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

Background: Phyllodes tumors are rare fibroepithelial neoplasm of the breast,representing ۰.۳ to ۰.۵% of all female breast neoplasms. The term ‘‘phyllodestumor” 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 andaccounts for approximately ۲۵% of all phyllodes tumors. Case Presentation: A ۲۳-year-old female patient Gravida ۰ Para ۰, previouslyhealthy, with no family history of breast or ovarian cancer was referred to ourinstitution for managing a right breast mass increasing in size over a period of ۱month associated with reddish-brown discoloration of the skin. Breast ultrasoundshowed an isodense oval mass measuring approximately ۱۶x۱۴x۱۲cm in the rightlower outer quadrant of her breast. Core biopsy and FNA done revealed a low gradephyllodes tumor. MRI of breasts showed a huge mass of the right breast occupyingall quadrants, measuring ۱۵x۱۴.۵ cm in its greatest axis with involvement of thepectoralis major muscle, with no evidence of suspicious axillarylymphadenopathy. Distant metastatic work-up with CT scan of chest abdomen andpelvis and a PET scan did not show distant metastasis. Hence, the patientunderwent right total mastectomy with a final pathology compatible withmalignant phyllodes tumor. She is on regular follow up and ۱۸ months postsurgeryis 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 asepithelial breast cancers or as soft tissue sarcoma is another debate. On the otherhand, although challenging, accurate identification of phyllodes tumor initiallymay aid in decreased recurrence.

Keywords:

Phyllodes tumor , breast cancer , management