Phyllodes tumor

Case contributed by Dr Ammar Ashraf

Presentation

Mildly painful slowly growing left breast mass for 1 year. No history of nipple discharge or skin color changes.

Patient Data

Age: 50 years
Gender: Female
Mammography

A well-defined soft tissue density measuring approximately 2.2 x 2.4 x 2.6 cm is seen at 11-12 o'clock position in the left breast. Another small well-defined, benign looking soft tissue density nodule measuring approximately 3 mm is noted in the upper-outer quadrant of the left breast. No pleomorphic microcalcification clusters, abnormal skin thickening or nipple retraction is seen in either breast. No significant axillary lymphadenopathy is seen.

Ultrasound

A well-defined hypoechoic lesion with lobulated outlines measuring approximately 2.0 x 2.1 cm is noted at 11 o'clock position in the left breast, which is likely a fibroadenoma. No calcifications or internal vascularity is seen in it. Another small hypoechoic oval shape nodule measuring about 4 x 6 mm is noted at 2 o'clock in the left breast which is likely an intramammary lymph node or fibroadenoma.

MRI

A focal, well-defined, rounded, soft tissue lesion measuring 2.2 x 2.6 cm is seen at 11 o'clock position in the left breast. Another tiny well-defined nodule measuring 3.2 x 3.9 mm is seen at 2 o'clock position in the left breast. These nodules show type I curve enhancement (smaller nodule not shown here). No significant axillary lymphadenopathy is seen. 

Case Discussion

Procedure: Tru-cut biopsy followed by the left breast lumpectomy. 

Diagnosis: Phyllodes tumor (low-grade). Mitotic rate: 3 mitoses per 10 high-power fields. Size: 2.5 cm. Negative for atypia. Margins: free (tumor is entirely excised).

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