Pure ground glass opacity (GGO) on chest CT: a rare presentation of lung metastasis of Malignant Phyllodes Tumor
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CASE REPORT
Pure ground glass opacity (GGO) on chest CT: a rare presentation of lung metastasis of Malignant Phyllodes Tumor Shoko Nakamura1 · Takeshi Goto1 · Satoshi Nara1 · Yoichiro Kawahara2 · Shinichi Yashiro3 · Satoshi Kano3 · Yoshio Hosokawa4 · Hidetoshi Kamada1 Received: 25 February 2020 / Accepted: 14 June 2020 © The Japanese Breast Cancer Society 2020
Abstract Lung is the most common target organ for distant metastasis of phyllodes tumor (PT), where the metastatic tumors are mostly seen as nodules or masses. We report here a rare case in which pure ground-glass opacity (GGO) was observed on chest CT about 3 years after the initial treatment of breast PT. After the lung lobectomy, we histologically confirmed that it should be diagnosed as a metastasis of PT. GGO rarely shows on metastatic tumors, and no reports have been made on GGO thus far in connection with metastasis of PT. Thus, in case GGO was found on the CT of patients having a history of PT, we suggest to take possible distant-metastasis into consideration. Keywords Phyllodes tumor · Ground glass opacity · Lung metastasis · Surgical resection
Introduction Phyllodes tumor (PT) of the breast is relatively rare, accounting for 0.3–0.9% of breast tumors [1]. Malignant phyllodes tumor (MPT) can be seen in 16–30% of PT, and 16–35% of those cause distant metastases [1, 2]. We report here a very rare case of lung metastasis from MPT of the breast that showed pure ground-glass opacity (GGO) on chest CT about 3 years after the primary operation.
Case report A 71-year-old woman was admitted for a lump in her right breast that was growing in size since it was initially discovered 4 years prior. In addition, she reported breast pain that * Shoko Nakamura [email protected] 1
Breast Center, Kin-Ikyo Chuo Hospital, 5‑1‑9‑1 Higashinaebo, Higashi‑ku, Sapporo 007‑8505, Japan
2
Respiratory Center, Kin-Ikyo Chuo Hospital, 5‑1‑9‑1 Higashinaebo, Higashi‑ku, Sapporo 007‑8505, Japan
3
Department of Pathology, Kin-Ikyo Chuo Hospital, 5‑1‑9‑1 Higashinaebo, Higashi‑ku, Sapporo 007‑8505, Japan
4
Department of Surgery, Kin-Ikyo Sapporo Hospital, 4‑1‑9‑22 Kikusui, Shiroishi‑ku, Sapporo 003‑8510, Japan
began 4 months prior to admission. She had no past history of malignancy. On initial examination, we felt a movable elastic hard mass, 15 cm in diameter, covering the almost entire right breast with reddish skin. Axillary lymph nodes were not palpable. An ultrasonic observation revealed a 10.5 × 9.5 × 8.0 cm solid, lobulated and heterogeneous mass, including cystic slit-like spaces. MRI indicated a relatively well circumscribed, lobulated mass in the upper-outer quadrant. The mass showed heterogeneous enhancement overall and internal septations were enhanced in the early phase (Fig. 1). Although a core needle biopsy suggested benign PT, we could not deny the possibility of malignancy on MRI and ultrasonic images. After confirming no visible distant metastasis, we decided to conduct a surgical operation (total mastectomy). The tumor was completely excised wi
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