Giant breast mass

Last revised by Dr Rohit Sharma on 07 Sep 2022

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.

Pathology

A wide variety of breast conditions can result in solitary or multiple giant masses:

Radiographic features

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 2-4Phyllodes 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.

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Cases and figures

  • Case 1: giant breast mass (Phyllodes tumor)
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  • Case 2: giant breast mass (Phyllodes tumor)
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  • Case 3: phyllodes tumor
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  • Case 4: phyllodes tumor right breast
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  • Case 5: phyllodes tumor right breast
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  • Case 6: breast hamartoma
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  • Case 7: breast lipoma
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  • Case 8: giant breast hamartoma
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