PMC5681332_01
A) Transverse ultrasound image of the left breast demonstrates a heterogeneous, mostly hypoechoic mass (blue arrows), the full extent of which is not demonstrated on the images. B) Transverse ultrasound image of the left breast with color doppler interrogation demonstrates a heterogeneous, mostly hypoechoic mass with internal vascularity (blue arrows), the full extent of the mass is not demonstrated on the images.
gr1.jpg
PMC5681332_01_gr1.jpg
fig0005
An ultrasound revealed a heterogeneous, mostly hypoechoic mass with internal vascularity (Fig. 1A, and B).
Mammogram imaging of the left breast. A). The right craniocaudal view showing heterogeneously dense breast tissue with a fairly well defined spherical opacity in the right upper inner quadrant (blue arrows). B). The left craniocaudal view showing a large mass 13 cm (AP) x 13 cm (TS) with lobulated margins replacing most of the left breast parenchyma (blue arrows). A few scattered foci of coarse, punctate and plaque-like calcifications are seen within the mass centrally (red arrows).
gr2.jpg
PMC5681332_01_gr2.jpg
fig0010
A mammogram revealed a heterogeneously dense breast tissue with a well-defined spherical opacity in the right upper inner quadrant (Fig. 2A). Further, a large mass with lobulated margins replacing most of the left breast parenchyma along with a few scattered foci of coarse, punctate and plaque-like calcifications were noted (Fig. 2B).
Images from a CT chest post IV contrast in the arterial phase and in soft tissue window without significant enhancement post IV contrast administration. A). Axial view. Partially seen in the field of view of the scan is a large lobulated soft tissue density mass in the left breast corresponding to the previously seen mammographic mass (blue arrows). The visualized portion measures 9 cm (AP) x 12 cm (TS). No enlarged axillary or internal mammary lymph nodes seen. B). Coronal image. Partially seen in the field of view of the scan is a large lobulated soft tissue density mass in the left breast corresponding to the previously seen mammographic mass (blue arrows). Few central calcifications were observed (red arrow). The visualized portion measures 12 cm (TS) x 12 cm (Cranial-Caudal, CC). C) Para-sagittal image. Partially seen in the field of view of the scan is a large lobulated soft tissue density mass in the left breast corresponding to the previously seen mammographic mass (blue arrows). The visualized portion measures 9 cm (AP) x 12 cm (CC).
gr3.jpg
PMC5681332_01_gr3.jpg
fig0015
Computed tomography (CT) imaging of the chest revealed a large lobulated soft tissue density mass in the left breast (Fig. 3A-C).
Phyllodes tumor biopsy shows marked stromal cellularity with mild pleomorphism (Hematoxylin and eosin, H&E; 20x).
gr4.jpg
PMC5681332_01_gr4.jpg
fig0020
An ultrasound-guided Tru-cut needle biopsy demonstrated features such as high stromal cellularity with moderate pleomorphism that would support a differential diagnosis of benign PT (Fig. 4).
Phyllodes tumor. Glandular elements showing duct hyperplasia at the periphery of the tumor (black arrow head). (H&E;10x).
gr5.jpg
PMC5681332_01_gr5.jpg
fig0025
The epithelial component in the adjoining tissue and tumor showed ductal and lobular hyperplasia and focal in situ carcinoma (Fig. 5).
Phyllodes tumor. Cellular stroma shows brisk mitoses (black arrow heads). (H&E; 40x).
gr6.jpg
PMC5681332_01_gr6.jpg
fig0030
There were foci of tumor necrosis, mild-moderate atypia foci of marked cellularity resembling fibrosarcoma with a mitotic index >5/10 hpf in the active areas (Fig. 6).
Tumor showing a pushing growth pattern.
gr7.jpg
PMC5681332_01_gr7.jpg
fig0035
The tumor showed a predominately pushing growth pattern (Fig. 7).
Selected images of a CT chest post IV contrast in the arterial phase and in soft tissue window. A). Axial view B). Coronal view. C). Sagittal view showing post-surgical changes noted (left mastectomy) with no recurrent/residual masses seen (blue arrow).
gr8.jpg
PMC5681332_01_gr8.jpg
fig0040
She had an uneventful postoperative course and ten months later a surveillance CT did not reveal any recurrent or residual mass (Fig. 8).