PMC8597354_01
Clinical examination revealed a large phyllodes tumor in the left breast: front image (A) and lateral image (B)
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F1
Left axillary lymphadenopathy of approximately 1.8/1 cm was also identified (Figure 1, A and B).
Ultrasonography of the left breast revealed an enlargement of the breast, with a mixed echostructure and a decreased blood flow signal on Doppler (A). The CT of the left breast showing a mass that is not invading the adjacent structures (B). CT: Computed tomography
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F2
Lymph node images were described intramammary, axillary (the station I), and retro-mammary, with dimensions less than 2 cm (Figure 2B).
Left mastectomy specimen measuring 18/17/5 cm (A). Tumor mass of 10 cm, well defined, fibromatous, with areas of necrosis and hemorrhages (B)
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F3
Three ganglia with diffuse sclerosis were identified in the left axillary adenopathy block (Figure 3, A and B).
IHC analysis of the left breast revealed: (A) Detail with "leaf-like" epithelial structures; (B) CD34-positive reaction in vessels and stromal cells, negative reaction in epithelial cells (x100); (C) IHC staining for ERs, positive reaction in epithelial cell nuclei (x100); (D) Ki67 positive in both stromal and epithelial cells, in a proportion of approximately 20% (x200); (E) p53 positive in approximately 35% of stromal cells, negative in epithelial cells (x400); (F) The area with a fibroadenomatoid appearance, with ducts flattened in deer antlers. HE staining: (A) x200; (F) x100. CD34: Cluster of differentiation 34; ERs: Estrogen receptors; HE: Hematoxylin-Eosin; IHC: Immunohistochemical
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Immunohistochemical examination was carried out and showed positivity in tumor cells in the epithelial component for E-cadherin and estrogen receptors (ERs) (55%) (Figure 4C). p53 was positive in approximately 35% of tumor cells in the stromal component, with a mosaic pattern (Figure 4E). In tumor cells from the stromal component, cluster of differentiation (CD)34 was zonal positive (Figure 4B) and Ki67 was positive in 15% of cells (Figure 4D).
(A) Patient at three months postoperative. (B) Result of DIEP flap breast reconstruction. DIEP: Deep inferior epigastric perforators
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