Giant breast tumors: surgical management of phyllodes tumors, potential for reconstructive surgery and a review of literature

Abstract

Background: Phyllodes tumors are biphasic fibroepithelial neoplasms of the breast. While the surgical management of these relatively uncommon tumors has been addressed in the literature, few reports have commented on the surgical approach to tumors greater than ten centimeters in diameter - the giant phyllodes tumor.

Case presentation: We report two cases of giant breast tumors and discuss the techniques utilized for pre-operative diagnosis, tumor removal, and breast reconstruction. A review of the literature on the surgical management of phyllodes tumors was performed.

Conclusion: Management of the giant phyllodes tumor presents the surgeon with unique challenges. The majority of these tumors can be managed by simple mastectomy. Axillary lymph node metastasis is rare, and dissection should be limited to patients with pathologic evidence of tumor in the lymph nodes.

Figure 1

Case 1: The mass measured 36 × 30 cm with the characteristic bluish discoloration of the skin with nipple excoriation.

Figure 2

Case 1: Intra-operative photo revealing dissection of the tumor with no invasion of the deeper chest wall.

Figure 3

Case 1: Intra-operative photo after tumor resection with placement of two #19 Blake drains under the superior and inferior flaps.

Figure 4

Case 1: A) Large, simple ducts were surrounded by a uniform, bland stroma in this tumor, which measured 30.0 × 25.0 × 20.0 cm ex vivo. B) The tumor had negative margins of resection that ranged from 0.3 to 1.0 cm. C) The Ki67 proliferation index for the tumor from patient A was 5 for the epithelial component and 13 for the stromal component. Case 2: D) Large, branching ducts were surrounded by a uniform, bland stroma; areas of hyalinization and myxoid change were rare in this 10.0 x 8.0 x 5.0 cm tumor. E) The tumor had negative margins of resection that ranged from 0.3 to 1.0 cm. F) The Ki56 proliferation index for the tumor from patient B was 0.8 for the epithelial component and 4 for the stromal component.