[Diagnostic imaging of phyllodes tumors: preliminary observations]

Phyllodes tumors are rare fibro-epithelial neoplasms; they may be classified as benign, borderline and malignant according to their histologic features of mitotic index, stroma pleomorphism and lesion outline. Their epidemiology is rather different from that of other breast neoplasms, since these lesions most frequently affect white Latin women 45 to 49 years old. The incidence of metastases is strictly correlated with the degree of histologic aggressiveness, although even small lesions, either borderline or with low malignancy, may metastasize. To assess the incidence of this neoplasm and its metastases and to investigate the role of diagnostic imaging, we retrospectively reviewed 8000 mammograms, 2000 sonograms, 1000 color-Doppler sonograms and 4500 CT scans of the chest; 7 phyllodes tumors and 2 metastases were detected. This neoplasm showed no specific characteristics either at mammography or at sonography, whereas rich neovascularization with venous flow and low resistance arterial flow were shown at color-Doppler US. Secondary lesions, first diagnosed at radiography and then studied with CT for number, size and lymph node involvement were: a large solitary mass with no involvement of mediastinal nodes, which was observed 36 months after surgical ablation of the primary lesion and multiple small lesions, involving both lungs, with no mediastinal metastases, diagnosed 42 months after surgical removal of the primary lesion. In both cases the primary neoplasm was histologically classified as borderline and responded to adjuvant therapy. Therefore, our work confirms the polymorphic nature of this condition which is rather difficult to diagnose and whose prognosis is unpredictable. However, even though color-Doppler US may open new diagnostic perspectives, the reliability of conventional radiography and CT in the follow-up of these lesions is nowadays a matter of fact. In our opinion, every case should be followed-up, regardless of the histologic classification of the primary tumor.