the rule. Sample generously, with more blocks from solid, fleshy or haemorrhagic areas and from the tumour edge, where infiltrative growth is judged.
Count mitoses in the most active stromal area, and look specifically for heterologous elements. If the first sections suggest a higher grade than expected, or a feature is equivocal, take further blocks before signing out.
- Take extra blocks from fleshy, solid or haemorrhagic areas.
- Sample the margin to assess the growth pattern.
- Count mitoses in the most cellular stromal area.
- Go back for more blocks when a grading feature is borderline.
Why it matters
Under-sampling is a common reason a malignant phyllodes tumour is graded borderline.
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