Member of the Duke Cancer Institute
Office:
Duke University Medical Center,
Department of Surgery, Box 3513
Durham, NC 27710
Phone (Office): 919-470-8649
Pager: 919-970-3616
X: @RosenbergerMD
Overview
Phyllodes tumors are rare breast tumors and represent fewer than 1.0% of all primary breast tumors. Most National Comprehensive Cancer Centers treat only about 5-10 phyllodes tumors annually, making collaborative research in this area vital. Dr. Rosenberger and her multi-disciplinary team treat approximately 20-30 women with phyllodes annually at Duke and focus on advancing our understanding of these tumors.
Phyllodes tumors are classified into three subtypes: (1) benign, (2) borderline, and (3) malignant grades, which have extremely diverse biological behavior, and are poorly understood at this time. Benign phyllodes tumors are similar to fibroadenomas, the most common benign breast mass in teenagers, whereas malignant phyllodes, on the other end of the spectrum, have overlapping features with aggressive breast sarcomas. Typically identified in younger women (average age of 40 years), all grades of phyllodes tumors are treated almost exclusively with surgery alone. Surgery remains the only effective therapy, as there is no known effective chemotherapy, immunotherapy, or hormonal therapy. When tumors are metastatic, few treatment options exist making prognosis poor. Because of the rarity of these tumors, there exists common misdiagnosis, inconsistent management, patient anxiety and significant surgical morbidity in these young women due to classically large tumors and no pre-surgical therapies.
Phyllodes Tumor Collaborative Network
The Duke Department of Surgery in collaboration with the Duke Cancer Institute is uniquely positioned to lead critical investigations into the genomic profiling of these rare tumors, development of early detection strategies, prevention, and even the potential development of a therapeutic target. Dr. Rosenberger is the founder and Principal Investigator of an 11-site multi-center collaborative network of Comprehensive Cancer Centers that research phyllodes tumors. She also leads an open phyllodes tumor registry study, which collects biospecimens and stores live tumor/tissue for future research.
Clinical Partners
At Duke, Dr. Rosenberger collaborates with specialists from all areas of breast cancer diagnosis and treatment, including Dr. Juneko Grilley-Olson (Sarcoma Medical Oncology), Dr. Nicole Larrier (Sarcoma Radiation Oncology), Dr. Betty Tong (Thoracic Surgery), and Drs. Geoffroy Sisk and Brett Phillips (Plastic & Reconstructive Surgery). Importantly, these clinicians also collaborate with the scientists within Surgery, Pathology, Genetics, and within the Duke Cancer Institute. Together, these physicians and researchers are developing novel strategies directed at hereditary germline mutation identification, genomic profiling, and the potential to develop future therapeutic targets.
Key Contributions
- Established a multi-institutional Phyllodes Tumor research network with multiple peer-reviewed publications
- Rosenberger LH, Thomas SM, Nimbkar SN, Hieken TJ, Ludwig KK, Jacobs LK, Miller ME, Gallagher KK, Wong J, Neuman HB, Tseng J, Hassinger TE, Jakub JW. Germline Genetic Mutations in a Multi-Center Contemporary Cohort of 550 Phyllodes Tumors; An Opportunity for Expanded Multi-Gene Panel Testing. Annals of Surgical Oncology, 2020; 27:3633-3640. doi: 10.1245/s10434-020-08480-z. PMID: 32504368.
- Rosenberger LH, Thomas SM, Nimbkar SN, Hieken TJ, Ludwig KK, Jacobs LK, Miller ME, Gallagher KK, Wong J, Neuman HB, Tseng J, Hassinger TE, Jakub JW. Variable Practice Patterns in a Contemporary Multi-Institutional Cohort of 550 Cases of Phyllodes Tumors (2007-2017) Demonstrate a Need for More Individualized Margin Guidelines. Journal of Surgical Oncology. 2021; 39:178-189. doi: 10.1200/JCO.20.02647. PMID: 33301374.
- Rosenberger LH, Quintana LM, Thomas SM, Nimbkar SN, Hieken TJ, Ludwig KK, Jacobs LK, Miller ME, Gallagher KK, Wong J, Neuman HB, Tseng J, Hassinger TE, King TA, Jakub JW, Bentley RC, Schnitt SJ. Limited Reporting of Histopathologic Details in a Multi-Institutional Academic Cohort of Phyllodes Tumors: Time for Standardization. Annals of Surgical Oncology. 2021; 28:7404-7409. doi: 10.1245/s10434-021-10118-7. PMID: 33990927.
