Phyllodes Tumor of the Breast

Thirty nine year old Female with Rapidly Enlarging Right Breast Mass • Xray of the Week

This 39 year old female presented with a rapidly enlarging right breast mass. Mammogram and ultrasound were performed. The patient had an ultrasound guided biopsy of the mass, and subsequent excision. What did the surgeon find?

Left: Right breast ultrasound showing a large mass measuring 13.8 x 6.4 cm with peripheral heterogeneity.

Right: Bilateral MLO mammogram images. Normal left breast and large mass throughout most of the right breast.

Ultrasound-guided biopsy of the large right breast mass.

Phyllodes tumor is a rare mass of the breast, comprising less than 1% of breast cancers. Usually found as a rapidly enlarging mass in women between ages 35 and 60, the tumor is almost always benign. Some case are classified as borderline, and less than 10% of these tumors are frankly malignant with distant metastases. However, at least 25% of the time there is local recurrence following excision and a wide resection margin is required. Very large masses often require mastectomy. In the rare cases of metastatic disease, treatment is similar to sarcoma, rather than breast cancer regimens.

References:

1. Fibrous Lesions of the Breast: Imaging-Pathologic Correlation RadioGraphics 2005; 25:1547–1559 http://pubs.rsna.org/doi/full/10.1148/rg.256045183

2. Tan H, Zhang S, Liu H et-al. Imaging findings in phyllodes tumors of the breast. European J Radiology. 2011; 81 (1):e62–e69 doi:10.1016/j.ejrad.2011.01.085

3. Buchberger W, Strasser K, Heim K et-al. Phylloides tumor: findings on mammography, sonography, and aspiration cytology in 10 cases. AJR Am J Roentgenol. 1991;157 (4): 715-9.

4. Lifshitz OH, Whitman GJ, Sahin AA et-al. Radiologic-pathologic conferences of the University of Texas M.D. Anderson Cancer Center. Phyllodes tumor of the breast. AJR Am J Roentgenol. 2003;180 (2): 332.

5. Wurdinger S, Herzog AB, Fischer DR et-al. Differentiation of phyllodes breast tumors from fibroadenomas on MRI. AJR Am J Roentgenol. 2005;185 (5): 1317-21.

6. Chao TC, Lo YF, Chen SC et-al. Sonographic features of phyllodes tumors of the breast. Ultrasound Obstet Gynecol. 2002;20 (1): 64-71.

7. Yabuuchi H, Soeda H, Matsuo Y et-al. Phyllodes tumor of the breast: correlation between MR findings and histologic grade. Radiology. 2006;241 (3): 702-9. doi:10.1148/radiol.2413051470

Kevin M. Rice, MD is the president of Global Radiology CME

Dr. Rice serves as the Chair of the Radiology Department of Valley Presbyterian Hospital in Los Angeles, California and is a Radiologist with Renaissance Imaging Medical Associates. Dr. Rice has made several media appearances as part of his ongoing commitment to public education. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. In 2015 Dr. Rice founded Global Radiology CME to provide innovative radiology education at exciting international destinations, with the world's foremost authorities in their field.

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