A 53-year-old genotypic XY male, phenotypic female transgender, with a history of exogenous estrogen use since the age of 19 and status postbilateral saline implants since 1988 presented with a 2-month history of pain and induration in an enlarging left breast mass. Her history dates back 1 year ago when she noted that her left breast implant had deflated and shrunk in size but did not seek medical care at that time. Of note, her family history was positive for breast cancer in three sisters. Physical exam showed a morbidly obese, phenotypic female with a large, firm, indurated, erythematous, and focally fluctuant left breast. The patient was referred to our Breast Imaging Center.Imaging findings were as follows: On ultrasound, there was loss of the normal echogenicity and tissue fat planes with an ill-defined mass within the soft tissues of the left breast (Fig. 1). The lesion demonstrated internal vascularity on color Doppler ultrasound.A diagnostic mammogram was then obtained, which revealed a large, high density, and lobulated mass within the left breast. There were partially circumscribed, partially obscured margins as well as coarse, dystrophic calcifications, and adjacent skin thickening (Fig. 2). The mass measured 14 · 15 cm in the central region and occupied almost the entire breast.A fine-needle aspiration of the mass was performed. The hypercellular smears revealed abundant large sheets of bland ductal epithelium associated with hyperchromatic myoepithelial cells. Focally, hyperchromatic ovoid to spindled cells with crowding, architectural disarray, and prominent nucleoli were seen in a background of blood and necrotic debris. These findings were consistent with an atypical proliferative lesion suspicious for phyllodes tumor with the recommendation to completely excise the lesion for definitive diagnosis (Fig. 3). The patient underwent a simple mastectomy of the entire mass.Phyllodes tumors of the breast are rare neoplasms, comprising less than 1% of all breast tumors and only 2-3% of fibroepithelial neoplasms (1,2). First described by Johannes Muller in 1838, review of the literature has reported only 13 cases in males (3), of those, only 4 of the 13 were considered malignant. It has also been estimated that approximately 7% of phyllodes tumors contain adipose tissue in small amounts, with liposarcomas arising in the breast being extremely rare (Fig. 4) (4). Thus far, liposarcoma in malignant phyllodes had only been reported in females (5). Herein, we present a case of malignant phyllodes
