Giant benign phyllodes tumor equal to size of patient’s abdomen: a case report

Abstract

Introduction: Phyllodes tumor is a rare form of breast malignancy. Although the Phyllodes tumor rarely metastasizes, they can grow faster than any other breast tumor. Diagnosis and treatment are crucial, and surgery is the first line of action. Large tumors represent a surgical challenge because the excision with free margins is essential to prevent local recurrence and metastatic spread. In this presentation, we report a rare case of a giant Phyllodes tumor measuring 34x36x24 cm in a 58-year-old woman and a review of the literature highlighting some issues surrounding the management of phyllodes tumors.

Case Report A 58-year-old woman, without known relevant precedents, was admitted due to a large, ulcerated and infected mass in the left breast of dimensions 34x36x24 cm. An incisional biopsy report suggested haemorrhage and coagulative type of necrosis in overlying ulcer with FNAC showing inflammatory pathology. No distant metastasis was identified. After infection control, a left mastectomy was performed, with primary closure of the defect by mobilizing the skin flaps. The postoperative period was uneventful. Pathological examination revealed a 34x36x24 cm Phyllodes tumor with free margins. Patient was discharged in stable condition and followed up for six months with no added complaints.

Discussion: Clinically PT is traditionally a well delineated and circumscribed tumor such as fibroadenoma, albeit usually larger. The cut surface shows sliced spaces with interspersed of stromal overgrowth and the dilated ducts. Large tumors may rarely show hemorrhagic and necrotic areas, and malignant PT may have sarcoma-like cut surface. The proliferative activity of the PTs by Ki-67 index is now one of the WHO criteria for PT grading. Surgical therapy is the gold standard for the treatment of PTs but the kind of surgery has been a source of study and debate over the years. Benign PT may also transform into a higher grade and recur as borderline or malignant PT.

Conclusion: Phyllodes tumor is a rare breast tumor, with the malignant phenotype being the rarest of them all. Surgical therapy is the gold standard for the treatment of phyllodes tumors. Phyllodes tumors should be removed with, at least, 1 cm free margins, especially if they’re malignant tumors. The role of adjuvant therapy is still controversial.