PMC9633576_01
Patient case presentation 1. (A,B) Focused ultrasound of the right breast at 9 o'clock position showed a 4.8 x 4.0 x 1.8 cm oval, parallel, circumscribed hypoechoic mass in gray scale antiradial and radial planes. (C) Internal blood flow is shown by Doppler antiradial plane.
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Target ultrasound of the right breast at the 9 o'clock position demonstrated a 4.8 x 4.0 x 1.8 cm oval, parallel, hypoechoic mass (Fig. 3).
PMC9633576_02
Malignant phyllodes tumor. (A) Focal benign breast epithelium, supporting the diagnosis of a phyllodes tumor (20x). (B) Marked stromal atypia and multiple mitotic figures (40x).
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She subsequently underwent right mastectomy. Surgical pathology of tissue specimen yielded 18.5 cm malignant phyllodes with marked stromal atypia and cellularity, stromal overgrowth, mitotic rate of 12 mitoses per 10 HPFs, and infiltrative tumor borders (Figs. 2A,B and 5B,C).
Patient case presentation 2. (A, B) Right MLO mammogram without and with calipers demonstrated a very large 20.9 cm oval high-density mass replacing the normal parenchyma and resulting in overlying skin thickening and trabecular thickening. (C, D) Accompanying ultrasound of the right breast in gray scale transverse and sagittal planes at 11 o'clock position showed a large oval, parallel heterogeneous mass (incompletely included because of its prohibitive size).
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Bilateral diagnostic digital mammograms with tomosynthesis and targeted right breast and axillary ultrasound were performed (Fig. 4).
Patient case presentation 2. (A) Clinical breast exam demonstrated a very large mass replacing much of the right breast, with a 2.5 cm open wound draining serous fluid in the upper outer quadrant, as well as areolar complex displaced medially. (B, C) Gross cross-sections from 2 sites in mastectomy specimen of tumor showed heterogeneity, including some white, firm, whorled areas along with areas with hemorrhage and necrosis.
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The right nipple areolar complex was displaced medially (Fig. 5A). She subsequently underwent right mastectomy. Surgical pathology of tissue specimen yielded 18.5 cm malignant phyllodes with marked stromal atypia and cellularity, stromal overgrowth, mitotic rate of 12 mitoses per 10 HPFs, and infiltrative tumor borders (Figs. 2A,B and 5B,C).