A GIANT PHYLLODES TUMOR: А CASE REPORT AND LITERATURE OVERVIEW
Abstract
Introduction: Phyllodes tumors of the breast are extremely uncommon, both in Serbia and worldwide. Identifying and treating these tumors can be challenging and they often represent a dilemma in diagnosis and treatment.
Case report: We are presenting the case of a 60-year-old female with a large breast tumor that she had had for 15 years. According to the histopathologic diagnosis, it is a borderline phyllodes tumor measuring 18x17x7 cm and weighing 4.6 kg.
Conclusion: An accurate preoperative diagnosis and proper management of borderline phyllodes tumors are crucial for successful surgery and for avoiding any further surgeries. This secondary prevention is critical because phyllodes tumors often recur and have malignant potential.
References
Esposito NN, Mohan D, Brufsky A, Lin Y, Kapali M, Dabbs DJ. Phyllodes tumor: a clinicopathologic and immunohistochemical study of 30 cases. Arch Pathol Lab Med. 2006 Oct;130(10):1516-21. doi: 10.5858/2006-130-1516-PTACAI.
Yohe S, Yeh IT. “Missed” diagnosis of Phyllodes tumor on breast biopsy: pathological clues to its recognition. Int J Surg Pathol. 2008;16(2):137-42. doi: 10.1177/1066896907311378.
Farias-Eisner GT, Small K, Swistel A, Ozerdem U, Talmor M. Immediate implant breast reconstruction with acellular dermal matrix for treatment of a large recurrent malignant phyllodes tumor. Aesthetic Plast Surg. 2014 Apr;38(2):373-8. doi: 10.1007/s00266-014-0283-9.
Khosravi-Shahi P. Management of non metastatic phyllodes tumors of the breast: review of the literature. Surg Oncol. 2011 Dec;20(4):e143-8. doi: 10.1016/j.suronc.2011.04.007.
Lakhani SR, Ellis IO, Schnitt S, Tan PH, van de Vijver M. WHO classification of tumours of the breast. Lyon: IARC Press; 2012.
Khan SA, Badve S. Phyllodes tumors of the breast. Curr Treat Options Oncol. 2001 Apr;2(2):139-47. doi: 10.1007/s11864-001-0056-y.
Bapat K, Oropeza R, Sahoo S. Benign phyllodes tumor of the male breast. Breast J. 2002 Mar-Apr;8(2):115-6. doi: 10.1046/j.1524-4741.2002.08209.x.
Nielsen VT, Andreasen C. Phyllodes tumour of the male breast. Histopathology. 1987 Jul;11(7):761-2. doi: 10.1111/j.1365-2559.1987.tb02690.x.
Rajendra B, Tubachi P, Prabhu R, Shenoy R. Phyllodes tumor – a clinicopathological study. IOSR J. Dent. Med. Sci. 2016;15(3):33-7. doi: 10.9790/0853-15313337.
Pietruszka M, Barnes L. Cystosarcoma phyllodes: a clinicopathologic analysis of 42 cases. Cancer. 1978 May;41(5):1974-83. doi: 10.1002/1097-0142(197805)41:5<1974::aid-cncr2820410543>3.0.co;2-c.
Moffat CJ, Pinder SE, Dixon AR, Elston CW, Blamey RW, Ellis IO. Phyllodes tumours of the breast: a clinicopathological review of thirty-two cases. Histopathology. 1995 Sep;27(3):205-18. doi: 10.1111/j.1365-2559.1995.tb00212.x.
Azzopardi JG, Ahmed A, Millis RR. Problems in breast pathology. London: Saunders; 1979. p. 346.
Salvadori B, Cusumano F, Del Bo R, Delledonne V, Grassi M, Rovini D, et al. Surgical treatment of phyllodes tumors of the breast. Cancer. 1989 Jun 15;63(12):2532-6. doi: 10.1002/1097-0142(19890615)63:12<2532::aid-cncr2820631229>3.0.co;2-q.
Mishra SP, Tiwary SK, Mishra M, Khanna AK. Phyllodes tumor of breast: a review article. ISRN Surg. 2013;2013:361469. doi: 10.1155/2013/361469.
Erhan Y, Zekioglu O, Ersoy O, Tugan D, Aydede H, Sakarya A, et al. p53 and Ki-67 expression as prognostic factors in cystosarcoma phyllodes. Breast J. 2002 Jan-Feb;8(1):38-44. doi: 10.1046/j.1524-4741.2002.08008.x.
Tan PH, Jayabaskar T, Chuah KL, Lee HY, Tan Y, Hilmy M, et al. Phyllodes tumors of the breast: the role of pathologic parameters. Am J Clin Pathol. 2005 Apr;123(4):529-40. doi: 10.1309/U6DV-BFM8-1MLJ-C1FN.
Kuipers T, Stark GB, Spilker G. Explosive malignant transformation of a primarily benign phyllodes tumor. Eur J Plast Surg, 1992 Sep;15(5):233-6. doi: 10.1007/BF00193661.
Chen WH, Cheng SP, Tzen CY, Yang TL, Jeng KS, Liu CL, et al. Surgical treatment of phyllodes tumors of the breast: retrospective review of 172 cases. J Surg Oncol. 2005 Sep 1;91(3):185-94. doi: 10.1002/jso.20334.
Ofri A, Stuart KE, Chan B, Mak C, Warrier S, Bhadri V, et al. Diagnosis and management of phyllodes tumours for the surgeon: An algorithm. Surgeon. 2022 Dec;20(6):e355-e365. doi: 10.1016/j.surge.2022.01.004.
Limaiem F, Kashyap S. Phyllodes Tumor of the Breast. [Updated 2023 Jan 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541138/
Ogunbiyi S, Perry A, Jakate K, Simpson J, George R. Phyllodes tumour of the breast and margins: How much is enough. Can J Surg. 2019 Feb 1;62(1):E19-E21. doi: 10.1503/cjs.005718.
Mustață L, Gică N, Botezatu R, Chirculescu R, Gică C, Peltecu G, et al. Malignant Phyllodes Tumor of the Breast and Pregnancy: A Rare Case Report and Literature Review. Medicina (Kaunas). 2021 Dec 26;58(1):36. doi: 10.3390/medicina58010036.
Lissidini G, Mulè A, Santoro A, Papa G, Nicosia L, Cassano E, et al. Malignant phyllodes tumor of the breast: a systematic review. Pathologica. 2022 Apr;114(2):111-20. doi: 10.32074/1591-951X-754.
Wei Y, Dai Y, Guan Q, Min N, Geng R, Hu H, et al. Predicting the recurrence-free survival of phyllodes tumor of the breast: a nomogram based on clinicopathology features, treatment, and surgical margin. Gland Surg. 2023 Feb 28;12(2):152-64. doi: 10.21037/gs-22-542.
Li Y, Song Y, Lang R, Shi L, Gao S, Liu H, Wang P. Retrospective study of malignant phyllodes tumors of the breast: Younger age, prior fibroadenoma surgery, malignant heterologous elements and surgical margins may predict recurrence. Breast. 2021 Jun;57:62-70. doi: 10.1016/j.breast.2021.03.001.
Shin E, Koo JS. Prognostic factors of breast phyllodes tumors. Histol Histopathol. 2023 Aug;38(8):865-78. doi: 10.14670/HH-18-600.