PMC3037889_01
Anterior view of the breast tumor on presentation to our clinic.
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F1
Examination revealed a huge, globular, lobulated mass measuring 40 cm x 35 cm with an inferomedially deviated and retracted nipple with peau d'orange skin changes (Figures 1 and 2).
Right lateral view of the breast tumor at presentation.
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F2
Examination revealed a huge, globular, lobulated mass measuring 40 cm x 35 cm with an inferomedially deviated and retracted nipple with peau d'orange skin changes (Figures 1 and 2).
Four months after surgery. Anterior view of the breast four months after the mastectomy and immediate latissimus dorsi reconstruction.
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F3
As she had reduced abdominal subcutaneous tissue for a transverse rectus abdominus myocutaneous (TRAM) flap, she elected a latissimus dorsi pedicled myocutaneous flap (Figure 3).
H&E staining of the breast tissue (x1.25 magnification). This low-power view shows the "leaf-like" growth pattern typically seen in phyllodes tumors because of the overgrowth of stroma. Here the "leaf-like" areas project into dilated luminal space (arrows).
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F4
Microscopically, the mass was composed of compressed ducts lined by two-tiered epithelium arranged in clefts and surrounded by an overgrowth of stroma arranged in a leaf-like structure (Figures 4 and 5).
Phyllodes tumor border H&E staining (x1.25 magnification). This section is a low-power view showing the border of the phyllodes tumor in this case (arrow), which is "well-circumscribed" and "pushing," rather than "invasive" (invasion would indicate malignant change). This well-circumscribed border favors a benign diagnosis.
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F5
Microscopically, the mass was composed of compressed ducts lined by two-tiered epithelium arranged in clefts and surrounded by an overgrowth of stroma arranged in a leaf-like structure (Figures 4 and 5).
Phyllodes tissue H&E staining (x40 magnification). High-power view shows the cellularity of the stroma, with presence of mitosis (arrow) and moderate cellular pleomorphism. The presence of increased mitotic activity (five per 10 high-powered fields (hpfs) in this patient), as well as the moderate cellular pleomorphism, indicates a diagnosis of "borderline" phyllodes tumor.
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F6
A borderline giant phyllodes tumor was diagnosed after the identification of five mitoses per 10 high power fields (hpfs) at the most mitotically active area, and a predominantly expanding border with no overt malignant features (Figure 6).