LETTER TO EDITOR
Year : 2010 | Volume
: 53 | Issue : 2 | Page : 385--386
Benign intracystic phyllodes tumor of breast
KV Santosh, BS Sumana
Department of Pathology, Vydehi Institute of Medical Sciences and Research Center, Bangalore, India
K V Santosh
12, 3rd Main, Venkatamma Ramaiah Layout, Mathikere, Bangalore - 560 054
|How to cite this article:|
Santosh K V, Sumana B S. Benign intracystic phyllodes tumor of breast.Indian J Pathol Microbiol 2010;53:385-386
|How to cite this URL:|
Santosh K V, Sumana B S. Benign intracystic phyllodes tumor of breast. Indian J Pathol Microbiol [serial online] 2010 [cited 2020 Aug 14 ];53:385-386
Available from: http://www.ijpmonline.org/text.asp?2010/53/2/385/64318
A 36-year-old woman presented with a painless swelling in her left breast, which she had noticed one month earlier. There was no other relevant history; she denied any nipple discharge. Examination showed a mobile, non-tender superficially located swelling in the upper inner quadrant of the breast, not tethered to the skin and measuring about 1.5 cm in diameter. No axillary lymph nodes were palpable. A clinical diagnosis of 'fibroadenoma' was considered. Fine needle aspiration and mammography were not performed and the swelling was excised.
The specimen received was a pale brown irregular tissue of size 3.5x2.5x2 cm along its greatest diameters with wisps of adipose tissue on the surface. On cutting through, a centrally located circumscribed area, 1.3 x 1.2 cm was evidenced, surrounded by grey-tan regions. The central lesion contained gelatinous, mucoid pale yellow-green areas along with grey-white solid areas. No necrosis or hemorrhage was observed.
Microscopy revealed a cystically dilated ductal structure lined partially by cuboidal and partly by a hyperplastic, multilayered epithelium. An irregular proliferating mass, forming broad branching leaf-like fronds was observed within the lumen [Figure 1]. Its exact point of attachment to the cyst wall could not be determined and the lesion appeared to have retracted from the capsule. The fronds were lined by a bilayered epithelium, with a suggestion of apocrine change at places. The stroma was of variable cellularity, consisting of uniform spindle cells with focal paucicellular, hyalinized areas [Figure 2]. No stromal cellular atypia, mitoses, necrosis or hemorrhage were present. Minimal lymphocytic infiltration was noted in the cellular areas. Empty spaces of the cyst contained pink, secretory material. The surrounding breast tissue revealed fibrosis, adenosis and several cystically dilated ducts. Apocrine metaplasia, epithelial hyperplasia and atypia were absent. The fibrotic stroma showed areas of hyalinization and patchy lymphocytic infiltration, especially around the epithelial elements.
Phyllodes tumors represent fibro epithelial proliferations of the breast tissue. Larger lesions are prone to cystic degeneration. It is, however, rare to observe a phyllodes tumor growing entirely within a cystically dilated ductal structure in the breast. Only three similar cases have been reported in literature so far; two from Japan. Two separate reports of an intracystic growth pattern of phyllodes tumor, both borderline cases, were described in 1998 by Horiguchi et al. and Shintaro et al. . More recently, an intracystic phyllodes tumor which grew along the lumen of the lactiferous duct and caused nipple discharge was described in a Malay woman by Lian et al.
Our case, at 36 years is the youngest and the lesion is also the smallest, perhaps attributable to early detection and biopsy. Interestingly, all the three cases reported so far have been among Asians. Also noted among the Asians is the earlier age of occurrence of phyllodes tumors. 
An intraductal growth pattern may mimic an intraductal papilloma on ultrasonography, leading to microdochectomy rather than the preferred wide excision for phyllodes tumor. 
|1||Horiguchi J, Iino Y, Aiba S, Itoh H, Tanahashi Y, Ikeya T, et al. Phyllodes Tumor Showing Intracystic Growth: A Case Report. Jpn J Clin Oncol 1998;28:705-8.|
|2||Shintaro T, Goi S, Futoshi A, Hidemi F, Hidetomo M, Motoko I, et al. Phyllodes tumor with features of intracystic tumor. Jpn J Breast Cancer 1998;13:813-6.|
|3||Lian D, Cheah E, Tan PH, Thng CH, Tan SM. Phyllodes Tumor with Intraductal Growth: A Rare Case of Nipple Discharge. Histopathology 2007;50:666-9.|
|4||Bellocq JP, Magro G "Fibroepithelial tumors". In: Tavassoli FA, Devilee P, editors. Pathology and Genetics of Tumors of the Breast and Female Genital Organs. Series: WHO Classification of Tumors. Lyon: IARC Press; 2003. p. 99-103.|