Roentgenography of giant fibroadenoma of the breast (cystosarcoma phylloides).

Abstract

Breast tumors coming under the category of cystosarcoma phylloides are infrequently encountered. The x-ray observations in a small group found in breast surveys at the Albert Einstein Medical Center in Philadelphia during scribed three forms: the first with a fibrosarcomatous structure, containing smoothlined cysts; the second like the first variety except that within the larger cysts were younger cysts attached by pedicles; the third, cystosarcoma phylthe past eight years will be presented here. Some 50-odd names have been given to these giant tumors (6). Müller, in 1838, seems to have been the first to use the term “cystosarcoma” for fibrocystic masses having a sarcomatous texture. He deloides, forming a large firm mass with a more or less uneven surface. The fibrous substance which constitutes the greater part of this tumor has a grayish-white color, is extremely hard and as firm as fibrocartilage. Large portions of the tumor are made up entirely of such tissue, but in some parts there are cavities or clefts not lined with a distinct membrane. Muller never intended to convey the impression that these tumors actually threatened life in the ordinary sense of malignant neoplasms (6). Cystosarcoma phylloides may be regarded as a giant form of intracanalicular fibroadenoma. However, even a smaller fibroadenoma might be labeled cystosarcoma phylloides if giant intracanalicular projections were present. Some laboratories term these smaller varieties miniature cystosarcoma phylloides. Actually the only difference between an intracanalicular fibroadenoma and a cystosarcoma phylloides is one of size and cellularity! Also, in contrast to fibroadenoma, cystosarcoma phylloides has been known to metastasize even though the primary tumor was well encapsulated; after local excision, recurrences have been reported with or without distant metastases. Cystosarcoma phylloides is a rare tumor presenting a variety of symptoms and clinical findings. Details of our 9 cases are summarized in Table I. The microscopic picture in Cases I, II, and III was typical of cystosarcoma phylloides. The tumors were large, nodular, and almost entirely encapsulated. Intracanalicular projections and occasional cystic spaces were found on histologic section. On the x-ray film all 3 tumors were smooth-margined and somewhat lobulated (Fig. 1). The general appearance was that of large, but entirely benign, lesions. Giant fibroadenomas are said to grow rapidly, but in Case III there was a history of slow growth over an eight-year interval. Another unusual circumstance in this case was the development of a carcinoma in the opposite breast during a long period of repeated clinical observation (Fig. 2, A). A clear-cut microscopic picture of cystosarcoma phylloides was also found in Cases IV and V. Because of their small size, the tumors were labeled “miniature” by the pathologist.