Clinicopathology and treatment of a giant malignant phyllodes tumor of the breast: A case report and literature review

Surgical Management and System Therapy of the Most Giant Known Malignant Metastatic Breast Phyllodes Tumor: A Case Report and Review of the Literature

INTRODUCTION

Phyllodes tumors belong to uncommon fibroepithelial breast tumors with a range of biological behaviors. Phyllodes tumors are responsible for less than 1 percent of all neoplasms of the breast.

CASE PRESENTATION

A 66-year-old woman presented to our Breastcancer Unit in March 2021 because of a huge mass of her left breast with bleeding out of a tumor necrosis. Five years ago in 2016, a benign phyllodes tumor was diagnosed externally. When we started the treatment, the tumor had a weight of 18.6 kg.

CONCLUSION

We describe the surgical management and the systemic treatment of metastatic disease.

Rare case of gigantic ulcerating phyllodes tumour in developed country with a review of the literature

Phyllodes tumour (PT) is a rare type of fibroepithelial breast tumour that can present in a wide spectrum of biological behaviours, accounting for <1% of breast malignancies. Herein, we present a case of a rare gigantic ulcerating PT in a middle-aged woman from regional Western Australia, who presented with a rapidly growing right breast mass. Core biopsy showed spindle cell lesion with differentials being PT of at least borderline variety or metaplastic carcinoma. The ulcerations over the fungating tumour showed heavy growth of Staphylococcus aureus. The treating team subsequently proceeded to right total mastectomy with level 1 and 2 axillary clearance. This report emphasizes the rare presentation of PT, dilemma in investigations and the difficulties in managing non-compliant patient where treatment protocol needs to be modified.

A giant malignant phyllodes tumor of breast post mastectomy with metastasis to stomach manifesting as anemia: a case report and review of literature

BACKGROUND

Phyllodes tumors (PTs) are well known for local recurrence and progression. Less than 10% of these tumors grow larger than 10 cm. Distant metastases have been reported in up to 22% of malignant PTs, with most metastases being discovered in the lungs. PTs of the breast rarely metastasize to the gastrointestinal tract, and reported cases are scarce. To date, a review of the English literature revealed only 3 cases, including our case, of PTs metastasis to stomach.

CASE PRESENTATION

An 82-year-old female patient had 10-year-duration of palpable huge tumor on left breast which was in rapid growth in recent months. Total mastectomy of left breast was performed thereafter, and pathology diagnosis was malignant phyllodes tumor. Adjuvant radiotherapy was suggested while she declined out of personal reasons initially. For PTs recurred locally on left chest wall 2 months later, and excision of the recurrent PTs was performed. She, at length, completed adjuvant radiation therapy since then. Six months later, she was diagnosed of metastasis to stomach due to severe anemia with symptom of melena. Gastrostomy with tumor excision was performed for uncontrollable tumor bleeding.

CONCLUSION

For PTs presenting as anemia without known etiologies, further studies are suggested to rule out possible gastrointestinal tract metastasis though such cases are extremely rare. Management of metastatic gastric tumor from PTs should be done on a case-to-case basis, surgical intervention may be needed if there is persistent active bleeding despite medical treatment. Adjuvant radiotherapy is recommended in borderline and malignant PTs with tumor-free margin < 1 cm and high-risk malignant tumors. Adjuvant chemotherapy or target therapy may be helpful for metastatic PTs. Molecular and genomic techniques may predict clinical outcomes of benign and borderline PTs more precisely.

Giant phyllodes tumor occupying the whole breast in a young female: feasibility of mastectomy and immediate reconstruction

Giant phyllodes tumors are rare fibroepithelial breast neoplasms typically >10 cm by definition. The best investigation for preoperative diagnosis is core biopsy, although it is often difficult for the pathologist to distinguish fibroadenomas from phyllodes tumors and determine the level of malignant potential. The wide excision is the appropriate therapy for phyllodes tumors taking into consideration that mastectomy may be required for huge phyllodes tumors. In the modern era of breast tissue expanders and breast implants, immediate breast reconstruction is feasible. We present a case report of a patient with a giant phyllodes tumor of 24 cm diameter who underwent mastectomy and immediate breast reconstruction with breast tissue expander.

Recurrent borderline phyllodes tumor of the breast submitted to mastectomy and immediate reconstruction: Case report

•

Phyllodes tumors of the breast are rare fibroepithelial neoplasms.

•

They are histologically classified into benign, borderline and malignant variants.

•

Anatomopathological examination is considered the definitive diagnostic method.

•

They have a high rate of local recurrence and the possibility of metastases.

•

Surgery is the definitive treatment and adjuvant therapy is controversial.

Introduction

Phyllodes tumors are biphasic fibroepithelial tumors that account for fewer than 1% of mammary tumors. They usually appear in middle-aged women, with an average size of 4–7 cm and rapid growth.

Presentation of case

A 25-year-old woman sought care after excision of recurrent nodules in the right breast, with a diagnosis of borderline phyllodes tumor. She had no new lesions on physical examination. Imaging studies revealed an anechoic collection and nodular areas in a previous surgical site, correlated with pathology. Immuno-histochemical examination was positive for vimentin, calponin, Ki-67 and estrogen receptor. Systemic staging did not show metastases. Skin-reducing mastectomy was performed on the right side, followed by reconstruction and left reduction mammaplasty for symmetry. At 8-month follow-up, there was no relapse of the lesions on clinical and ultrasonographic examinations.

Discussion

Phyllodes tumors are rare neoplasms characterized by rapid growth, occurring in women between 35–55 years of age. They are classified as benign, borderline and malignant, according to histological parameters. There are reports of genetic mutations in TP53 associated with malignant phyllodes tumor. On immunohistochemistry, there is a greater tendency to malignancy in tumors with Ki-67 and estrogen receptor expression. Imaging methods may aid in diagnosis, which is only definitive after excision and histopathological analysis of the tumor. These tumors have high local recurrence rates and possibility of metastases, closely related to histology.

Conclusion

Phyllodes tumors are a great challenge to the surgeon. Treatment is surgical, with wide excision; radiotherapy and chemotherapy are controversial.

Imaging and Clinical Features of an Unusual Unilateral Breast Enlargement Diagnosed as Fibrocystic Change: A Case Report

Patient: Female, 38

Final Diagnosis: Fibrocystic change

Symptoms: Breast swelling

Medication: —

Clinical Procedure: Breast biopsy

Specialty: Radiology