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Case 1

Phyllodes (Phylloides or Cystosarcoma Phyllodes) Tumor: Wide Local Excision is the Preferred Method of Treatment

The sonogram from October 7, 1999 (Fig. 1A) shows a subcentimeter circumscribed solid nodule suggestive of a fibroadenoma. The sonogram from February 10, 2000 (Fig. 1B) shows a large macrolobulated mass in the same location as the small nodule. The mass is predominately homogeneous, circumscribed, and hypoechoic to adjacent fibroglandular parenchyma. Doppler sonography shows internal vascularity (Fig. 1C).

View larger version (89K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A. —52-year-old woman with enlarging palpable mass in upper outer right breast. Targeted sonogram of upper outer right breast. Note subcentimeter well-circumscribed nodule (arrows).

View larger version (95K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B. —52-year-old woman with enlarging palpable mass in upper outer right breast. Targeted sonogram of same area in right breast 4 months after A. Note large macrolobulated mass (arrows) where previously only small nodule was identified.

View larger version (109K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C. —52-year-old woman with enlarging palpable mass in upper outer right breast. Doppler sonogram of mass shows internal flow (arrowhead).

Phyllodes tumors are usually identical to fibroadenomas on sonography. The key to differentiating phyllodes tumors from fibroadenomas is the relatively large size and rapid growth of phyllodes tumors. Occasionally, small fluid-filled spaces are identified within the mass. The term "phyllodes" is derived from the Greek word meaning leaf. The mass in this case shows the classic "leafy" (shamrock) pattern of growth.

Medullary carcinoma is a reasonable choice in this case because it can have the appearance of a lobulated well-circumscribed mass. However, medullary carcinoma is typically more indolent and would not be expected to grow as quickly as the mass in this patient did.

Phyllodes tumors are uncommon tumors similar to fibroadenomas in that both consist of epithelial and stromal elements originating from the terminal duct lobular unit. Phyllodes tumors differ from fibroadenomas in that they show increased cellularity and overgrowth of the stromal component and commonly have irregular margins that may extend into the adjacent mammary tissue [1]. Most of these tumors are benign and indolent, but approximately 25% will recur locally if treated incompletely [2]. Approximately 10% contain sarcomatous elements and may metastasize to the lungs, pleura, or bones. Phyllodes tumors usually do not metastasize to the axilla by way of the lymphatics but more often metastasize hematogenously [2].

Wide excision is preferred; however, if the tumor recurs, a more radical wide excision or mastectomy is the treatment of choice.

References

1. Kopans DB. Breast imaging. Philadelphia: Lippincott-Raven, 1998:594 -598[Abstract/Free Full Text]
2. Sewell CW. 19th annual Pittsburgh breast imaging seminar. Pittsburgh Mercy Health System and Pittsburgh Breast Imaging Seminar Associates, October 1999:13 -15[Medline]

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This Article Figures Only Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Sinclair, D. S. Articles by Spigos, D. G. Search for Related Content PubMed PubMed Citation Articles by Sinclair, D. S. Articles by Spigos, D. G. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?