Breast ImagingCystosarcoma phyllodes
also called phyllodes
tumour, circumscribed periductal stromal tumours of breast with variable cellularity and cellular atypism of the stromal component. While a plethora of synonyms have been utilized for this
neoplasm, regardless of the term used it is essential that it should convey the pathologist's assessment of histologic malignancy. This can be done by appending the prefix "
benign" or "
malignant" to the designation. Alternatively, these tumours which lack characteristics of stromal malignancy might be considered as cellular fibroadenomas, while those tumours with stromal cell overgrowth, increased and abnormal mitotic activity, and cellular pleomorphism might best be considered as periductal sarcomas. These tumours have a propensity for local recurrence if incompletely removed. Moreover, the
malignant tumours may metastasize haematogenously, obviating the need for axillary
lymph node
dissection.
On mammography, a phyllodes tumour is usually a circumscribed round, oval or lobulated tumour, sometimes with partly indistinct borders but spiculation is not a feature of these lesions (Fig.1). Calcifications are unusual.
On ultrasonography, phyllodes tumours present as circumscribed hypoechoic lesions with varying degrees of inhomogeneities and often with small cystic spaces (Fig.2).
Differentiation between benign and malignant phyllodes tumours is not possible on imaging.
IA/JT
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Mammogram, craniocaudal view. Predominantly circumscribed mass in a 72-year old women representing a malignant phyllodes tumour.
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Cystosarcoma phyllodes, Fig.1 | | Cystosarcoma phyllodes, Fig.2 | |