A 17-year-old girl presents with a large palpable left breast mass

 

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Doctor's Information

Name : Maryam
Family : Noori
Affiliation :Teb Azma Imaging Center,Ghom,Iran
Academic Degree : Radiologist
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : ------------------

 

Case Section

Breast Imaging

 

Patient's Information

Gender : Female
Age : 17

 

Clinical Summary

The girl complains of rapid growing left breast mass.

 

Imaging Findings

There is a large well circumscribed mass in left breast with signal intensity equivalent to the parenchyma on T1w & isointense to hyperintense in comparison to parenchymal signal intensity on T2w images. After contrast administration strong contrast enhancement within solid tumor portions increasing demarcation of existing cystic or necrotic areas. The post initial signal (Not shown) shows a continuous increase & plateau curves (BIRADS IV).

 

Differential Diagnosis

Giant fibroadenoma (less cystic spaces but pathologic diagnosis), Invasive Cancer: more likely to have indistinct margins & associated pleomorphic Ca++. Primary sarcoma & periductal sarcoma are differentiable by pathology.

 

Final Diagnosis

Phyllodes tumor.

 

Discussion (Related Text)

The phyllodes tumor is a distinctive fibroepithelial tumor of the breast without counterpart in any other organ of the body. The benign form of this tumor is characterized by its structural similarity to the fibroadenoma, a low mitotic activity no nuclear atypia and a tumor growth pattern that displaces the surrounding tissue. The stroma of the tumor can show fibrous, lipoid, myxoid and muscular differentiation. In addition, the tumor often shows signs of hemorrhage and ulceration. Phyllodes tumors constitute 0.3% of all breast tumors. Women with this tumor are generally older than women with fibroadenomas. The average age is 45, but age range is 10-80. About 30% of phyllodes tumors recur and 10% metastasize. This tumor most frequently metastasizes to lungs (66%), skeleton (28%), and lymph nodes (15%). Mammographically, phyllodes tumors are generally well defined, uncalcified, and are lobulated, round, or oval. They are similar to fibroadenomas, but should be considered if the mass is greater than 6 to 8 cm or is rapidly growing. Sonographically, these masses are hypoechoic or heterogeneous echogenicity with posterior acoustic enhancement. Unlike fibroadenomas, phyllodes tumors commonly have thin, irregular cystic spaces within them. On MRM, T1-weighted sequence (precontrast): Well-circumscribed lesion without pseudocapsular demarcation with signal intensity equivalent to that of parenchyma. Occasionally documentation of rounded inclusions with comparatively hypointense signal as MR equivalent of cystic or necrotic changes. On T2-weighted sequence; Well-circumscribed lesion with isointense to hyperintense signal in comparison to parenchymal signal intensity. Occasionally documentation of rounded inclusions with hyperintense signal as MR equivalent of cystic or necrotic changes. On T1-weighted sequence (contrast-enhanced): strong contrast enhancement within solid tumor portions increasing demarcation of existing cystic or necrotic areas in the further course of the examination. Initial contrast enhancement is usually 100% or more. The postinitial signal usually shows a continuous increase or plateau. When no liquid inclusions are documented differentiation from a fibroadenoma with a high proportion of epithelial tissue is not possible. Differentiation of this benign lesion from a malignant phyllodes tumor or a borderline phyllodes tumor is not possible in MR mammography.

 

References

Breast Imaging A Correlative Atlas, Beverly Hashimoto & Donald Bauermeister. Practical MR Mammography, Uwe Fischer. Diagnostic Imaging Breast. Berg & Birdwell et al.

 

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