The largest and neglected giant phyllodes tumor of the breast-A case report and literature review

Abstract

Phyllodes tumours are rare fibro-epithelial lesions. The role of the pathologist in the preoperative diagnosis of phyllodes tumours of the breast is critical to appropriate surgical planning. Wide local excision or mastectomy with adequate margin remains the treatment of choice. Local recurrence occurs in approximately 10- 16.1% of patients (Wei et al., 2014) [1] and distant metastases occurs in 6.3-31% of patients with malignant phyllodes tumours (Wei et al. (2014), Chaney et al., 1998) [1,2] but only in 4% of all phyllodes tumours (Salvador et al., 1989) [3]. Emphasis should be given in early diagnosis and intervention to decrease morbidity and mortality.

Keywords: Benign giant phyllodes tumor; Giant fibroadenoma; Invasive adenocarcinoma of the breast; Malignant phyllodes tumor.

Fig. 1

Initial mammogram shows lobulated mass on right breast with architectural distortion.

Fig. 2

(a) Giant phyllodes tumour with prominent dilated subcutaneous vessels.(b) The fungating giant phyllodes tumour. (a, b): The fungating giant phyllodes tumour with prominent dilated subcutaneous vessels.

Fig. 3

CT chest showing heterogeneous enhancing mass in right breast with ill-defined deep margin.

Fig. 4

Chest wall after excision of phyllodes tumor.

Fig. 5

Phyllodes tumor after excision.

Fig. 6

LD flap to cover the anterior chest wall.

Fig. 7

Photograph taken on postop follow up.

Fig. 8

(a) Leaf like growth pattern with hypercellular stoma characteristic of benign phyllodes. (b) Stromal cellularity with scanty mitoses and minimal nuclear atypia.