Malignant breast phyllodes: Literature review of management and case report

Abstract

The rarity of malignant phyllodes leads to variability in diagnosis and management. Most of the reported cases in the literature are large malignant phyllodes tumor. Malignant phyllodes tumor was seen in the age group between 35 and 55 years. The youngest age reported was an 11-year-old girl. The eldest reported was an 89-year-old woman. Phyllodes tumors are characterized by a typical rapid growth. Phyllodes tumor are composed of epithelial element and connective tissue stroma with stromal increased cellularity, cellular atypia, and pleomorphism with increased mitosis. The most common path of spread is hematological mostly to the lung, pleura, bone, heart, liver, metastasis to the brain and adrenal have been reported. Palpable axillary lymph node is found in 10%–15% cases; only <1% of them is pathologically positive for malignancy. Surgery in the form of breast conservative or mastectomy remains the primary treatment of malignant breast phyllodes. No literature support axillary lymph node dissection. For breast conservative surgery (BCS), 1 cm free margin is recommended less than that will be associated with higher recurrence rate. Mastectomy is indicated only if tumor-free margin cannot be obtained by BCS. In multivariate analysis, patient with more adverse prognostic factors underwent postoperative radiation therapy (RT). The RT groups were not inferior to non-RT groups on cancer-specific survivor regardless of surgery (mastectomy or BCS). But post-operative radiation therapy for BCS will significantly reduce local recurrence. Post-operative chemotherapy is seeing increased in palliation of metastatic cases.