Phyllodes tumors of the breast

Abstract

The aim of this study was to describe the clinical, mammographic, and sonographic findings of phyllodes tumor of the breast and correlate them to the benign or malignant pathological nature of the lesion and its clinical behavior. We retrospectively reviewed the clinical, radiologic, and pathologic findings of 12 cases of phyllodes tumors diagnosed in our hospital in the past 6 years, 6 of which were malignant. The surgical management and clinical course of the patients were also reviewed. Mammographically, soft tissue masses ranging from 2.5 to 15 cm were present in all patients. One patient had a mixed fat and water density mass and 2 patients had masses associated with coarse calcifications. At sonography, all tumors were well circumscribed; two of them were homogeneously hypoechoic, and the rest had heterogeneous internal echoes. Eight patients showed internal cystic areas. None of these characteristics proved to be useful in ascertaining the benign or malignant nature of the tumor. At surgery, 5 patients underwent mastectomy and 7 patients local excision of the tumor. Three of the later tumors, one benign and two malignant, recurred after several months. Fine-needle aspiration biopsy suggested the diagnosis of phyllodes tumor in only 3 cases. After surgery, six tumors were classified as benign and six as malignant, three of which being of low-grade malignancy. None of the clinical or radiologic characteristics of the tumors were useful in predicting their histological nature or their behavior after surgery. Preoperative fine-needle aspiration biopsy often misdiagnosed the tumor as benign fibroadenoma. Only the histopathologic features of the excised mass proved to be helpful in assessing malignancy.

Differentiation between Phyllodes Tumors and Fibroadenomas Based on Mammographic Sonographic and MRI Features

“…The posterior acoustic enhancement phenomenon is a sonographic feature that has been observed in 50-77% of phyllodes tumors in different studies [9,14]. This is explained by the presence of intramural cysts representing areas of degeneration and focal necrosis [15,19]. In accordance with the literature, posterior acoustic enhancement was more commonly detected in phyllodes tumors than in fibroadenomas in the present study (supplemental fig.…”

“…Some groups reported that phyllodes tumors are frequently lobulated in shape [14,15] while others found no significant difference in shape between fibroadenomas and phyllodes tumors. Both tumors tend to be oval or lobulated in shape [6,8,9,12].…”

“…Buchberger et al [14] and Blanco et al [15] reviewed the sonographic features of phyllodes tumors. In accordance with most findings in the literature, they reported that phyllodes tumors had circumscribed margins.…”

“…In addition, demographic findings of the cases were not analyzed, as this study was based only on imaging findings. Fourth, histopathological types of phyllodes tumors were not considered, since previous studies failed to establish radiological characteristics that predict benign, borderline, or malignant cytology [14,15]. …”

Combination of shear-wave elastography and color Doppler: Feasible method to avoid unnecessary breast excision of fibroepithelial lesions diagnosed by core needle biopsy

“…Similarly to previous studies, the heterogeneous echo pattern was a significantly frequent B-mode US feature in PTs, which might reflect their stromal heterogeneity or internal cystic structures [10,34,35]. However, the heterogeneous echo pattern cannot be regarded as specific or pathognomonic for PTs, because it can be observed in a substantial number of FAs (13.5–51%) [10,34].…”