SonoWorld.com uses cookies to improve your experience on the site. Your continued use of the site constitutes your acceptance of use of cookies on this site.
Find out more about how SonoWorld uses cookies. I’m OK with Cookies from SonoWorld - stop showing me this banner.
×
 
170,014 Registered Members as of 12/15/2018.
Breast » Breast
Phyllodes tumor
« Back to Listing
 
 
Presentation This 24 year old female presents for ultrasound of the left breast.  There is a grossly obvious mass protruding from the surface of the breast.
 
 
 
Caption: Mammography images
Description: The mass occupies the entire left (Izquerida) breast.
 
 
 
Caption: Left breast external mass
Description: 
 
 
 
Caption: Color Doppler of the mass
Description: Color Doppler shows blood flow within the mass
 
 
 
Caption: Left breast, radial 12 of the mass
Description: Elastography score 2 suggesting benign classification of lesion
 
 
 
Caption: Left breast, radial 12 of the mass
Description: A second elastography image, again with score 2
 
 
 
Caption: Left Breast Radial 03
Description: Solid Nodules
 
 
 
Caption: Left breast Radial 10-11
Description: Solid nodule at radial 10-11 with some internal inhomogenity
 
 
 
Caption: Surgical specimen
Description: 
 
Differential Diagnosis
Phyllodes tumor
Giant fibroadenoma
Juvenile fibroadenoma
Angiosarcoma
Carcinoma
Inflammatory carcinoma
Adenocarcinoma
 
Final Diagnosis Phyllodes tumor (giant fibroadenoma)
 
Discussion This 24 years old female, gestation 1 caesarean section 1, was sent for sonographic examination of a mass in the left breast.  The mass had been present as a palpable tumor in the breast since the age of 16,  It had remained small in size until onset of pregnancy which stimulated very rapid growth accompanied by intense pain.  By the end of pregnancy (approximately 3 months prior to the present examination) the mass had protruded from the surface of the breast, as a kind of horn covered with skin. 

On ultrasound examination the solid external mass is 6.06 X 5.72 cm and exhibits soft edges with lobulations. Radial images of the breast visualize the mass as solid hypo-echoic rounded nodules, some with increased vascular flow on Color Doppler.  Elastography yielded a Score 2 in the nodules. Prior to our examination, she had a biopsy that showed that it was a phyllodes tumor of the breast. She has scheduled a total left mastectomy that had not been done before due to the pregnancy-cesarean section. In this case, as in many others, Elastography proves to be of value because it suggests the benignity of the mammary lesions.

The benign / malignant phyllodes tumor of breast of fibroepithelial origin is a very rare pathology, it is considered that it corresponds to 0.3 to 1% of all breast tumors, although in a Cuban retrospective study it showed an incidence of 4.1% and in Asia (Singapore) incidents of 6.9% are reported. Its behavior is erratic, often with very rapid growth and its classification as benign, borderline or malignant is not possible with diagnostic imaging . In our case, the extension of the nodular lesions covering the entire radial area of the left breast is striking, as is the intensity of the pain suffered by the patient and the age of the latter (24 years) when the most frequent are older ages (40-50 years). It should be noted that the pregnancy of the patient had been a factor in the acceleration of tumor growth, as previously reported in other studies.

A phyllodes tumour is a rare fibroepithelial neoplasm of the breast.  It will usually appear on ultrasound as a well-defined macro-lobulated mass with smooth margins and mildly heterogenous and hypoechoic internal echoes [1,2].  It is typically large and fast-growing and in the majority of cases is benign.  A very large phyllodes tumor may erode through overlying skin and present as an external fungating breast mass [3].  Findings on imaging studies are not definitively diagnostic of phyllodes tumors. [4]


