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

Background: Phyllodes tumours are rare fibroepithelial neoplasm ofconnective tissue of the breast accounting for ۰.۳-۱% of all breast tumours with۱۰% of them being malignant. They resemble fibroadenomas clinically and can bemistakenly ignored.Case presentation: A ۳۸-year-old unmarried Philipino lady presented to theprimary health center with a mass in the right breast for the past year. Over thepreceding ۶ months, it had progressively increased in size and pain. Onexamination, a ۵ x ۳ cm firm and lobulated mass was palpated in the right upperouter quadrant. Ultrasound scan showed a solid ۴.۲۵ x ۳.۳ x ۲.۴ cm mass withheterogeneous mixed echopattern. She was referred to Surgery department wherean ultrasound-guided core biopsy showed a lesion suspicious for benign phyllodestumor. An excision biopsy revealed three foci of malignant Phyllodes on thebackground of fibroadenoma. A staging CT was performed which showed noevidence of lymph node involvement or distant metastasis. A simple mastectomywas performed and histopathology confirmed the diagnosis of malignantphyllodes tumor. Postoperatively, the patient is on regular follow up in the breastclinic and physiotherapy department. Conclusion: Phyllodes tumor bears specific clinical characteristics and shouldbe considered as a differential diagnosis in any mass lesion of the breast..Diagnosis and management are crucial in phyllodes tumor because of theirmalignant potential recurrence. Clinicians should be competent in distinguishingbetween fibroadenoma and a phyllodes tumor. Lastly, given the rarity of phyllodestumors, there is a need to establish guidelines to incorporate regular follow up forearly detection of distant metastasis.

Keywords:

Breast cancer , phyllodes tumor , malignancies