PMC3895737_01
Bulky tumor mass with extensive necrosis and ulceration was seen on left breast.
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F1
The mass was extruded skin outside, and skin overlying the mass was thickened with edematous change (Figure 1).
Image findings. (a) Enhanced chest computed tomography (CT) showing a huge breast mass with necrosis and multiple lymph node (LN) enlargements in the left axilla, both supraclavicular area. (b) 18 F-FDG positron emission tomography (PET)/CT revealed a huge uneven hypermetabolic mass and massive hypermetabolic LN metastases without the evidence of distant organ metastasis.
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F2
A chest computerized tomography (CT) showed a 22-cm-sized huge breast mass with necrotic changes and multiple LN enlargements in the left axilla, both supraclavicular and parasternal areas including the left internal mammary and paracardiac LNs (Figure 2a). On 18 F-FDG positron emission tomography (PET)/CT, a huge uneven hypermetabolic mass was seen in the left breast, and there was no evidence of distant organ metastasis except for extensive hypermetabolic LN metastasis (Figure 2b).
Pathologic findings and photomicrographs of the rumor. (a) Macroscopic examination of the left breast showed a well demarcated mass which composed of two separated tumorous lesions; phyllodes tumor (red arrow) and invasive carcinoma of no special type (blue arrow) with clearly defined margin (white thick arrows). (b) Malignant phyllodes tumor showing a marked stromal cell proliferation with brisk mitotic activity, resembling fibrosarcoma (original magnification x 400). (c) Area of invasive carcinoma of no special type (original magnification x 400). (d) Area with pleomorphic carcinoma (original magnification x 400).
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F3
Macroscopic examination of the resection specimen revealed a firm and well-demarcated mass with hemorrhage and necrosis, measuring approximately 24 cm in the largest dimension (Figure 3a). The malignant phyllodes tumor was composed of highly cellular stromal cells, moderate and variable nuclear atypia, and increased mitotic activity (>10 mitotic figures per 10 high-power fields) (Figure 3b). In addition, in almost one-third of the tumor, frankly invasive carcinoma of no special type (Figure 3c) with foci of pleomorphic carcinoma was observed (Figure 3d).
Photomicrographs of the tumor. (a) Thickened skin showing dermal lymphatic tumor emboli (original magnification x 100). (b) Collision tumor composed of phyllodes tumor and invasive carcinoma of no special type (original magnification x 40).
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F4
The skin was thickened and showed pathognomonic dermal lymphatic tumor emboli, consistent with inflammatory carcinoma (Figure 4a). On serial section, there was no histologic evidence of transition from phyllodes tumor to invasive ductal carcinoma, so the lesion was thought to be a collision tumor with invasive carcinoma of no special type and malignant PT, rather than ductal carcinoma arising from PT (Figure 4b).