|LETTER TO EDITOR
|Year : 2022 | Volume
| Issue : 1 | Page : 168-169
Phyllodes tumor of the breast in a postmenopausal woman: Radio- pathological correlation of a rare entity
Department of Radiology, St. John's Hospital, Bengaluru, Karnataka, India
|Date of Submission||31-Mar-2021|
|Date of Decision||09-Apr-2021|
|Date of Acceptance||05-Jan-2022|
|Date of Web Publication||27-Jun-2022|
Dr. Ravikanth Reddy
Department of Radiology, St. John's Hospital, Bengaluru - 560 034, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Reddy R. Phyllodes tumor of the breast in a postmenopausal woman: Radio- pathological correlation of a rare entity. BLDE Univ J Health Sci 2022;7:168-9
A 60-year-old elderly female was referred to the department of general surgery with a history of painless lump in the right breast showing progressive increase in size for 10 years. There was no significant family history or a history of abnormal nipple discharge. On physical examination, a firm mass lesion was palpable measuring approximately 11 cm × 9 cm × 10 cm in the superior quadrants of the right breast. There was no evidence of superficial skin ulceration or significant axillary lymphadenopathy. Laboratory investigations revealed that the complete blood cell picture and serum biochemical profile were within normal limits. Ultrasonography (Toshiba Xario 200; Toshiba Medical Systems Corporation, Otawara, Japan) of the breast was performed with a curvilinear probe of 3.75 MHz which demonstrated a large well-defined, heteroechoic, and predominantly hypoechoic mass lesion measuring 11 cm × 9 cm × 10 cm (mediolateral × anteropo sterior × craniocaudal dimensions) with prominent central vascularity located in the upper outer quadrant of the right breast with retroareolar extension [Figure 1]a and [Figure 1]b. On ultrasonography, the mass lesion was categorized as Breast Imaging Reporting and Data System 3 based on irregular shape with hazy margins which only recommended a short-interval follow-up after 6 months. Based on ultrasonography findings, the differential diagnosis included phyllodes tumor (cystosarcoma phyllodes) and giant fibroadenoma. Histopathological examination of the core tissue biopsy of the mass lesion confirmed the diagnosis of cystosarcoma phyllodes [Figure 2]. Phyllodes tumor of the breast is a rare benign fibroepithelial neoplasm which constitutes 0.3%–1% of breast tumors. Phyllodes tumor represents a transitional entity in the morphologic continuum from benign to malignant tumors of the breast. The World Health Organization classification of phyllodes tumors into malignant, borderline, and benign types is based on histopathology findings such as tumor margins, nuclear atypia, mitotic activity, stromal cellularity, and stromal overgrowth. On ultrasonography, phyllodes tumor is noted to be a well-circumscribed mass lesion with lobulated margins having an echogenic rim and displaying homogenous low-level internal echoes. High-resolution ultrasonography demonstrates a solid mass lesion with fluid-filled clefts, good thorough transmission, and devoid of microcalcifications. Phyllodes tumor is a clinically benign entity characterized by rapid intracanalicular growth pattern with leaf-like projections on gross pathology occurring typically during the perimenopausal age. Malignant transformation of phyllodes tumor is a relatively rare phenomenon and is characterized by infiltrative margins, frequent mitotic figures, nuclear atypia, and enhanced stromal pleomorphism. The diagnosis of malignant transformation of phyllodes tumor is largely based on clinical suspicion and is often delayed until review of the surgically excised specimen on histopathology examination. Ultrasonography and mammography are often inconclusive, and histopathological examination remains the mainstay for establishing a diagnosis of phyllodes tumor. Wide excision of the mass lesion with tumor-free margins is the treatment of choice for benign and borderline types of phyllodes tumor, and simple mastectomy is the usual option for malignant types. However, mastectomy with breast reconstruction may be reserved for giant phyllodes tumors which has completely replaced the normal breast parenchyma. The recurrence rate of phyllodes tumor following wide excision ranges from 3.4% to 13.2%. In conclusion, cystosarcoma phyllodes is a rare benign tumor of the breast in the perimenopausal age group. Patients typically present with a large, firm, well-circumscribed, painless mass lesion of the breast characterized by rapid growth progression. Phyllodes tumor of the breast, even though benign, can still mimic a malignant breast tumor due to its growth pattern and prominent central vascularity.
|Figure 1: (a) Transverse ultrasonography image demonstrating a well-circumscribed heterogeneous, hypoechoic mass lesion with lobulated margins in the right breast. (b) Color Doppler ultrasonography image demonstrating central vascularity within the mass lesion|
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|Figure 2: Histopathology image of the core biopsy specimen of breast lesion demonstrating stromal pleomorphism, frequent mitosis, and infiltrative borders consistent with features of phyllodes tumor (H and E, ×400)|
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Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
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[Figure 1], [Figure 2]