2009 Volume 18 Issue 2 Pages 189-195
Coexistence of a phyllodes tumor and a breast cancer in the same breast is very rare. Nineteen such cases have been reported previously in Japan, and the presenting symptom was a palpable tumor in almost all cases. Here we present a case in which a tumor was palpable at breast cancer screening.
A female patient in her 6th decade presented with a history of fine calcific deposits that had been found at breast cancer screening 7 years before, when a stereo-guided mammotome biopsy at a closed examination yielded a diagnosis of mastopathy. No abnormal findings had been detected at two other breast cancer screenings conducted 3 years and 1 year previously. On this occasion, a lump was palpable. When the patient visited our institution, a tumor measuring 5×4.5 cm was palpated in the upper lateral quadrant of the right breast, and lymph nodes were palpable in the right axilla. Mammography showed only a Category 2 finding of a popcorn-like calcific deposit, suggesting the presence of a fibroadenoma in the right breast. Ultrasonography demonstrated a low-echoic mass shadow with an irregular margin and calcific deposits. Needle biopsy cytology gave a diagnosis of invasive ductal carcinoma, and chest computed tomography showed multiple lung metastases. Thus the preoperative diagnosis was a breast cancer, T2 N3 M1, Stage IV.
The patient underwent a right mastectomy with preservation of the pectoral muscles and right axillary node dissection (Bt+Ax). The final histopathologic diagnosis was an invasive ductal carcinoma (papillary ductal carcinoma) combined with a phyllodes tumor. Metastatic lesions were found in 22 of 24 resected lymph nodes. Chemotherapy and irradiation were carried out after surgery.
This case was a rare combination of a phyllodes tumor and a breast cancer, the latter having been missed at three previous biennial screenings and having presented at an advanced stage when detected at the fourth screening.
