J Korean Soc Radiol.  2015 Aug;73(2):127-130. 10.3348/jksr.2015.73.2.127.

Multi-Focal Lobular Carcinoma In Situ Arising in Benign Phyllodes Tumor: A Case Report

• Lee TK
• Choi CH
• Kim YJ
• Kim MY
• Lee KH
• Cho SG

• KMID: 1964265
• DOI: http://doi.org/10.3348/jksr.2015.73.2.127

Abstract

Coexistent breast malignancy arising in phyllodes tumor is extremely rare, and most of them are incidental reports after surgical excision. Coexistent malignancy in phyllodes tumor can vary from in-situ to invasive carcinoma. Lobular neoplasia is separated into atypical lobular hyperplasia and lobular carcinoma in situ (LCIS). LCIS is known to have a higher risk of developing invasive cancer. We reported imaging findings of multifocal LCIS arising in benign phyllodes tumor.

MeSH Terms

Breast
Carcinoma, Lobular*
Hyperplasia
Phyllodes Tumor*
Spectrum Analysis

Figure

• 

  Fig. 1 A 41-year-old woman with multi-focal lobular carcinoma in situ in a phyllodes tumor. A. A craniocaudal mammogram shows a 4.16 × 3.70 × 3.80 cm sized, round mass with obscured margin and equal density in right subareolar breast at 12 o'clock (arrow). B. Breast ultrasonography shows relatively oval mass with heterogeneous echogenicity. C. T2-weighted axial MRI shows iso- and high-signal intense oval mass (arrow). D. Post-contrast T1-weighted MRI shows heterogeneous enhancement with dark non-enhancing internal septations (arrowheads) in the mass. E. Kinetics demonstrate initial fast (181%) followed by delayed washout (> 10%) with a fully automated computer-aided detection-based analysis. F. MR spectroscopy of the mass shows the presence of total choline containing compounds spectrum with a peak height at 3.2 ppm that was 2 fold above the baseline noise. G. The mass depicts 5 × 4-cm, benign phyllodes tumor with less than 3 mitotic figure/10 HPF and clear resection margins (H&E stain, × 40). Multi-focal lobular carcinoma in situ involves the stromal components of benign phyllodes tumor (inlet, H&E stain, × 200). H&E = hematoxylin and eosin

Reference

1. Shirah GR, Lau SK, Jayaram L, Bouton ME, Patel PN, Komenaka IK. Invasive lobular carcinoma and lobular carcinoma in situ in a phyllodes tumor. Breast J. 2011; 17:307–309.

2. Padmanabhan V, Dahlstrom JE, Chong GC, Bennett G. Phyllodes tumor with lobular carcinoma in situ and liposarcomatous stroma. Pathology. 1997; 29:224–226.

3. Nio Y, Iguchi C, Tsuboi K, Maruyama R. Ductal carcinoma in situ arising within a benign phyllodes tumor: a case report with a review of the literature. Oncol Lett. 2011; 2:223–228.

4. Nomura M, Inoue Y, Fujita S, Sakao J, Hirota M, Souda S, et al. A case of noninvasive ductal carcinoma arising in malignant phyllodes tumor. Breast Cancer. 2006; 13:89–94.

5. Shin DJ, Kim DB, Roh JH, Kwak BS. Ductal carcinoma in situ arising in a benign phyllodes tumor: a case report. J Korean Soc Radiol. 2013; 68:423–426.

6. Deodhar KK, Baraniya JB, Naresh KN, Shinde SR, Chinoy RF. Cancerization of phyllodes tumour. Histopathology. 1997; 30:98–99.

7. Tan H, Zhang S, Liu H, Peng W, Li R, Gu Y, et al. Imaging findings in phyllodes tumors of the breast. Eur J Radiol. 2012; 81:e62–e69.

8. Kuhl CK, Mielcareck P, Klaschik S, Leutner C, Wardelmann E, Gieseke J, et al. Dynamic breast MR imaging: are signal intensity time course data useful for differential diagnosis of enhancing lesions? Radiology. 1999; 211:101–110.

9. Tse GM, Yeung DK, King AD, Cheung HS, Yang WT. In vivo proton magnetic resonance spectroscopy of breast lesions: an update. Breast Cancer Res Treat. 2007; 104:249–255.