A Giant Malignant Phyllodes Tumour of the Breast: A Rare Entity

Abstract

Introduction

Phyllodes tumours are rare neoplasms that comprise less than 1% breast tumours and are unique in a way that they occur exclusively in the female breast. These tumours are biphasic fibroepithelial neoplasms of breast which are generally classified as benign, borderline and malignant. Given its infrequent description in the literature, guideline regarding management is based on small-scale retrospective clinical trials or case reports. We describe here a giant malignant phyllodes tumour that we encountered in our centre.

Case

50-year-old female presented with rapidly enlarging breast swelling since 6 months. On local examination, there was huge breast swelling measuring 41 × 37 × 22 cm swelling on left breast with lobulated appearance and dilated veins over it with fixity to the skin and underlying muscle but not to the chest wall. Imaging was done using CECT of the local part with thorax which was suggestive of 42.5 × 35 × 24 cm tumour in subcutaneous plane infiltrating parts of underlying muscle. After adequate preoperative preparation and optimization, patient underwent left radical mastectomy under general anaesthesia. The defect was closed primarily. Final histopathology revealed 40 × 32 × 22 cm encapsulated malignant phyllodes tumour high grade with mitotic rate of 32 per high-power field and margins clear. Axillary lymph nodes showed no disease. Multidisciplinary tumour board meeting recommended adjuvant treatment in form of chemotherapy consisting of Ifosfamide and Adriamycin along with chest wall radiation. Patient on follow-up showed a healthy wound, and sutures were removed. Patient received six cycles of chemotherapy followed by radiation to the chest wall.

Discussion

The term giant phyllodes is used when the tumour size exceeds 10 cm in maximum diameter. In the available literature search, only a few reports have specifically commented on the giant phyllodes tumour, an entity that presents the surgeon with several unique management problems. This case is one of the largest malignant phyllodes tumour resected among the few that have been reported. Size described ranges from 15 to 50 cm. Surgery typically requires mastectomy as clear margins are not possible with local excision. Defect can be closed primarily or coverage can be provided in form of flap or split-thickness skin graft. Usually, adjuvant chemotherapy as well as radiation is given in cases with high-grade malignant phyllodes tumour but yet there is no guidelines regarding the same.