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Case Reports
. 2019 Dec 21;13(1):378.
doi: 10.1186/s13256-019-2313-3.

Recurrent giant fibroadenomas with transformation to cystosarcoma phyllodes in a 17-year-old girl: a rare case report from Syria

Sawsan Ismail  1 , Sara Alaidi  2 , Sarah Jouni  2 , Yahya Kassab  3 , Zuheir Al-Shehabi  4
Affiliations
Case Reports

Recurrent giant fibroadenomas with transformation to cystosarcoma phyllodes in a 17-year-old girl: a rare case report from Syria

Sawsan Ismail et al. J Med Case Rep. .

Abstract

Background: Fibroadenoma is the most prevalent benign breast lesion that generally affects middle-aged women; it is rare in adolescents and younger children. The transformation into malignancy is not common. However, multiple recurrences of rapidly enlarging fibroadenomas suggest a high possibility of transforming into phyllodes tumors, which are uncommon fibroepithelial lesions that account for 0.3-0.5% of female breast tumors and typically present in premenopausal women.

Case presentation: We report a case of a 17-year-old Syrian girl who previously had three episodes of recurrence of multiple rapidly enlarging fibroadenomas in her left breast and underwent three operations for complete resection of the lesions. However, a few months later, she was readmitted with multiple large masses in the same breast, and pathological findings confirmed a surprising combination of multiple fibroadenomas for the fourth time with a malignant phyllodes tumor (cystosarcoma phyllodes). The patient underwent lumpectomies followed by adjuvant radiotherapy. Long-term follow-up was recommended.

Conclusion: Our patient had an extraordinary number of episodes of recurrence at a young age and a rare combination of malignant and benign lesions in the same breast with multiple recurrences. We present her unique, very challenging case with the aim of highlighting the importance of clinical correlation, detailed diagnosis, and careful follow-up.

Keywords: Breast lesions; Fibroadenoma; Phyllodes tumors (cystosarcoma phyllodes).

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Morphological features of juvenile fibroadenoma: diffuse proliferation of fibrous tissue surrounding acinar and cystically dilated ductal structures with no cellular atypia a Hematoxylin and eosin (H&E) stain, original magnification × 200. b Hematoxylin and eosin (H&E) stain, original magnification × 400
Fig. 2
Fig. 2
A large, well-circumscribed mass resected in the third recurrence, measuring 15 cm in diameter
Fig. 3
Fig. 3
Resected, well-circumscribed masses measuring together 20 × 15 × 16 cm in the fourth recurrence right after the surgical procedure
Fig. 4
Fig. 4
Resected, well-circumscribed masses measuring together 20 × 15 × 16 cm. The red circle points to the largest mass, measuring 8 cm in diameter, and diagnosed microscopically as malignant phyllodes tumor
Fig. 5
Fig. 5
Nodular proliferation of multiplicated cellular fibrous tissue and distended ductal structures with prominent areas of stromal overgrowth, nuclear pleomorphism, and mitotic figures (5–7/10 high-power fields). a and b Hematoxylin and eosin (H&E) stain, original magnification × 200. c and d Hematoxylin and eosin (H&E) stain, original magnification × 400
Fig. 6
Fig. 6
A timeline of the patient’s case. Ds diagnosis, T time
See this image and copyright information in PMC

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