Yeungnam Univ J Med.  2021 Jan;38(1):78-82. 10.12701/yujm.2020.00759.

Pancreatic metastasis from malignant phyllodes tumor of the breast

• Lee SE
• Bae YK
• Choi JH

• KMID: 2512072
• DOI: http://doi.org/10.12701/yujm.2020.00759

Abstract

Pancreatic metastasis from malignant phyllodes tumor (PT) of the breast is rare, and only a few cases have been reported in the literature. Here, we report a case of pancreatic metastasis from malignant PT of the breast in a 48-year-old woman. She had had three episodes of recurrence of malignant PT in her right breast. She presented with epigastric pain for 2 months. Computed tomography and magnetic resonance imaging revealed a 6 cm-sized, well-defined, heterogeneous mass with peripheral enhancement in the body of the pancreas. Endoscopic ultrasonography-guided fine-needle aspiration was performed, and the pathologic report suggested spindle cell mesenchymal neoplasm. Subsequently, surgical excision was performed, and the mass was confirmed as a metastatic malignant PT. The imaging findings are discussed and the literature is briefly reviewed in this report.

Keyword

Breast; Malignancy; Neoplasms; Pancreas metastasis; Phyllodes tumor

Figure

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  Fig. 1. Radiologic and pathologic findings of recurrent malignant phyllodes tumor of the breast in a 48-year-old woman. (A) Mammography of the right breast reveals an oval, circumscribed, hyperdense mass in the right inner breast, above the implant, with an approximate size of 3.6 cm. (B) Ultrasonography reveals a 3.6×3.0×2.0 cm-sized, oval, microlobulated, hypoechoic mass at the 3 o’clock location of the periareolar area. (C) The recurred breast mass shows stromal overgrowth and hypercellularity. The stromal cells are spindle-shaped and show significant nuclear atypia. Benign epithelial component is present (hematoxylin and eosin stain, ×100).

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  Fig. 2. Computed tomography imaging findings of pancreatic metastasis from malignant phyllodes tumor of the breast. Precontrast (A), arterial (B), and portal (C) phase of contrast-enhanced abdominal computed tomography show a 6 cm-sized, well-defined heterogeneous mass involving the body of the pancreas. The mass reveals central cystic or necrotic portion (asterisk) and internal septa (arrow). The mass shows progressive, peripheral, and septal enhancement.

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  Fig. 3. Magnetic resonance imaging findings of pancreatic metastasis from malignant phyllodes tumor of the breast. The mass shows low signal intensity on T1-weighted image (A) and high signal intensity and internal septa with low signal intensities (arrows) on T2-weighted images (B, C). (D–F) Dynamic studies after the administration of gadolinium show thick irregular peripheral enhancement and septal enhancement with central poorly enhancing areas.

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  Fig. 4. Endoscopic ultrasonography (EUS) finding of pancreatic metastasis from malignant phyllodes tumor of the breast. EUS revealed a 6-cm mixed and heterogeneous hypoechoic mass in the body of the pancreas.

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  Fig. 5. (A) Gross photograph of the pancreatic tumor shows a 6.0×5.0-cm, grayish white, myxoid and solid cut surface with hemorrhage. (B) Histologic photographs of the pancreatic tumor show proliferation of spindle-shaped tumor cells in the myxoid stroma. (C) The tumor cells have elongated hyperchromatic nuclei, with fascicular pattern (hematoxylin and eosin stain, ×100 [B] and ×200 [C]).

Reference

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