 
Case References
  1. Phyllodes tumors. Rowell MD, Perry RR, Hsiu JG, Barranco SC.  Am J Surg. 1993 Mar; 165(3):376-9.a
  2. Li L-J, Zeng H, Ou B, et al. Ultrasonic Elastography Features of Phyllodes Tumors of the Breast: A Clinical Research. Coleman WB, ed. PLoS ONE. 2014;9(1):e85257. doi:10.1371/journal.pone.0085257  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3893177/
  3. Nabi J, Akhter SM, Authoy FN. A case of large phyllodes tumor causing "rupture" of the breast: a unique presentation. Case Rep Oncol Med. 2013. 2013:871292.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3666329/
  4. Cole-Beuglet C, Soriano R, Kurtz AB. Ultrasound, x-ray mammography, and histopathology of cystosarcoma phylloides. Radiology. 1983 Feb. 146(2):481-6.  https://pubs.rsna.org/doi/10.1148/radiology.146.2.6294737
  5. Differentiation between phyllodes tumor and fibroadenoma using real-time elastography. Adamietz BR, Kahmann L, Fasching PA, Schulz-Wendtland R, Uder M, Beckmann MW, Meier-Meitinger M.  Ultraschall Med. 2011 Dec;32 Suppl 2:E75-9. doi: 10.1055/s-0031-1282024. Epub 2011 Dec 22.   DOI: 10.1055/s-0031-1282024
  6. Bendifallah S, Canlorbe G. [Common benign breast tumors including fibroadenoma, phyllodes tumors, and papillary lesions: Guidelines]. J Gynecol Obstet Biol Reprod (Paris). 2015 Dec. 44 (10):1017-29. http://reference.medscape.com/medline/abstract/26547891

 
Follow Up See http://diariodeunmedicoii.blogspot.com/search?updated-max=2018-03-26T09:30:00-04:00&max-results=7 for a prior publication of this case (Scroll down about 2/3 of this page to find the case)

TUMOR FILOIDES DE MAMA
  Tumor Filoides de Mama

Femenina 24 años edad, gesta 1 cesárea 1 ,enviada para revisión sonografica de masas en mama izquierda.Presenta tumoración palpable en la mama desde los 16 años, era de pequeño tamaño hasta que en ocasión de un embarazo que terminó en cesárea hace 3 meses, presentó un crecimiento vertiginoso lo cual incluye dolores muy intensos y la aparición de una masa que protuye sobre la mama, como una especie de cuerno recubierto de piel, la masa externa solida de bordes suaves con lobulaciones, mide en la sonografia 6,06 X 5,72 cm ( ver primera imagen). En todos los radiales de la mama se visualizan masas nodulares solidas, hipo-ecogenicas, redondeadas, algunas con incrementos del flujo vascular cuando se aplica el Doppler Color, lo mismo es valido para la Elastografia que al ser aplicada muestra un Score 2 en los nódulos ( ver imágenes ). Previamente a nuestro examen, se le había realizado una biopsia que demostró que se trataba de un tumor Filoides de la mama. Tiene programado una mastectomia izquierda total que no se había realizado antes debido al embarazo-cesárea que la paciente acaba de pasar. En este caso, como en muchos otros la Elastografia demuestra ser de gran valor pues asegura ( hasta prueba en contrario ) la benignidad de las lesiones mamarias.
El tumor filoides benigno/ maligno  de mama de origen fibroepitelial , es una patología muy poco frecuente, se considera que se corresponde a 0,3 al 1 % de todos los tumores de mamas, aunque en un estudio retrospectivo cubano mostró una incidencia de 4,1 % y en Asia ( Singapur )se reportan incidencias de 6,9 %. Su comportamiento es errático, muchas veces con crecimiento muy rápido y su clasificación como benigno, borderline o maligno es incierta. En nuestro caso llama la atención la extensión de las lesiones nodulares que abarcan la totalidad de los radiales de la mama izquierda, la intensidad del dolor que sufre la paciente  y la edad de esta ( 24 años) cuando lo mas frecuente son edades mas avanzada ( 40-50 años ). Hay que resaltar que el embarazo de la paciente ha sido un factor de aceleración del crecimiento tumoral , tal como ha sido reportado previamente en otros estudios.

 
Other Cases in This Category