- Nash AL, Thomas SM, Nimbkar SN, Hieken TJ, Ludwig KK, Jacobs LK, Miller ME, Gallagher KK, Wong J, Neuman HB, Tseng J, Hassinger TE, King TA, Hwang ES, Jakub JW, Rosenberger LH. Racial-Ethnic Variations in Phyllodes Tumor Among a Multicenter United States Cohort. Journal of Surgical Oncology. 2023; 127:369-373. doi: 10.1002/jso.27117. PMID: 36206024.
- Developed the first Phyllodes Tumor Cancer Reporting Protocol for the College of American Pathologists (CAP)
- Established the first prospective Phyllodes Tumor registry study and tissue repository
Lab Members
Samantha Thomas, MS, Senior Biostatistician (2016-Present)
Amanda L. Nash, MD, Duke University General Surgery Resident (2019-Present)
- Oral Presentation: American Society of Breast Surgeon’s 22nd annual meeting
- Nash AL, Rosenberger LH. Image-Guided Breast Biopsy and Cyst Aspiration. The SCORE Portal. https://www.surgicalcore.org/modulecontent.aspx?id=1000456. 2019
- Nash AL, Thomas SM, Plichta JK, Fayanju LM, Hwang ES, Greenup RA, Rosenberger LH. Contralateral Axillary Nodal Metastases: Stage IV Disease or a Manifestation of Progressive Locally Advanced Breast Cancer? Annals of Surgical Oncology. 2021; 28:5544-5552.
- Nash AL, Thomas SM, Nimbkar SN, Hieken TJ, Ludwig KK, Jacobs LK, Miller ME, Gallagher KK, Wong J, Neuman HB, Tseng J, Hassinger TE, King TA, Hwang ES, Jakub JW, Rosenberger LH. Racial-Ethnic Variations in Phyllodes Tumor Among a Multicenter United States Cohort. Journal of Surgical Oncology. 2023; 127:369-373. doi: 10.1002/jso.27117. PMID: 36206024.
Rosenberger LH, Thomas SM, Hieken TJ, Gallagher KK, Spanheimer PM, Neuman HB, Weiss AC, King TA, Wong J, Tong BS, Nash AL, Frazier MP, Menendez CS, Hwang ES, Jakub JW, Plichta JK. Germline genetic mutations in a multi-center cohort of 248 phyllodes tumors. Breast Cancer Res Treat. 2025; 209:275-282. doi: 10.1007/s10549-024-07488-3. PMID: 39269552.
Anna Louie, MD, Duke University General Surgery Resident
- Louie AD, Rosenberger LH. Phyllodes Tumors of the Breast: Addressing the Gaps in Consensus Recommendations for Clinical Management. Ann Surg Oncol. 2023; 30:6296-6298. doi: 10.1245/s10434-023-14147-2. PMID: 37580616.
Elle Reason, BS, Duke Medical Student (2023-present)
- Reason EH, Aiduk MD, Eward WC, Rosenberger LH. Relapsing malignant phyllodes tumour presenting as isolated acrometastases. BMJ Case Rep. 2024; 17: e258640. doi: 10.1136/bcr-2023-258640. PMID: 38960430.
- Reason EH, Sotolongo G, Bentley RC, Factor RE, Jeck WR, Rosenberger LH. Wide Margins are Still Relevant: A Case of a Well-Circumscribed Borderline Phyllodes Tumor With a Satellite Nodule in a Re-excision Margin. Cureus. 2025; 17: e79890. doi:10.7759/cureus.79890
- Oral Presentation: Reason EH, Thomas SM, Plichta JK, Botty van den Bruele AM, Hwang ES, Tong BC, Larrier NA, Grilley-Olson JE, Rosenberger LH. Utility of the Singapore Recurrence Nomogram for Phyllodes Tumors in a United States Cohort. Academic Surgical Congress 20th Annual Meeting. Las Vegas, NV, Feb 11-13, 2025.
Michael Aiduk, BS, Duke Medical Student and Ph.D. Candidate
- Reason EH, Aiduk MD, Eward WC, Rosenberger LH. Relapsing malignant phyllodes tumour presenting as isolated acrometastases. BMJ Case Rep. 2024; 17. doi: 10.1136/bcr-2023-258640. PMID: 38960430.
Beth Bronson, Senior Clinical Research Specialist
Felicia Walton, BS, Clinical Research Coordinator
Prior Lab Members
- Miller KN, McGuire EL, Yon JR, Sutherland JD, Meyer MA, Rosenberger LH. Isolated Liver Metastasis from a Malignant Phyllodes Presenting with Hemoperitoneum. The Breast Journal. 2020; 26:2246-2247.
- Oral Presentation: Society of Surgical Oncology, 73rd annual cancer symposium
- Gutnik L, Ren Y, Thomas SM, Plichta JK, Greenup RA, Fayanju OM, Hwang ES, Rosenberger LH. Malignant Phyllodes Tumor and Primary Breast Sarcoma; Distinct Rare Tumors of the Breast. Journal of Surgical Oncology. 2022; 125:947-957.
