Phyllodes Tumor of the Breast: Ultrasound-Pathology Correlation

Kalambo, Megan; Adrada, Beatriz E.; Adeyefa, Modupe M.; Krishnamurthy, Savitri; Hess, Ken; Çarkaci, Selin; Whitman, Gary J.

doi:10.2214/ajr.17.18554

Cited by 53 publications

(38 citation statements)

References 22 publications

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“…Jalaguier-Coudray et al and Wiratkapun et al in their papers reported that in ultrasound, present of internal cystic spaces or round cysts in lesions that appear like fibroadenoma is highly suggestive of phyllodes tumors. [ 36 , 37 ] A previous study has also reported a high percentage of cystic components in malignant PTs (80%), albeit a small sample size. [ 38 ] In contrast, equal presence of cystic component in all categorization, was seen in another study.…”

Section: Discussionmentioning

confidence: 97%

Radiopathological characteristics and outcomes of phyllodes tumor of the breast in Malaysian women

et al. 2018

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Phyllodes tumor or cystosarcoma phyllodes is a rare fibroepithelial neoplasm which arises from the periductal stroma of the breast. They are classified as benign, borderline, and malignant based on the histologic features. However, all phyllodes tumor (PT) subtypes are regarded as having malignant potential and correct diagnosis is important for surgical management and optimal care. This study is a retrospective review of 76 women diagnosed as PT with highlights on the imaging characteristics, pathology, and surgical treatment over a 7-year period in a tertiary medical center of urban population in Malaysia. There were 45 benign, 16 borderline, and 15 malignant PT. The median age for benign PT was 43, borderline 48.5, and malignant 42 years. The Malay ethnic group constitute 52.6% of cases, with 27.6% and 18.4% in Chinese and Indian ethnic groups, respectively. On mammograms, most benign (64.3%) and 33.3% of malignant PT showed high-density lesions. Calcifications were only seen in 2 benign PT. On ultrasound, 86% of benign PT was well-circumscribed whilst 50.0% of malignant PT had irregular outline. Cystic spaces were seen in 40.0% of malignant and 9.5% of benign PT. 80% of malignant PT lesions were heterogenous. Malignant PT demonstrates tumor heterogeneity, cystic spaces, and posterior acoustic enhancement on ultrasound. Half of malignant PT showed regular borders on ultrasound and appear well circumscribed on mammogram. A total of 46 patients had wide local excision or excision biopsy whilst 30 underwent mastectomy as primary treatment. The majority of the borderline and malignant PTs in our study (75.0% and 85.7% respectively) and only 5 out of the 43 (11.6%) benign PT underwent mastectomy. There were 2 tumor recurrence in the benign PT group and 1 case in the borderline and malignant group respectively.

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Section: Discussionmentioning

confidence: 97%

Radiopathological characteristics and outcomes of phyllodes tumor of the breast in Malaysian women

et al. 2018

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“…According to Liberman et al most of phyllodes tumors exhibited hypoechoic internal echotexture and posterior acoustic enhancement and the presence of cystic spaces on USG was known to be more common in malignant cases (6). According to Kalambo et al an irregular shape, noncircumscribed margins, and/or mass size > 7 cm may indicate more borderline and malignant subtypes of phyllodes tumors (7). In our case, the mass was observed as a mainly hyperechoic mass, with oval shape, indistinct margin, and cystic portions.…”

Section: Discussionmentioning

confidence: 99%

“…On ultrasonography (USG), most of these tumors exhibited lobulated contours, smooth margins, hypoechoic echotexture, with posterior acoustic enhancement. Malignancy may be suspected if the tumor contains cystic space, or if it is with an irregular shape or non-circumscribed margin (5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Hyperechoic Appearance of Malignant Phyllodes Tumor with Liposarcomatous Differentiation: A Case Report with Pathologic Correlation

et al. 2019

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A malignant phyllodes tumor is a rare disease of the breast that usually differentiates into fibrosarcoma, with liposarcomatous differentiation rarely being reported. In general, malignant phyllodes tumors appear as hypoechoic lesions on ultrasonography examination, and have rarely been reported as hyperechoic tumors. Here, we present an extremely rare case of a 62-year-old woman with a palpable mass that was diagnosed as a malignant phyllodes tumor with liposarcomatous differentiation, seen as an unusual hyperechoic mass on ultrasonography. She underwent resection and biopsy, and there was no evidence of tumor recurrence on follow-up examinations. Radiological explanations of this case are presented in detail, and the possible associations between hyperechoic appearance and liposarcomatous differentiation are described. Through our case report, we can identify several potential rare features of various and unpredictable phyllodes tumors.

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“…Although juvenile fibroadenoma is easily distinguishable from PT from a histological point of view, the condition can initially cause signs and symptoms that are similar to those of PT. Moreover, the US features are quite similar [ 17 ] and do not permit either the differentiation of PT from juvenile fibroadenoma or the evaluation of the type of PT [ 18 ]. Only magnetic resonance imaging (MRI) can be useful for the diagnosis and to establish the relationship of the mass with the surrounding normal tissue [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Inflamed Phylloides Tumour in a Girl: A Challenging Diagnosis in Paediatric Breast Lesions

Testa

Salvatori

Prestipino

et al. 2018

IJERPH

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Introduction: Phylloides tumours (PTs) are rare fibroepithelial neoplasms that account for 0.3–0.9% of all breast tumours. These tumours typically occur in women aged 30–70 years. The occurrence of these tumours in older children and adolescents poses particular diagnostic and therapeutic problems. However, early diagnosis is mandatory because although most of the cases of PTs in children are benign, the borderline and malignant cases with potential negative outcomes cannot be excluded. Case presentation: A 12-year-old girl presented at the Paediatric Emergency Department for hyperaemia and warmth of the left breast that occurred a few days prior without fever. The girl experienced menarche 8 months previously. She experienced no previous trauma and she had no family history of breast cancer. On physical examination, the left breast was painful, enlarged and tender. The overlying skin was erythematous and warm. A breast ultrasonography (US) revealed a large mass with features of an abscess, including a hyperechoic wall, scattered internal echoes and hypoechoic peripheral lacunae of apparent colliquative nature. After 4 days of unsuccessful antibiotic therapy, surgical drainage was performed due to the suspicion of a mammary abscess. At the surgical incision site, the lesion was not-well circumscribed and lacked a capsule. In addition, purulent material was not detected. Histological examination revealed that the tissue alterations were compatible with benign PT. With this diagnosis, the girl underwent definitive surgical removal of the lesion. The postoperative period passed without negative events. An US performed 6 months later revealed that no new mass was present at this time, suggesting no recurrence of the tumour. Conclusion: This case shows that in the presence of a clinical picture suggesting the inflammation of the breast in adolescent females, PT should be considered as a possible diagnosis and US-guided core biopsy should be considered to confirm this suspicion. Thereafter, when surgical excision is performed, particular attention must be paid to both the preservation of all the normal breast parenchyma and future aesthetic problems.

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Phyllodes Tumor of the Breast: Ultrasound-Pathology Correlation

Cited by 53 publications

References 22 publications

Radiopathological characteristics and outcomes of phyllodes tumor of the breast in Malaysian women

Radiopathological characteristics and outcomes of phyllodes tumor of the breast in Malaysian women

Hyperechoic Appearance of Malignant Phyllodes Tumor with Liposarcomatous Differentiation: A Case Report with Pathologic Correlation

Inflamed Phylloides Tumour in a Girl: A Challenging Diagnosis in Paediatric Breast Lesions

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