A Giant Exulcerated Phyllodes Breast Tumor - A Case Report

AbstractPhyllodes tumors of the breast can be benign, malignant, or borderline. Benign and borderline tumors are rare tumor types that have a positive outlook and high survival rate, while the risk of recurrence is typical for malignant breast tumors. Giant phyllodes tumors are larger than 10 cm in diameter and demand a serious diagnostic and treatment approach.In this study we present a case of a female patient treated for an exulcerated breast carcinoma- a giant borderline phyllodes tumor of the breast. The patient presented to the department for the right breast lump with ulcerated skin and nipple abnormalities. The core biopsy was performed and the patient was diagnosed with a benign tumor. Simple mastectomy was performed and final histopathological report revealed a borderline phyllodes tumor. Diagnosis and treatment of a giant phyllodes tumor remain a great challenge for the surgeons. Establishing the preoperative diagnosis based on histopathological findings is imperative to disease management. Surgery is the mainstay of treatment and mastectomy has been the traditional procedure; in cases where suspicious findings in the axilla are revealed, radical mastectomy is performed and the axilla is to be dissected.

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Phyllodes tumor of breast, real-world data from a referral center in Mexico.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e19356 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e19356-e19356

Author(s):

María Inés Contreras-Salcido ◽

Carlos Eduardo Salazar-Mejía ◽

Adriana González-Gutiérrez ◽

Rolando Jacob Martinez ◽

Jackeline Grace Lara-Campos ◽

...

Keyword(s):

Radical Mastectomy ◽

Phyllodes Tumor ◽

Breast Disease ◽

Breast Conserving Surgery ◽

Real World Data ◽

Referral Center ◽

Phyllodes Tumors ◽

Wide Range ◽

Simple Mastectomy ◽

Mixed Histology

e19356 Background: Phyllodes tumors of breast (PTB) comprise a wide range of rare fibroepithelial neoplasms representing less than 1% of all breast tumors. Studies that describe the clinical characteristics of Mexican women with PTB are scarce. Methods: We performed a retrospective analysis of all patients with newly diagnosed PTB treated at an oncology referral center in Northeast Mexico from 2013 to 2018. Results: Twenty-three women were included in the analysis. Median age at diagnosis was 51 years. Diagnosis was made by self-detection in all cases, with a median tumor size of 12.8 cm. Approximately 26% of patients had a history of benign breast disease. Regarding treatment received 39% underwent radical mastectomy whereas simple mastectomy and breast-conserving surgery were performed in 39 and 22%, respectively. PTB were classified as benign, borderline, and malignant in 17, 13, and 70% of cases, respectively. Patients with malignant PTB showed a heterologous component in 22% of cases (60% with mixed histology, 20% fibromyxosarcoma, and 20% osteosarcoma). Metastatic disease at diagnosis was documented in 3 patients. Relapse of disease was confirmed in eight patients, two of them corresponded with borderline histology and six to malignant subtype. Recurrence sites by frequency were locoregional only 38%; distant disease to the lungs only 12%; and combined metastases to lung, liver and central nervous system 50%. Regarding management of recurrence, four patients received chemotherapy, two received only radiotherapy, one was treated with radiotherapy and chemotherapy and one woman received surgical treatment with adjuvant radiotherapy. Among all patients analyzed, the median overall survival was 23.6 months. Conclusions: To our knowledge, this is one of the first studies analyzing the clinical-pathological characteristics of phyllodes tumors in the Mexican population.

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Effective Treatment of a Malignant Breast Phyllodes Tumor with Doxorubicin-Ifosfamide Therapy

Case Reports in Oncological Medicine ◽

10.1155/2019/2759650 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5

Author(s):

Shinya Yamamoto ◽

Shigeru Yamagishi ◽

Toshiro Kohno ◽

Ryosuke Tajiri ◽

Toshikazu Gondo ◽

...

Keyword(s):

Pleural Effusion ◽

Left Lung ◽

Phyllodes Tumor ◽

Lung Mass ◽

Malignant Phyllodes Tumor ◽

Phyllodes Tumors ◽

Malignant Breast ◽

One Year ◽

The Right ◽

Chemotherapy Strategy

Malignant phyllodes tumors of the breast occur infrequently and are difficult to treat with chemotherapy. Here, we present an effective chemotherapy strategy for recurrent malignant breast phyllodes tumors. A 48-year-old woman was diagnosed with a malignant phyllodes tumor in her right breast and underwent total right mastectomy. One year later, the tumor recurred in the right (a 2.2 cm mass) and left (a 10 cm mass) lungs; pleural effusion was also observed in the left lung. Eight courses of doxorubicin-ifosfamide (AI) therapy were administered. After treatment, the right lung mass and pleural effusion regressed completely and the left lung mass regressed to 2 cm. In conclusion, AI therapy is useful for treating recurrent malignant breast phyllodes tumors.