- Oral Presentation: American College of Surgeons, 106th annual clinical congress
- Olivere LA, Hill IT, Thomas SM, Codd PJ, Rosenberger LH. RFID Tracking for Tray Optimization: An Instrument Utilization Pilot Study in Surgical Oncology. Journal of Surgical Research. 2021; 264;490-498.
- Hill I, Olivere L, Helmkamp J, Le E, Hill W, Wahlstedt J, Khoury P, Gloria J, Richard MJ, Rosenberger LH, Codd P. Measuring Intraoperative Surgical Instrument Use with Radio-Frequency Identification. JAMIA Open. 2022; 5(1): ooac003.
- Oral Presentation: Society of Surgical Oncology, 73rd annual cancer symposium
- Fellows & Professors Case Presentations; Metachronous Contralateral Axillary Lymph Node Metastases.
Works in Progress
- Phyllodes Prospective Patient Registry & Tumor Biorepository
- The PHYTR lab has the only prospective phyllodes tumor database in the United States, with 124 patients currently enrolled.
- Circulating Tumor DNA (ctDNA) is Reliably Detected in Patients with Metastatic Malignant Phyllodes Tumors; A Feasibility Study.
- We are investigating the role of ctDNA in the surveillance and management of malignant phyllodes tumors.
- In a cohort of nine patients, we have confirmed that detection of ctDNA is feasible in patients with phyllodes tumors and that higher levels are detected in patients with metastatic disease.
- This project will be presented at the American Society of Breast Surgeons 26th Annual Meeting in Las Vegas, NV on May 2nd. Our manuscript is currently in progress.
- Scoping Review on Systemic Therapy for Malignant Phyllodes Tumors
- Given the limited data on the use of systemic therapy for malignant phyllodes tumors, we are conducting a scoping review of all single- and multi-center studies that have evaluated the use of chemotherapy in patients with malignant phyllodes tumors.
- We are working with 12 co-authors, including surgical oncologists and medical oncologists that specialize in sarcoma treatment, from top institutions around the country.
- At present, we have completed the literature search, the abstract screening stage, the full text screening stage, and are now working on extracting data from selected full text articles. We will soon begin drafting the manuscript.
- Utility of the Singapore Recurrence Nomogram for Phyllodes Tumors in a United States Cohort
- In 2012, a nomogram for predicting recurrence of phyllodes tumors was published out of a high-volume center in Singapore.
- This nomogram has never been validated in a United States cohort. We applied this nomogram to the patients in our rare tumor registry and found that it was less accurate at predicting recurrence in patients with malignant tumors.
- This project has been presented at the Academic Surgical Congress 20th Annual Meeting in Las Vegas from February 11-13th, 2025. The manuscript is in progress.
- PHYTR (Phyllodes Tumor Registry) TRIAL; Prospective, Multi-Center Observational Study to Evaluate the Association of Molecular Residual Disease with Metastatic Progression
- The PHYTR trial will a be prospective, multi-center observational arm of a forthcoming interventional trial for those with minimal residual disease (positive ctDNA at 4 weeks post-operation or conversion to positive ctDNA in surveillance period).
- We are currently in the early stages of developing this trial and are recruiting additional centers to participate.
- Genomic Profiling of Malignant Phyllodes Tumors – Defining Targetable Opportunities
- AIM 1: To determine the repertoire of alterations in BLPT & MPT, to define the impact of these on outcomes (undefined), identify potential drivers of disease and potential therapeutic targets.
- AIM 2: To assess the classification of PT by new CAP reporting template, create predictive model for LR and nomogram development.
Research Events
Pictured: Elle Reason (left) and Laura Rosenberger (right)
Back row, left to right: Elle Reason, Laura Rosenberger, Bobby May, Jennifer Plichta
Front row, left to right: Tori Chanenchuk, Akiko Chiba, Danielle Burner
Pictured: Elle Reason presenting her work on the Utility of the Singapore Recurrence Nomogram for Phyllodes Tumors in a United States Cohort
Back row: Drs. Jennifer Plichta, Hannah Woriax, Kendra Parrish, Amanda Nash, Ton Wang, and Sydney Record, BA.
Front row: Drs. Laura Rosenberger, Astrid Botty van den Bruele, Akiko Chiba, Shelley Hwang
Drs. Laura Rosenberger, Astrid Botty van den Bruele, Krislyn Miller, Jennifer Plichta, Gayle Dilalla, Kendra Parrish
Drs. Lola Fayanju, Laura Rosenberger, Jennifer Plichta
Funded Projects and Publications
Dr. Rosenberger's Publications
To view all of Dr. Rosenberger's funded projects and publications, visit her faculty profile.