Search

The patient was a 43-year-old premenopausal woman with a 14×11 mm tumor in upper outer quadrant of the left breast, diagnosed as a fibroepithelial lesion using core needle biopsy. Resection was performed. Histopathologically, the resected specimen was diagnosed as a fibroadenoma with lobular carcinoma in situ(LCIS). Tamoxifen was administered as endocrine therapy to reduce recurrence risk. We report a case of LCIS accidentally discovered by surgical resection of a benign tumor.

Phyllodes tumor is a rare interstitial and epithelial mixed tumor which constitutes 0.3-0.9% of all breast tumors. It is classified into benign, borderline malignant, and malignant. Differentiating this from fibroadenoma is difficult, however, when diagnosed, complete surgical resection is recommended. Patients and results: Forty-four patients who underwent surgery between April 2009 and April 2020 and were diagnosed with phyllodes tumors and the median observation period was 44 months. The average tumor diameter was 39.2 mm, and the surgical procedures performed were mastectomy in 3 cases, partial resection in 26 cases, and extirpation in 15 cases. The surgical margin was positive in 6 cases. Intra-breast recurrence occurred in 4 cases, of which the initial surgery in 3 cases was extirpation. The pathological diagnosis was malignant in 4 cases, malignant in 15 cases, and benign in 25 cases. Conclusion: In this study, intra-breast recurrence occurred in many cases treated by extirpation, and it was considered that the surgical technique for complete resection such as partial resection should be selected.

A 33-year-old woman underwent resection of a right breast mass, which was diagnosed as a fibroadenoma 15 years ago. Ten years later, a right breast mass appeared again, and it was diagnosed as a fibroadenoma based on core needle biopsy. After observation for a while, the mass increased in size, and she underwent resection of the tumor, which was diagnosed as a borderline-malignant phyllodes tumor. A mass appeared again in the right breast and rapidly expanded. A malignant phyllodes tumor was suspected, and right mastectomy was performed. The pathological diagnosis revealed a benign phyllodes tumor. Four years ago, a left breast mass was also detected. Because the mass was suspected to be a fibroadenoma, it has been observed for a few years. The mass has increased in size since 1 year ago, and another mass emerged 2 months ago. Core needle biopsy of the 2 masses revealed that both were phyllodes tumors. She underwent left mastectomy, and the pathological examination revealed that both masses were benign phyllodes tumors. We report this rare case of metachronal phyllodes tumors that presented bilaterally.

We report a case in which we were able to treat multiple tumors in the right breast with breast-conserving surgery. The patient was a 60-year-old woman in whom mammography revealed grouped round calcifications and distortion in the right breast. The tumor was not palpable. Ultrasonography revealed 3 tumors in the patient's right breast. One tumor, 14.5 mm in diameter, was located in the AC area of her right breast. Vacuum-assisted core-needle biopsy was performed on this tumor, and histopathological examination revealed invasive ductal carcinoma of the breast. The tumor was estrogen receptor (ER)-positive, progesterone receptor( PgR)-negative, and human epidermal growth factor receptor( HER)-2-positive. Another tumor, 5.5 mm in diameter, was located in the C area of the patient's right breast. This tumor was diagnosed as a satellite lesion of the tumor in the AC area. The third tumor, 19.0 mm in diameter, was located in the A area of the patient's right breast. This tumor was expected to be a fibroadenoma on the basis of the clinical findings. We performed breast-conserving surgery to remove these 3 tumors and biopsied the sentinel lymph nodes. Intra-operative rapid pathological diagnosis indicated that the surgical margins were negative and the sentinel lymph nodes were negative for metastasis. The final pathological diagnosis was the same as the preoperative diagnosis.

Endoscopic extirpation using a fine endoscope and related devices via the extramammary approach (mainly the transaxillary approach) has been applied for benign breast tumors since 1997 in the Second Department of Surgery, Kyushu University. The operative procedures, morbidity, and mortality are presented here. We have treated 37 patients with a mean age of 27.6 years, whose tumors had been diagnosed as benign; average tumor diameter was 3.6 cm. Seven patients had multiple tumors, including 4 with bilateral lesions. The transaxillary approach was chosen in 35 patients and the inframammary approach, which was a procedure in the early phase, was chosen in the remaining 2 patients. Patients with benign tumors can thus avoid direct incision on the breast by endoscopic extirpation via the extramammary approach. We recommend this procedure as a new option instead of direct excisional biopsy for benign breast tumors.