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Large Malignant Phyllodes Tumor of the Breast: Case Report of a Young Female and Review of Literature

Archives of Breast Cancer ◽

10.32768/abc.202073136-142 ◽

2020 ◽

pp. 137-146

Author(s):

Melissa Kyriakos Saad ◽

Imad El Hajj ◽

Elias Saikaly

Keyword(s):

Malignant Tumors ◽

Pectoralis Major Muscle ◽

Phyllodes Tumor ◽

World Health ◽

Low Grade ◽

Accurate Identification ◽

Malignant Phyllodes Tumor ◽

Phyllodes Tumors ◽

Post Surgery ◽

The Right

Background: Phyllodes tumors are rare fibroepithelial neoplasm of the breast, representing 0.3 to 0.5% of all female breast neoplasms. The term ‘‘phyllodes tumor” by the World Health Organization (WHO) categorizes it into benign, borderline, and malignant tumors based on histopathological characteristics. Malignant phyllodes tumor is an uncommon but aggressive breast malignancy and accounts for approximately 25% of all phyllodes tumors.Case Presentation: A 23-year-old female patient Gravida 0 Para 0, previously healthy, with no family history of breast or ovarian cancer was referred to our institution for managing a right breast mass increasing in size over a period of 1 month associated with reddish-brown discoloration of the skin. Breast ultrasound showed an isodense oval mass measuring approximately 16x14x12cm in the right lower outer quadrant of her breast. Core biopsy and FNA done revealed a low grade phyllodes tumor. MRI of breasts showed a huge mass of the right breast occupying all quadrants, measuring 15x14.5 cm in its greatest axis with involvement of the pectoralis major muscle, with no evidence of suspicious axillary lymphadenopathy. Distant metastatic work-up with CT scan of chest abdomen and pelvis and a PET scan did not show distant metastasis. Hence, the patient underwent right total mastectomy with a final pathology compatible with malignant phyllodes tumor. She is on regular follow up and 18 months post-surgery is still disease free.Conclusion: Management of malignant phyllodes tumor remains debatable, especially when it comes to the effect of adjuvant radiotherapy and chemotherapy. From a surgical perspective, whether phyllodes tumors should be considered as epithelial breast cancers or as soft tissue sarcoma is another debate. On the other hand, although challenging, accurate identification of phyllodes tumor initially may aid in decreased recurrence.

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Fibroepithelial Breast Tumors: Cohort Study

Tumori Journal ◽

10.1177/0300891620914176 ◽

2020 ◽

Vol 106 (1_suppl) ◽

pp. 39-39

Author(s):

Mohammed Gamil ◽

Magda Murad ◽

Nelly Hassan Ali el din ◽

Ashraf Sobhy Zakaria

Keyword(s):

Local Excision ◽

Wide Local Excision ◽

Radical Mastectomy ◽

Breast Tumors ◽

Needle Aspiration ◽

Cancer Epidemiology ◽

Modified Radical Mastectomy ◽

Phyllodes Tumors ◽

Simple Mastectomy ◽

Study Population

Background: The frequency of mesenchymal breast tumors is very low, being represented mostly by tumors with biphasic proliferation (phyllodes tumors) and less by other types of non-epithelial tumors. Objective: To review the Management of phyllodes tumors of the breast in the NCI Cairo university during a period of 10 years (2000 till 2010). Material and Methods: Retrospective study including 99 patients who diagnosed and treated with phyllodes tumors of the breast between (2000 to 2010). Data were collected from the biostatistics and cancer epidemiology department. Results: Out of 99 patients; 51 (51.5%) were benign and 32 (32.3%) were borderline and 16 (16%) were malignant; the median age of the study population was 45.5 years (range 18–71 years).The main radiological tool of diagnosis was breast US and mammography 100%. Preoperative fine needle aspiration (FNA) was performed in 12(37.5%) cases for cytodiagnosis but true cut biopsy was done in 87 (87%) cases. Wide local excision was done in 86%, wide local excision with axillary evacuation was done in 1% only, simple mastectomy was done in 9.3% and modified radical mastectomy was done only in 3% of all cases. Conclusion: Different surgical modalities are considered the main line for management of phyllodes breast tumors. Local recurrence can be avoided with wide local excision from the first surgery. Axillary LN dissection is not a role in management of breast PT.

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CASE REPORT: METASTATIC PHYLLODE TUMOR

International Journal of Advanced Research ◽

10.21474/ijar01/11925 ◽

2020 ◽

Vol 8 (10) ◽

pp. 989-992

Author(s):

E. Lemrabott ◽

◽

N. Abdelkader ◽

A. Cheikh ◽

N. Mamouni ◽

...

