Surgical management of a giant malignant phyllodes tumour of the breast: a case report

Abstract

Phyllodes tumour (PT) is a rare fibroepithelial neoplasm, being divided into benign, borderline or malignant, and usually presents as large masses with rapid growth. Breast tumours above 4 cm with these characteristics are highly suspicious of PT, and those above 10 cm are considered giant PTs, representing only 20% of these tumours. Prognosis relies on histological type and a mostly on a complete surgical resection with margins above 1 cm. Surgical management of giant PTs can be a technical challenge, and may require advanced breast reconstructive techniques. We present the case of a giant PT, completely resected with a mastectomy and nodal dissection. The patient was discharged without any complications and is currently on follow-up without recurrence. Adequate resection margins should always be the principal aim when providing an optimal surgical treatment of a PT. A multidisciplinary team evaluation by an experienced breast surgeon or a plastic reconstructive surgeon is recommended when planning a proper resection with further reconstruction. Axillary node metastases are rare, and dissection is limited to patients with pathological preoperative findings. Hematogenous dissemination may be present in malignant PTs. Classical adjuvant therapies like chemotherapy, hormonotherapy or radiotherapy are no widely prescribed when treating PT. We strongly emphasize in providing a correct initial resection of the tumour.