CASE REPORT 
Annals of Nuclear Medicine Vol. 7, No. 1, 51-52, 1993 
99mTc-HMDP accumulation in a phyllodes tumor of the breast, a case report 
Hitoya OHTA,* Tomoo KOMIBUCHI,* Ryuichiro ADACHI,** Hiroshi OTANI,** Hideyo TAKEDA,* Kanji HAMAZAKI,* Kazuyo SHIMIZU,* Toshikatsu TANIGUCHI,* Kunikatsu IRIE,*** and Kazutaka YAMAMOTO**** 
Departments of *Laboratories, **Surgery, ***Pathology, Osaka Red Cross Hospital, Osaka **** Department of Radiology, Fukui Medical School, Fukui, Japan 
In a patient with breast tumor, 99mTc-HMDP accumulation in the tumor was recognized in evaluating bone metastasis. Surgery and histopathology revealed that the tumor was a phyllodes tumor. This scintigraphic finding was thought to be rare and phyllodes tumor should be included in differential diagnosis when 99mTc-HMDP accumulation in the breast was recognized. 
Key words: breast, phyllodes tumor, bone scintigraphy, 99mTc-HMDP 
CASE REPORT 
A 45-year-old female was referred to our hospital due to a right large breast mass. 3 years before, she noticed an asymptomatic right breast mass 2 cm. in diameter which gradually increased in size. When the patient was admitted, the mass was lobulated, well-delineated, movable and measured 18cm in diameter. No skin ulcer or lymph node enlargement was recognized. CT showed a large lobulated, homogeneous density tumor replacing the entire right breast (Fig. 1). 
99mTc-HMDP bone scintigraphy was employed to evaluate bone metastasis, and there was abnormal accumulation in the tumor but no bone metastasis was recognized (Fig. 2A, B). 
Simple mastectomy was performed and the histopathological finding was a phyllodes tumor of the breast. There was no microscopic calcification or necrosis (Fig. 3A, B). 
DISCUSSION 
Phyllodes tumor is not so common (2-3% of the fibroepithelial tumors of the breast), and giant fibroadenoma is a synonym for it. It was first described in 1838 by Johannes Muller and he emphasized its benign character yet called it cystosarcoma phyllodes because of its leaf-like and sometimes blastomatous aspect. This tumor is characterized by its bulky sphenoidal mass and rapid growth, and it often derives from a small pre-existing fibroadenoma.1,2 
The accurate diagnosis of this tumor is dependent on histological examination after its removal, and noninvasive preoperative diagnosis is not so easy.3 It is reported that ultrasound findings including low-level internal echoes, smooth walls and good through transmission are useful in diagnosis.4 Many causes of breast accumulation in bone scintigraphy are also reported. Breast carcinoma is common and other tumors are rare.5 In breast carcinoma, it is reported that the breast accumulation of 99mTc-MDP is affected by tumor size but has no relationship with histological type, estrogen receptor or microscopic calcification.6 
In conclusion, a phyllodes tumor of the breast was reported. 99mTc-HMDP accumulation in the tumor was recognized. This finding was rare. 
ACKNOWLEDGMENTS
The authors thank nihon medi+physics, Miss Yumiko Tsuda, Mr. Kenichi Takehara Mr. Keigo Tanaka and Mr. Michito Shimizu for their valuable assistance. 
REFERENCES 
l. Haagensen CD: Diseases of the breast, 2nd edition-revised reprint, Philadelphia, Saunders, pp 227-249, 1971 
2. Ashley DTB : Evan's histological appearances of tumours, 3rd edition, Edinburgh, Churchill Livingstone, pp 377-380, 1978 
3. Kitagawa S, Okuyama H, Kawaguchi T, et al: Six cases of cystosarcoma phyllodes-with special reference to preoperative ultrasound findings-. J Jpn Soc Clin Surg 47: 1578-1582, 1986 
4. Cole-Beuglet CMD, Soriano R, Kurtz AB, et al: Ultrasound. X-ray mammography, and histopathology of cystosarcoma philloides. Radiology 146: 481-486, 1983 
5. Datz FL: Gamuts in nuclear medicine, 2nd edition, Connecticut, Appleton & Lange, pp 126-127, 1987 
6. Kato S, Sugiyama S, Yamakawa M, et al: The abnormal accumulation of 99mTc-MDP in cancer of the breast. Rynsho Hoshasen 31: 881-884, 1986