Total mastectomy and chest reconstruction for a rapidly progressing giant phyllodes tumor with skin necrosis: a case report

Abstract

Phyllodes tumors are rare fibroepithelial neoplasms of the breast. In the literature, borderline or malignant tumors have been reported to present with unusual characteristics including a short clinical history and extremely rapid tumor growth. Skin necrosis and infection sometimes accompanies these malignancies. Giant phyllodes tumors have a good prognosis when treated with total mastectomy, but reconstruction of the chest wall has been a challenge because of the need for a wide-range excision.We report a case of a malignant phyllodes tumor that was initially diagnosed as borderline because sudden growth of the tumor contrarily induced sparse to moderate stroma cellularity in the sections of the tumor that were biopsied. Total mastectomy without axillary lymph node resection and chest wall reconstruction using a full-thickness mesh skin graft was performed. The patient has remained free from infection and recurrence for over a year since diagnosis.

The largest and neglected giant phyllodes tumor of the breast—A case report and literature review

“…In 10–15% cases axillary lymph nodes are palpable but only <1% had pathological positive nodes. In recent years several giant phyllodes tumour have been reported (Hsu et al, 30 × 25 cm; Tarun et al, 50 × 25.2 cm; Juliana Alves De Suza et al, 14 × 10 cm; Ramesh sarvanandan et al, 40 × 35 cm; Junaid Nabi et al, 9 × 8 cm; Mohammed A. Sbeih et al, 25 × 20 cm; Tapanutt Likhitmaskul et al, 20 × 20m; Dong Xia et al, 47.5 × 37 cm; Rumi Khajotia et al, 24 × 22 cm; Banno A. et al, 30 cm) [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] .…”

“…Most experts currently advocate that surgeons obtain at least 1 cm margins on primary excision or re-excision of a tumour removed with close margins, as long as the tumour to breast size will permit [2] , [3] , [10] , [27] , [28] . Mastectomy should be reserved for larger tumours between 5 and 10 cm in diameter [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [24] , [25] and should be considered in recurrent tumours, and especially of the malignant tumours [3] .…”

“…There is no contraindication to immediate reconstruction after mastectomy in cases of giant phyllodes tumour, and this decision can be made solely based upon patient preference. Most often immediate reconstruction of the chest wall was performed with prosthetic implant or chest wall are covered with splits skin graft, marlex mesh or latissimus dorsi muscular/myo-cutaneous flap; if the fascia or muscle is infiltrated [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [25] , [29] , [30] , [31] .…”

Application of a rhomboid flap for the coverage of defects after malignant breast tumor resection: A case report

“…It is rare for flap coverage to be required for skin defects after the resection of malignant phyllodes tumors. However, if the tumor invades the surrounding tissues an extended tumor resection is required (17,18).…”

Review of Procedures for Reconstruction of Soft Tissue Chest Wall Defects Following Advanced Breast Malignancies

“…Usually, split thickness grafts are used, but there have been reported cases where full-thickness skin grafts were used in chest reconstruction. 5 Unfortunately, not only does a skin graft cause a defect at a secondary donor site but it also is completely infeasible when exposed bone and tendons inhibit adherence and necessitate dermal substitutes and multiple procedures. Additionally, the frequent need for early postoperative chemo/radiation therapy often precludes the use of skin grafts as these therapies can impair wound healing resulting in complete graft loss (for an example of radiation-induced tissue changes, see Figure 3).…”