PMC6223390_01
A huge borderline phyllodes tumor in the right breast of a 44-year-old woman: front image (A) and lateral image (B).
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The skin on the surface of the lump was dark, with ulceration area of 7x5 cm and without bleeding or discharge (Figure 1A and B).
The images of imaging examination.. Notes: (A and B) Mammography (CC) showing a huge right breast, about 23x23 cm and the normal left breast. (C) Ultrasonography of the right breast showing enlargement obviously; inset, echo intensity disorder and a little blood flow signal. (D) The CT of right breast showing the mass not invading chest muscle or breaking into the chest cavity.. Abbreviations: CC, craniocaudal; CT, computed tomography.
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Mammography showed a huge right breast, about 23x23 cm, with dermal ulceration around nipple (Figure 2A and B). Ultrasonoscopy showed the right mammary gland that was enlarged obviously, with inset showing echo intensity disorder and blood flow signal probed (Figure 2C). The chest computed tomography (CT) revealed that the lump had not broken into the chest cavity, and the lungs were normal (Figure 2D).
The resected phyllodes tumor measuring 22x17x14 cm (diameter of the dressing bowl, 16 cm).
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Then, the patient underwent mastectomy of the right breast (Figure 3) and sentinel lymph node biopsy.
The tissue section showing borderline phyllodes tumor with mucoid degeneration and some areas abounded in cell: (A) 100x and (B) 200x. IHC results of (C) AE1/AE3, (D) SMA, (E) CD34, (F) BCL-2, (G) P53, (H) ki67, (I) ER, and (J) PR.. Abbreviations: IHC, immunohistochemistry; SMA, smooth muscle actin; ER, estrogen receptor; PR, progesterone receptor.
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Postoperative paraffin-based histopathology showed fast cellular proliferation, mitosis about 9/10 high-power fields (HPFs) (Figure 4A and B). Immunohistochemistry (IHC) was as follows: spindle cells AE1/AE3, smooth muscle actin (SMA) (+), Desmin (-), CD34 partial (+), BCL-2 (-), p53 partial (+), ki-67 15%, tumor cells, estrogen receptor (ER) <1% weakly positive, progesterone receptor (PR) <1% weakly positive, and Ki67 40% (Figure 4C-J).
The examination images and pathology of the recurrent tumors.. Notes: (A and B) Mammography (MLO) showing the large tumors on the right chest and the normal left breast. (C) Ultrasonography of the right chest showing the largest tumor about 6.7x4.0 cm. (D) The tissue section showing spindle-shaped tumor cells that were arranged in bundles or wheels, and mitoses were obvious (200x).. Abbreviation: MLO, mediolateral oblique.
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Her palpation and imaging examinations indicated three large masses on the right chest, the largest one of about 6.7x4.0 cm (Figure 5A-C). Then, she had lumpectomy, and the tumor was diagnosed as malignant PT (Figure 5D).