Ultrasound Characteristics of Phyllodes Tumors

• Rapid growth of breast lesions like the one seen above suggests that it is a phyllodes tumor:
  • Although a giant fibroadenoma is another possibility
• The ultrasound image shows:
  • An isoechoic, heterogeneous mass that contains cystic, fluid filled spaces, and is vascular on Doppler examination
• In most cases, benign phyllodes tumors have margins that are well-circumscribed, and a thin, echogenic capsule is demonstrable
• The doubling time for a benign phyllodes tumor:
  • Is about four months
• The doubling time for a malignant phyllodes tumor:
  • Is a little over a month
• Rapidly growing phyllodes tumors:
  • Whether benign or malignant:
    • Often cause prominent veins on the skin from the developing vascularity
• Phyllodes tumors are more common:
  • In women of Mexican descent;
    • Latin American women with phyllodes tumors tend to be diagnosed at an earlier age than other women
• A core needle biopsy:
  • Cannot reliably distinguish phyllodes tumors from fibroadenomas:
    • Is therefore not sufficient for a definitive diagnosis
• The correct management is excision:
  • With or without a pre-operative core biopsy, with care to completely excise the tumor
• Phyllodes tumors can also be difficult to distinguish from giant juvenile fibroadenomas:
  • But they should also be treated by surgical excision
• References:
  • Guillot E, Couturaud B, Reyal F, Curnier A, Ravinet J, Lae M, et al. Management of phyllodes breast tumors. Breast J. 2011;17(2):129-137.
  • Plaza MJ, Swintelski C, Yaziji H, Torres-Salichs M, Esserman LE. Phyllodes tumor: review of key imaging characteristics. Breast Dis. 2015;35(2):79-86.
  • Rajan PB, Cranor ML, Rosen PP. Cystosarcoma phyllodes in adolescent girls and young women: a study of 45 patients. Am J Surg Pathol. 1998;22(1):64-69.
  • Sosin M, Pulcrano M, Feldman ED, Patel KM, Nahabedian MY, Weissler JM, et al. Giant juvenile fibroadenoma: a systematic review with diagnostic and treatment recommendations. Gland Surg. 2015;4(4):312-321.
  • Stavros AT. Atypical, high-risk, premalignant, and locally aggressive lesions. In: Stavros AT. Breast Ultrasound. Philadelphia, PA: Lippincott

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