Giant phyllodes tumor of the breast: a case report

Abstract

The phyllodes tumor, originally described by Johannes Muller in 1838, is rare distinctive fibroepithelial tumor of the breast. The median size of phyllodes tumors is about 4 cm. Twenty percent of tumors grow larger than 10 cm, the arbitrary cut off point for the designation as a giant tumor. We report here a case with a giant phyllodes tumor of the left breast and discuss the diagnostic and management challenges. To our knowledge, this patient presented one of the biggest phyllodes tumors of breast in all cases reported in English-language publications so far. Case reportA 47-year-old Chinese female patient was referred to our hospital (Department of General Surgery, the First Affiliated Hospital, Luzhou Medical College, China) because of a large left breast mass. The mass had been present for at least 2.5 years, and the breast was swollen, streaked with grey and blue, and mildly tender. There was no personal or family history of breast cancer. Her past medical history was unremarkable. Her first menstrual period was at age 13, and she had two healthy daughters.On physical examination, the patient's left breast had an obviously large and relatively firm mass that measured approximately 45 cm in diameter and essentially replaced the entire breast (Fig. 1). The skin of the breast partly lost its integrity at the time of presentation, and the nipple was massively enlarged and excoriated. The contralateral breast was of normal size, with no significant masses on palpation. There was no palpable adenopathy in either of the axillary basins. Fine needle aspiration was performed during the initial visit and revealed highly atypical cells suspicious of a malignant neoplasm. Core tissue biopsy showed mixed epithelial-stromal proliferation suggestive of a phyllodes tumor. Bone scan and CT scans of the chest, abdomen, and head showed no evidence of distant metastasis.Left modified radical mastectomy with dissection of level I and level II lymph nodes was performed (Fig. 2). Axillary dissection was undertaken because of the presence of palpable level II nodes intra-operatively. Superior and inferior skin flaps were designed to allow skin approximation and closure after removal of the large tumor. Collaterals in the skin supplied the tumor, and no deep invasion was identified. The tumor was excised along with the pectoralis muscle fascia. One breast drain was placed beneath the inferior flap, followed by approximation of the flaps and skin closure (Fig. 3).The pathologic findings of this procedure were consistent with borderline phyllodes tumor. The tumor measured 47.5 cm × 37.0 cm × 28.0 cm and weighed 9.79 kg ex vivo. Microscopic sections demonstrated large branching ducts surrounded by a uniform, bland stroma (Fig. 4). The margin of resection was negative for the tumor with a tumor-free zone that ranged from 0.5 to 1.0 cm. Nineteen axillary lymph nodes were obtained and none of these showed evidence of malignancy. The patient had Abstract Objective: The aim of the study was to report a case with a giant phyllodes tumor of ...

A Recurrent Giant Phyllodes Tumor with Review of Literatures

“…The stromal elements are a key component in differentiating phyllodes tumors from fibroadenomas and in differentiating a benign tumor from a malignant one and based on histological finding phyllodes tumor is classified as benign borderline or malignant. On macroscopically benign phyllodes tumors show a well-circumscribed lobulated and solid firm mass with a white tan whirling cut surface similar to fibroadenoma bur large tumors especially malignant type tend to develop a hemorrhagic and necrotic areas with curved protrusions into the parenchymal spaces [6,14,26,27].…”

“…Mean age of diagnosis is 35-40 years and 80% of patients are in the premenopausal period of their lives. The median size of phyllodes tumors is about 4cm and 20% of tumors grow larger than 10 cm and this is the arbitrary cut off point for the designation as giant tumor [2,[4][5][6]. They grow rapidly and their symptoms mimic other breast malignant conditions particularly when they present with ulceration and bleeding.…”