Keyword(s):

Treatment Guidelines ◽

Phyllodes Tumor ◽

Left Breast ◽

Split Thickness Skin Graft ◽

Axillary Lymph ◽

Skin Defect ◽

X Ray ◽

Phyllodes Tumors ◽

Standard Treatment Guidelines ◽

The Right

Rationale: Malignant phyllodes tumors are rare breast neoplasms that are associated with a 6.2% to 25% incidence rate of distant metastasis the lung is the most common metastatic site. To date, there is no consensus regarding the treatment of metastatic malignant phyllodes breast tumors. Patient concern: A 34-year-old woman was admitted into the gynecology department for a rapidly growing left breast tumor that was first noticed month prior. Diagnosis: Core needle biopsy revealed a malignant phyllodes tumor. A chest computed tomography tomography/CT showed metastatic lymph nodes that appeared to have spread to the right axilla She was subsequently followed by course of radiotherapy, she consulted again 3 months later for a productive cough, X-ray thorax in comparison with that made preoperatively: presence of the left peri-hilar nodules which were not present on the first X-ray Interventions: A left mastectomy with axillary lymph node dissection was conducted and a thoracoabdominal flap and a split thickness skin graft were performed for the skin defect. And radiotherapie adjuvant. Lessons: As standard treatment guidelines for metastatic malignant phyllodes tumors are lacking, we opted for the aforementioned aggressive treatments that resulted in complete remission of the lung metastasis. Therefore, aggressive treatment, whenever possible, is warranted.

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Advance Malignant Phyllodes Tumor with Active Bleeding in Children: A Rare Case

Indonesian Journal of Cancer ◽

10.33371/ijoc.v15i4.797 ◽

2021 ◽

Vol 15 (4) ◽

pp. 208

Author(s):

Dedy Hermansyah ◽

Fernando Silalahi ◽

Albiner Simarmata ◽

Denny Rifsal Siregar

Keyword(s):

Physical Examination ◽

Rare Case ◽

Phyllodes Tumor ◽

Active Bleeding ◽

Breast Lesions ◽

Malignant Phyllodes Tumor ◽

Phyllodes Tumors ◽

Prompt Treatment ◽

The Right ◽

Current Guidelines

Introduction: Phyllodes tumors are fibroepithelial breast lesions that are uncommon in women and rare among children. Due to scarcity, there are only a few large pediatric phyllodes tumor series. Current guidelines do not differentiate treatment recommendations between children and adults.Case Presentation: A 12-year-old girl presented with a lump in her right breast which grew rapidly within a month. On physical examination, we found a mass on the right breast sized ± 10 x 10 cm; the lump was fragile and bled easily. The patient’s condition was getting worse and worse. Due to this deterioration, we performed a mastectomy immediately.Conclusions: The incidence of malignant phyllodes tumor in children is very rare and required prompt treatment in emergency cases.

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Primary epidermoid carcinoma of the breast presenting as a breast abscess and sepsis

Sao Paulo Medical Journal ◽

10.1590/s1516-31802011000600009 ◽

2011 ◽

Vol 129 (6) ◽

pp. 424-427 ◽

Cited By ~ 3

Author(s):

Andrea Pires Damin ◽

Fernanda Costa Nascimento ◽

João Batista Andreola ◽

Talita Haubert Cerutti ◽

Adriana Roehe ◽

...

Keyword(s):

Unusual Case ◽

Histopathological Examination ◽

Radical Mastectomy ◽

Definitive Treatment ◽

Breast Abscess ◽

Breast Carcinomas ◽

Large Breast ◽

Occult Malignancy ◽

Malignant Breast ◽

The Right

CONTEXT: Squamous cell carcinoma (SCC) of the breast is an extremely rare form of cancer, accounting for approximately 0.04% of all malignant breast tumors. To date, only a limited number of cases of SCC of the breast have been reported, and most of them presented like the usual breast carcinomas. CASE REPORT: A 39-year-old woman presented with a large breast abscess and signs of sepsis. After surgical debridement of the lesion, histopathological examination of the abscess capsule revealed the presence of SCC of the breast. The definitive treatment for the tumor consisted of modified radical mastectomy with resection of the residual lesion in the right breast. CONCLUSIONS: This unusual case illustrates how an apparently benign disorder such as a breast abscess might be related to a clinically occult malignancy. A review of the literature on SCC of the breast is presented

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A Malignant phyllodes Tumor of the Breast; Presentation of an Uncommon Case and Review of the Literature

Archives of Breast Cancer ◽

10.32768/abc.20207293-96 ◽

2020 ◽

pp. 93-96

Author(s):

