Neoplasia: phyllodes tumour: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Neoplasia: phyllodes tumour

Sample item

A 45-year-old woman has a rapidly enlarging, mobile 8 cm breast mass. Core biopsy shows leaf-like architecture and markedly hypercellular, atypical stroma with frequent mitoses. Which statement about the behaviour of the malignant form of this tumour is correct?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. It spreads by the bloodstream, usually to the lungs, and axillary nodal metastasis is uncommon

Phyllodes tumours have a benign epithelium and a neoplastic stroma, and only the stromal component metastasises, haematogenously to lung and bone. Because nodal spread is rare, axillary dissection is not routine, and the treatment is wide excision. Local recurrence is common if margins are inadequate.

Option by option

  • A. It is hormone-receptor driven and is controlled by tamoxifen

    Endocrine therapy is not the mainstay, since the neoplastic stroma is not hormone driven.

  • B. It is almost always bilateral and arises from lobular carcinoma in situ

    Phyllodes tumours are usually unilateral and unrelated to lobular carcinoma in situ.

  • C. It spreads by the bloodstream, usually to the lungs, and axillary nodal metastasis is uncommon (correct)

    Stromal sarcomatous spread is haematogenous, mostly to lungs.

  • D. Metastasis arises from the epithelial component and goes mainly to axillary nodes

    The epithelial component is benign and does not drive metastasis, and nodal spread is rare.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is C, It spreads by the bloodstream, usually to the lungs, and axillary nodal metastasis is uncommon. Phyllodes tumours have a benign epithelium and a neoplastic stroma, and only the stromal component metastasises, haematogenously to lung and bone.

Why is "It is hormone-receptor driven and is controlled by tamoxifen" not the answer?

Endocrine therapy is not the mainstay, since the neoplastic stroma is not hormone driven.

Why is "It is almost always bilateral and arises from lobular carcinoma in si…" not the answer?

Phyllodes tumours are usually unilateral and unrelated to lobular carcinoma in situ.

Why is "Metastasis arises from the epithelial component and goes mainly to ax…" not the answer?

The epithelial component is benign and does not drive metastasis, and nodal spread is rare.

What concept does this question test?

It tests Neoplasia: phyllodes tumour in Pathology. Because nodal spread is rare, axillary dissection is not routine, and the treatment is wide excision. Local recurrence is common if margins are inadequate.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neoplasia: phyllodes tumour?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.