Ann Surg Treat Res.  2017 Feb;92(2):110-112. 10.4174/astr.2017.92.2.110.

Fulminant course in a case of malignant phyllodes tumor

• Chang YW
• Kim HS
• Kim DW
• Son GS

• KMID: 2367924
• DOI: http://doi.org/10.4174/astr.2017.92.2.110

Abstract

We present the case of a 31-year-old woman with an inflammatory and ulcerative malignant phyllodes tumor in her right breast. A right modified radical mastectomy and transverse rectus abdominis myocutaneous (TRAM) flap were performed. A month after the initial operation, several masses recurred at the superior margin and deep margin of the TRAM flap. Wide excision was performed, but masses recurred at the inferior margin and in both lung fields 2 weeks after the second operation. Six weeks after the second operation, the patient died due to progression of dyspnea and respiratory failure.

Keyword

Phyllodes tumor; Phyllodes tumor; Breast neoplasms

MeSH Terms

Adult
Breast
Breast Neoplasms
Dyspnea
Female
Humans
Lung
Mastectomy, Modified Radical
Phyllodes Tumor*
Rectus Abdominis
Respiratory Insufficiency
Ulcer

Figure

• 

  Fig. 1 (A) An inflammatory and ulcerative mass in the right breast. (B) Post modified radical mastectomy image showing en bloc removal of the tumor including the invaded pectoralis muscle. (C) Mass-like protruding lesions that appeared at the superior margin of the transverse rectus abdominis myocutaneous flap a month after the initial operation.

• 

  Fig. 2 (A, B) Breast MRI showing recurrent tumor (84 mm × 48 mm) at the deep margin of the transverse rectus abdominis myocutaneous flap invading the pectoralis minor and intercostal muscles, a month after the initial operation. (C) A chest CT scan for both lung fields showing new round opacities and suggesting metastases (arrows).

Reference

1. Geisler DP, Boyle MJ, Malnar KF, McGee JM, Nolen MC, Fortner SM, et al. Phyllodes tumors of the breast: a review of 32 cases. Am Surg. 2000; 66:360–366.

2. Kim S, Kim JY, Kim DH, Jung WH, Koo JS. Analysis of phyllodes tumor recurrence according to the histologic grade. Breast Cancer Res Treat. 2013; 141:353–363.

3. Macdonald OK, Lee CM, Tward JD, Chappel CD, Gaffney DK. Malignant phyllodes tumor of the female breast: association of primary therapy with cause-specific survival from the Surveillance, Epidemiology, and End Results (SEER) program. Cancer. 2006; 107:2127–2133.

4. Rowell MD, Perry RR, Hsiu JG, Barranco SC. Phyllodes tumors. Am J Surg. 1993; 165:376–379.

5. Jang JH, Choi MY, Lee SK, Kim S, Kim J, Lee J, et al. Clinicopathologic risk factors for the local recurrence of phyllodes tumors of the breast. Ann Surg Oncol. 2012; 19:2612–2617.

6. Barth RJ Jr, Wells WA, Mitchell SE, Cole BF. A prospective, multi-institutional study of adjuvant radiotherapy after resection of malignant phyllodes tumors. Ann Surg Oncol. 2009; 16:2288–2294.

7. Morales-Vasquez F, Gonzalez-Angulo AM, Broglio K, Lopez-Basave HN, Gallardo D, Hortobagyi GN, et al. Adjuvant chemotherapy with doxorubicin and dacarbazine has no effect in recurrence-free survival of malignant phyllodes tumors of the breast. Breast J. 2007; 13:551–556.

8. Gortzak E, Azzarelli A, Buesa J, Bramwell VH, van Coevorden F, van Geel AN, et al. A randomised phase II study on neo-adjuvant chemotherapy for ‘high-risk’ adult soft-tissue sarcoma. Eur J Cancer. 2001; 37:1096–1103.

9. Telli ML, Horst KC, Guardino AE, Dirbas FM, Carlson RW. Phyllodes tumors of the breast: natural history, diagnosis, and treatment. J Natl Compr Canc Netw. 2007; 5:324–330.

10. Tse GM, Lee CS, Kung FY, Scolyer RA, Law BK, Lau TS, et al. Hormonal receptors expression in epithelial cells of mammary phyllodes tumors correlates with pathologic grade of the tumor: a multicenter study of 143 cases. Am J Clin Pathol. 2002; 118:522–526.