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A 21-year-old unmarried woman presented with rapid enlargement of the right breast of 3-months duration and ulceration in the lower part of 15-days duration. There was no history of recent nipple retraction or discharge from the nipple. Local examination revealed a massive, but well-circumscribed, firm, pedunculated lump involving the whole of the right breast, with an ulcer measuring 3 cm × 3 cm present in the lower outer quadrant. The lump was not adherent to the pectoralis major and axillary lymph nodes were not palpable. Fine-needle aspiration cytology of the lump was reported as "benign phyllodes tumor."Simple mastectomy of the right breast was performed. The tumor measured 45 cm × 35 cm × 28 cm and weighed 6500 g (Figs 1-3). The postoperative period was uneventful. Histopathology confirmed a benign phyllodes tumor. The resection margins were free. After 2 years of follow-up, the patient is doing well. This seems to be the largest and heaviest benign phyllodes tumor ever reported in the English literature reviewed by the authors.

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Abbreviations and AcronymsCT = computed tomography LRC = laparoscopic radical cystectomy ORC = open radical cystectomy RRC = robotic radical cystectomy TCC = transitional cell carcinoma ABSTRACT INTRODUCTION: Contemporary benchmarks of the short-term and long-term outcomes of open radical cystectomy (ORC) that can be used for future comparison of minimally invasive techniques are incomplete. The purpose of this prospective study was to evaluate the perioperative and 5-year oncological results of ORC with urinary diversion. METHODS: Between 2004 and 2009, 200 patients undergoing ORC with urinary diversion were prospectively enrolled. Indications for ORC included:(1) muscle-invasive bladder cancer detected by transurethral resection, or (2) high-grade stage Ta, T1, or carcinoma in situ that was refractory to repeated transurethral resection and intravesical immunotherapy or chemotherapy. Patients with metastatic disease were excluded. Mean patient age was 65.1 years. Perioperative, histopathologic, and postoperative follow-up data were recorded and analyzed statistically. RESULTS:Ileal conduits were constructed in 159 (79.5%) patients; an ileal orthotopic neobladder (Studer's procedure) was constructed in 41 (20.5%) patients. Mean operating time was 275 minutes. Mean estimated blood loss was 690 mL. Blood transfusion was required in 37 (18.5%) patients. Mean hospital stay was 6.1 days. Major and minor complications were recorded in 16 (8%) and 31 (15.5%) of the patients, respectively. Perioperative mortality was recorded in 2 (1.5%) patients. Pathologically organ-confined and nonorgan-confined cancer was found in 135 (67.5%) and 65 (32.5%) patients, respectively; 33 (16.5%) patients had pathologically confirmed lymph nodes. Median follow-up was 60.1 months. Local recurrence and distant metastases were recorded in 16 (8%) and 9 (4.5%) patients, respectively. The 5-year disease-free survival, cancer-specific survival, and overall survival rates were 75.5%, 71.5%, and 63.5%, respectively. Survival rates were significantly higher for patients with organ-confined cancers and negative lymph nodes. CONCLUSIONS:Open radical cystectomy has an acceptable perioperative morbidity and mortality, along with a favorable 5-year oncological efficacy. Minimally invasive techniques need long-term prospective comparison with this approach before they can be accepted as a standard treatment for urinary bladder malignancy.UroToday International Journal ® UI J