Phyllodes tumors are rare, rapidly growing tumors which account for about 1% of all breast neoplasms . They usually present with a palpable mass in middle-aged women.
Contrast-enhanced spectral mammography (CESM) is a valuable tool for evaluating breast masses. It combines iodinated contrast agent with digital X-ray mammography obtained with dual energy. This combination evaluates the morphology of the mass with a high spatial resolution, as well as adding the power of contrast material in the assessment of functional properties of the breast mass.
Phyllodes is derived from the Latin word Phyllodium which means ‘leaf-like’ based on a gross pathological description of a leafy, bulky, cystic and fleshy tumor of the breast . They are biphasic fibroepithelial neoplasms composed of stromal and epithelial components . Abundant cellular stroma in typical leaf-like architecture differentiates them from fibroadenomas and other sarcomas . World Health Organisation subclassifies phyllodes tumors as benign, borderline or malignant depending on the degree of overgrowth, cellular atypia and rate of mitosis . Approximately, 20–30% of resected phyllodes tumors are malignant .
Wide surgical excision with negative surgical margins (≥ 1 cm) without axillary lymph node dissection is the standard treatment method. Risk of local recurrence is as high as 65% in borderline and malignant subtypes and ranges from 5 to 30% in benign phyllodes tumors .
Phyllodes tumor and fibroadenoma have similar radiological findings. Fibroadenoma and phyllodes tumor may appear as mass lesions with distinct borders on conventional mammography. Tumor size over 3 cm, poorly demarcated borders and microlobulated architecture favor the diagnosis of phyllodes tumor. Cystic spaces which can be demonstrated by US and T2W sequences on breast MRI can be used for the differentiation of phyllodes tumor from fibroadenoma. Post-gadolinium-enhanced MRI findings of phyllodes tumor are reported in the literature; intense enhancement with no washout represents type 1 kinetic curve [8, 9].
CESM is also a post-contrast imaging modality demonstrating the functional properties of the breast tumor similar to breast MRI. To our knowledge, this is the first report of enhancement properties of phyllodes tumor as defined by CESM. Excellent spatial resolution of mammography combined with contrast enhancement demonstrates the well-defined borders as well as cystic spaces with rim enhancement within the tumor. This appearance is highly suggestive of phyllodes tumor. We also propose that more vivid enhancement may be an indicator for malignant potential. Further case series and studies are needed to support CESM findings phyllodes tumors.