Giant breast mass
Citation, DOI & article data
Giant breast masses are defined as breast masses >5 cm and may represent a late presentation of breast pathology, particularly in developing countries. They may be single or multiple and either benign or malignant. Many of the underlying etiologies for giant breast masses are indistinguishable on physical examination alone. Some of these lesions require mastectomy while others can be treated by local excision, aspiration or even conservative measures 1,2.
A wide variety of breast conditions can result in solitary or multiple giant masses:
Ultrasonography and mammography are the two basic imaging techniques for routine diagnostic imaging of breast diseases. For women over the age of 35 years presenting with a palpable or suspected breast mass, mammography is often the first imaging investigation to be performed. The US is used to determine whether the mass is a simple cyst or a complex or solid mass.
One algorithmic approach is based on mammographic features, i.e. whether a mass is well-circumscribed or not, and the presence of fat density with ultrasound, to determine whether the mass is a simple cyst, a complex mass, or a solid mass 2. Well-circumscribed masses with fat density on mammogram include lipoma and hamartoma and without fat density include a cyst, hematoma, giant fibroadenoma, phyllodes tumor and malignant masses as medullary carcinoma and primary lymphoma. Ill-defined mass on mammogram included breast carcinoma and breast abscess.
Differentiation between giant fibroadenoma and phyllodes tumor is done on a clinical, mammographic and sonographic basis. Giant fibroadenoma occurs at a younger age (25-40 years) with no malignancy risk, may regress with age, and is treated by simple excision with no local recurrence expected after surgical excision. On mammography, it will appear as a circumscribed low or intermediate density with the incidence of calcifications being more common. On sonography, it has homogeneous echogenicity with uncommon cystic changes or posterior acoustic enhancement 2-4. Phyllodes tumor occurs at an older age (35-55 years), and exist as a spectrum of pathology between benign and malignant. It has a rapidly progressive course with a high rate of recurrence after surgery of up to 20%. It is treated by wide local excision or mastectomy. On mammography it appears as a circumscribed high-density mass with a less common incidence of calcifications than giant fibroadenoma. On sonography, it appears as a well-defined mass with low-level uniform or scattered internal echoes, fluid-filled, elongated spaces or clefts within 2-4.
- 1. Moustafa A. Sonomammographic evaluation of circumscribed giant solid breast masses. European Congress of Radiology 2015.
- 2. Muttarak M, Chaiwun B. Imaging of giant breast masses with pathological correlation. (2004) Singapore medical journal. 45 (3): 132-9. Pubmed
- 3. Parker SJ, Harries SA. Phyllodes tumours. (2001) Postgraduate medical journal. 77 (909): 428-35. Pubmed
- 4. Eyl D. DIFFERENTIATION OF PHYLLODES TUMORS VERSUS FIBROADENOMAS Mammographic and sonographic features. 2002;43:34–9.
- 5. Chung J, Son EJ, Kim JA, Kim EK, Kwak JY, Jeong J. Giant phyllodes tumors of the breast: imaging findings with clinicopathological correlation in 14 cases. (2011) Clinical imaging. 35 (2): 102-7. doi:10.1016/j.clinimag.2010.01.004 - Pubmed