Cystosarcoma phyllodes tumor

Film screen mammogram of the right breast in 41 year old female showing large well defined dense lesion with smooth margins. No calcification. 

USG of the same patient showing heteroechoic mass lesion with well defined smooth margins. The lesion shows width>breadth. No evidence of calcification.

Discussion:

Cystosarcoma phylloides is a rare breast tumor that accounts for approximately 0.5% of breast tumors examined at biopsy and approximately 2.5% of-fibroid epithelial tumors examined at biopsy. This tumor was named in 1838 by Johannes Muller, who described large firm tumors of the breast. He believed the tumor to be benign and observed that the surface had a leaf-like (phylloide) configuration and contained narrow cyst-like spaces within a sarcoma- like stroma.

It was not until 1943 that Cooper and Ackerman reported on the malignant biological potential of this tumor. Clinically, patients present with a palpable breast mass. Although periods of rapid growth are known to occur, the mass usually develops slowly. The lesion is mobile, not fixed to the skin or the chest wall. Although the lesions have occasionally been noted in both breasts, they are usually found only in one. They have been reported to occur in patients of any age, although the average age is 40 to 45 years.

Mammogram usually shows well defined mass lesion of varying sizes, predominantly large mass. The lesion shows smooth margins in benign and irregular margins in malignant lesion. There may or may not have macrocalcification. USG shows solid mass lesion within the breast and shows a defined margins and some small fluid filled clefts with in the lesion may be diagnostic of cystosarcoma phylloides.