Phyllodes tumor of the breast: magnetic resonance imaging findings and surgical treatment

A 50-year-old women presented with a palpable left breast lump. Clinical examination revealed a solid breast mass (8 cm × 6 cm). X-ray mammography showed a nonspiculated soft tissue mass (Fig. 1); sonography showed a hypoechoic lobulated mass with cystic areas. Dynamic magnetic resonance imaging (MRI) demonstrated a multilobulated lesion with inhomogeneous signal intensity on T 1 - and T 2 -weighted images sequences. In the solid portion, there were cystic areas with internal septation. The posterior margin appeared irregular with areas of linear enhancement (Fig. 2). Multiplaner intensity projection (MIP) reconstruction showed marked enhancement of the lesion and regional hypervascularization (Fig. 3). The dynamic curve showed high percent signal intensity (200%) at first passage after administration of gadolinium-diethylenetriamine pentaacetic acid (Gd- DTPA) and plateau-type morphology. A wide resection of the breast tumor was performed with macroscopically adequate resection margins. Microscopic examination revealed a malignant phyllodes tumor with cystic areas and infiltration of margins at the site where MRI showed areas of linear enhancement (Fig. 4). Therefore mastectomy with immediate prosthesis placement was subsequently performed. Magnetic resonance imaging enables complete visualization of the phyllodes tumor even in the region close to the chest wall, as well as a clear delineation against healthy glandular tissue. Accurate preoperative assessment of tumors allows for complete surgical excision, such complete removal being imperative to prevent tumor recurrence