Giant breast mass

Last revised by Joshua Yap on 13 Jan 2023

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 a 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:

Radiographic features

Mammography and ultrasonography 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. Ultrasound is used primarily to determine whether the mass is simple or complex, cystic or solid.

One algorithmic approach considers whether a mass is well-circumscribed or ill-defined, and the presence or absence of fat density/echogenicity 2.

Giant fibroadenoma vs phyllodes tumor

Differentiation between a giant fibroadenoma and a phyllodes tumor is done on a clinical, mammographic, and sonographic basis 2-4

Giant fibroadenoma
  • occurs at a younger age (25-40 years) with no malignancy risk, may regress with age

  • on mammography, it is a circumscribed low or intermediate density with the incidence of calcifications being more common

  • on ultrasound, it has homogeneous echogenicity, with cystic changes or posterior acoustic enhancement being uncommon

  • is treated by simple excision with no local recurrence expected after surgical excision

Phyllodes tumor
  • occurs at an older age (35-55 years), and exists as a spectrum of pathology between benign and malignant; it has a rapidly progressive course

  • on mammography, it is a circumscribed high-density mass with a less common incidence of calcifications than giant fibroadenoma

  • on ultrasound, it is a well-defined mass with low-level uniform or scattered internal echoes, and fluid-filled, elongated spaces or clefts within

  • it is treated by wide local excision or mastectomy with a high rate of recurrence after surgery of up to 20%

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Cases and figures

  • Case 1: phyllodes tumor
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  • Case 2: phyllodes tumor
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  • Case 3: phyllodes tumor
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  • Case 4: phyllodes tumor
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  • Case 5: phyllodes tumor
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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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