case_images: PMC11301723_01
case_images: Left mammography pictures show that has a mass with increased density, lobulated edges, well - demarcated margins, and rough calcifications, without infiltrating signs. (a) Left Mediolateral Oblique (LMLO) View; and (b) Left Craniocaudal (LCC) view.
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case_images: Ultrasound scan and mammography of the left breast was done which demonstrated a defined margin, and a strongly irregular hypoechoic mass that was 66x31x100 mm in size (Figure 1(a) and (b)).
case_images: Photomicrographs of H&E stained slides show (a) Three grades of PT and, spectrum of carcinomatous transformation from benign (1st star) to borderline (2nd star) to malignant (3rd star), malignant transformation of one duct (Discontinuous lines and 4th star) and invasive carcinoma (5th star) (Magnification X5). (b) Magnification of the 4th star of Figure 1(a): Carcinoma cells (3rd arrow and star) tended to be located between the outer myoepithelial layer (1st arrow) and the inner luminal epithelial cells (2nd arrow) (Magnification X10). (c) Invasive lobular carcinoma with rhabdoid feature show cells are characterized by abundant eosinophilic cytoplasm with globular paranuclear eosinophilic inclusions and with an eccentric vesicular nucleus (Magnification X20). (d) Malignant spindle cell sheets of phyllodes tumor (Magnification X40).
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case_images: Microscopically, two distinct tumor components - carcinoma and PT with overlapping regions were seen (Figure 2(a)). The tumoral cells were in sheets, nests and sometimes singly disposed but clusters and tubules with occasional foci of few residual ducts were also seen (Figure 2(b) and (c)). Areas with malignant PT features showed bland spindle cells with mild nuclear atypia, pale eosinophilic cytoplasm and brisk mitosis with up to 8 mitoses per 1 high field power (Figure 2(d)).
case_images: Photomicrographs of IHC stained slides show (a) The pancytokeratin positive cancer cells (1st arrows) and negativity of malignant PT (1st star) (Magnification X20). (b) CD56 staining showed the various expression of three grades of PT: negativity of begnin PT (1st star), moderate expression of borderline areas (2nd star) and strong positive malignant PT (3rd white stars) (Magnification X10). (v) Ki67 index shows the difference of malignant PT and invasive carcinoma (separated by red dotted line) (Magnification X20). (d) p63 was expressed for the begnin myoepithelial cells and negativity of in situ carcinoma (red stars) and malignant PT (black star) (Magnification X10).
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case_images: Figure 3(d)). For PT tissues almost were negative for all of the above markers. Ki67 marker was expressed in less 1.0 and 5.0%, and 60.0% of benign, borderline and malignant phyllodes tumors (Figure 3(c)), respectively. Similarly, benign phyllodes tumor is negative for CD56 but this marker is expressed in moderate or strong levels of borderline or malignant phyllodes tumors, respectively (Figure 3(b)).