Phyllodes breast tumor in a patient on hormonal replacement therapy for primary ovarian failure with chronic kidney disease, hypertension with dilated cardiomyopathy and diabetes mellitus: A case report

Abstract

Background: Phyllodes tumors account for <1% of all breast neoplasms with a median age ofpresentation of the fourth decade. It is a fibroepithelial neoplasm that presents as a morphologiccontinuum from benign to malignant. The use of hormone replacement therapy has been linked to thedevelopment of breast cancer. The risk is increased with longer periods of use and with hormonalreplacement therapy. Phyllodes tumor is associated with Li-Fraumeni syndrome, a rare autosomaldominant condition characterized by the development of multiple tumors. Surgery is the preferred modeof treatment and involves wide local excision.Case presentation: A 37-year-old nulliparous presented with a left breast lump on self-examination. Shewas on follow-up for ovarian dysgerminoma when she first presented to a peripheral facility at the age of12 years with abdominal swelling. Hysterectomy and right oophorectomy were performed, followed by 10courses of chemotherapy with vincristine, actinomycin, and cyclophosphamide. She has also been onhormonal replacement therapy with on-and-off cyclical spotting and postcoital bleeding. She also hashypertension, diabetes, and dilated cardiomyopathy since 2016, and in 2018, she was diagnosed withchronic obstructive hydronephrosis. She then presented with a left breast lump in September 2023, andan ultrasound-guided core biopsy revealed a spindle cell neoplasm of malignant phyllodes tumor.Mastectomy was performed in December 2023, followed by radiotherapy, and hormonal replacementtherapy was stopped.Conclusion: Malignant phyllodes tumors differ from the more common type of breast cancer becausethey are less likely to respond to hormonal therapy and chemotherapy. Therefore, there is need for closefollow-up and monitoring.