Sumaiya Iqbal ◽

Juwairiya Iqba; ◽

Nowfala Nowshad ◽

Khadeeja Mohammad

Keyword(s):

Distant Metastasis ◽

Phyllodes Tumor ◽

Lymph Node Involvement ◽

Excision Biopsy ◽

Breast Clinic ◽

Malignant Phyllodes Tumor ◽

Simple Mastectomy ◽

The Right ◽

Surgery Department

Background: Phyllodes tumours are rare fibroepithelial neoplasm of connective tissue of the breast accounting for 0.3-1% of all breast tumours with 10% of them being malignant. They resemble fibroadenomas clinically and can be mistakenly ignored. Case presentation: A 38-year-old unmarried Philipino lady presented to the primary health center with a mass in the right breast for the past year. Over the preceding 6 months, it had progressively increased in size and pain. On examination, a 5 x 3 cm firm and lobulated mass was palpated in the right upper outer quadrant. Ultrasound scan showed a solid 4.25 x 3.3 x 2.4 cm mass with heterogeneous mixed echopattern. She was referred to Surgery department where an ultrasound-guided core biopsy showed a lesion suspicious for benign phyllodes tumor. An excision biopsy revealed three foci of malignant Phyllodes on the background of fibroadenoma. A staging CT was performed which showed no evidence of lymph node involvement or distant metastasis. A simple mastectomy was performed and histopathology confirmed the diagnosis of malignant phyllodes tumor. Postoperatively, the patient is on regular follow up in the breast clinic and physiotherapy department. Conclusion: Phyllodes tumor bears specific clinical characteristics and should be considered as a differential diagnosis in any mass lesion of the breast.. Diagnosis and management are crucial in phyllodes tumor because of their malignant potential recurrence. Clinicians should be competent in distinguishing between fibroadenoma and a phyllodes tumor. Lastly, given the rarity of phyllodes tumors, there is a need to establish guidelines to incorporate regular follow up for early detection of distant metastasis.

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Phyllodes tumor of right breast with metastasis to lungs, rare presentation

International Surgery Journal ◽

10.18203/2349-2902.isj20173914 ◽

2017 ◽

Vol 4 (9) ◽

pp. 3184

Author(s):

Prabhat B. Nichkaode ◽

Sachin Kumar Patel

Keyword(s):

Spindle Cell ◽

Phyllodes Tumor ◽

Benign Tumors ◽

Rare Presentation ◽

Complete Excision ◽

Cell Metastasis ◽

Younger Age ◽

Left Pleural Effusion ◽

Simple Mastectomy ◽

The Right

Incidence of Phylloids tumor of the breast is between 0.5% to 2% of all breast tumors. Most common age of occurrence is between 45-49 years but it can occur even at younger age. It is important to distinguish it from more benign tumors of the breast like fibroadenoma as far the management is concerned. Phylloids are fibroepethilial tumors with malignant potential, so needs complete excision. We present a case of 53 years female who underwent simple mastectomy for high grade Phylloids tumor in her right breast a year back, presented with breathlessness and local recurrence, proved to be metastatic Phylloids to lung causing left pleural effusion and nodule in the right upper lobe of lung. When the effusion was tapped it appeared to be pleomorphic spindle cell metastasis.

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Skin-Reducing Mastectomy and Immediate Reconstruction for a Large Recurrent Borderline Phyllodes Tumor

Applied Sciences ◽

10.3390/app11031224 ◽

2021 ◽

Vol 11 (3) ◽

pp. 1224

Author(s):

Daciana Grujic ◽

Horia Cristian ◽

Teodora Hoinoiu ◽

Codruta Diana Miclauș ◽

Simona Cerbu ◽

...

Keyword(s):

Phyllodes Tumor ◽

Left Breast ◽

Breast Hypertrophy ◽

Immediate Reconstruction ◽

Case Presentation ◽

Surgical Decision ◽

Simple Mastectomy ◽

Resection Specimen ◽

The Right

Background: Large recurrent phyllodes breast tumors are often malignant. Therefore, when taking the surgical decision, a simple mastectomy and immediate reconstruction must be considered. Case presentation: The patient, aged 40 years, with a benign phyllodes tumor in the left breast, having a recurrence 2 years after, with 4–7 cm conglomerate tumor masses, was subjected to skin-reducing mastectomy, breast reconstruction with a silicone mammary implant in the left breast, and symmetrization of the right breast. Discussion and conclusions: In the case of patients with breast hypertrophy and gigantomastia (cup size D–F), skin-reducing mastectomy and immediate reconstruction with an implant can be the option. It is important for the resection specimen to include the skin tissue above the tumor. After 14 months of follow-up, there was no recurrence of the lesions on a clinical examination, ultrasonography, or MRI.

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