Malignant Phyllodes Tumor Recurrence in the Pleural Cavity via the Deep Inferior Epigastric Perforator Flap and Internal Mammary Vessel Bundle

Abstract

We report a rare case that after rapid recurrence there was pathological transition from a fibroadenoma and benign phyllodes tumor to borderline and malignant phyllodes tumor. Another rare finding included tumor dissemination in the pleural cavity via reconstructed deep inferior epigastric perforator flap edge and internal mammary vessel bundle. Hence, we eliminated the use of internal mammary vessel bundle as the recipient vessel for free-flap reconstruction to avoid recurrence in the pleural cavity. Remarkably, we achieved successful reconstruction of 2 huge defects (reconstruction of breast following mastectomy and that of chest wall following en bloc excision of recurrence) using 2 different free flaps.

Malignant Phyllodes Tumor of the Breast: Case Report

“…It accounts for about 2.5% of fibroepithelial tumors of the breast 2 , with an incidence of 2.1 per million women 3 . PT of the breast usually manifests as a painless rapidly growing unifocal mass that is most commonly located in the LUQ, as occurred in the case report 4 . The patient developed a malignant PT before 30 years of age, which is a major rare event.…”

“…However, it is known that it is related to diverse factors, including hormone disorders (primarily hyperestrogenism), breast injury, ethnicity and breastfeeding. It may also occur during pregnancy 1,4 . Histologically, PT is characterized by a double-layered leaf-like epithelial pattern with hypercellular stroma 2 .…”

“…The treatment of choice for these cases is SR with a 1.0 cm margin and without axillary node dissection [1][2][3][4][5] . According to a systematic review with meta-analysis conducted by Toussaint et al, the width of the safety margin is related to lower local recurrence, mainly in malignant PT, although a significant difference in the occurrence of metastases was not found 6 .…”

“…Local recurrence of malignant PT is approximately 19-40%, and the mean period of recurrence is 1-39 months (mean: 20.3 months). The risk of distant metastases is higher than 75% in the first 120 months, meaning a worse prognosis 4 .…”