The giant phyllodes tumor of the breast — a case report

DOI: 10.32471/exp-oncology.2312-8852.vol-43-no-4.16902

Chelius first described this tumor in 1827 [1]. The first person who uses the term cysto-sarcoma phyllodes was Johannes Muller in 1838. This tumor was considered benign until 1943, when Cooper and Ackerman reported on its malignant biological potential. Fibroepithelial tumors of the breast with a greater degree of stromal cellularity than fibroadenomas and those with the characteristic “leaf-like” projections are classified as phyllodes tumors. In 1982, World Health Organization declared the term “phyllodes tumor” as the most appropriate among more than 60 synonyms. Furthermore, World Health Organization sub-classified them histologically as benign, borderline or malignant [2]. Here, we report a case of giant phyllodes tumor.

A 50-year-old woman was presented to the surgical department of the Kyiv City Clinical Oncology Center, with a rapidly growing mass in her right breast. On examination, there was a 20 × 20 cm firm mobile mass which totally replaced her right breast with redness of skin, well-circumscribed, no nipple discharge and her axillary lymph nodes were not palpable. She had no family history of breast and ovarian cancer. The mammography revealed a giant mass of right breast with a well-defined border (Fig. 1). Result of pathomorphological study after a core biopsy of the tumor of the right breast demonstrated spindle cell tumor.

The postoperative course was without complications, and the wound healed well. The oncology council decided to conduct a course of radiation as adjuvant therapy at a dose of 45 Gy. The patient is followed-up and undergoes regular examinations at 2-year intervals. No data of the progression of the disease have been recorded.

Phyllodes tumors are rare fibroepithelial tumors that account for 0.3% to 0.5% of all breast neoplasms [3]. Typically, this tumor is characterized by the mobile rapidly growing, well-circumscribed mass. < 10% of phyllodes tumors are larger than 10 cm in size and these tumors have been defined as giant phyllodes; very rarely they can be up to 48 cm in diameter [4]. They may occur at any age, with the median age being the 5^th decade [5]. There are no known predisposing factors for phyllodes tumors, and the diagnosis is often not suspected.

Noguchi et al. [6] conducted a clonal analysis of fibroadenoma and phyllodes tumor, which showed that, in a proportion of fibro-adenomas, a somatic mutation can result in a monoclonal proliferation, histologically indistinguishable from the polyclonal element, but with a propensity to local recurrence and progression to a phyllodes tumor.

Phyllodes tumors are infrequent type of breast tumors. To distinguish between a benign and malignant phyllodes tumor before surgery is difficult. Ultrasound and mammography are the most commonly used as a first line of diagnosing phyllodes tumors. In addition, for more targeted diagnosis core needle biopsy and magnetic resonance imagingcan be used. Core needle biopsy represents the preferred method of preoperative diagnosis for giant breast tumors with 99% of sensitivity [7, 8].

Surgical resection is the treatment of choice in case of such tumors, but adequate free margins must be obtained in all cases. Unnecessary delay can leads to disease progression and increase morbidity and mortality. The wide excision or mastectomy with adequate free margins is the treatment of choice in such cases; reconstruction is occasionally performed after mastectomy for giant malignant phyllodes tumors. The decision about immediate reconstruction can be made solely based upon patient preference and has no contraindication.

Adjuvant therapy options mainly include radiation therapy, which found to reduce local recurrence. No treatment benefit was found after adjuvant chemotherapy and its role remains uncertain. The prognosis of phyllodes tumors is good, with an 87% 10-year survival [5, 9, 10]. Patients with phyllodes tumors of breast should receive long-term follow-up.

REFERENCES

1. Chelius M. Naegele und Puchelt. Heidelberg Germany: 1827. Neue Jahrbucher Der Teutschen Medicin and Chirurgie.
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