Confronting a colossal challenge: A case report and literature review on the diagnosis and management of a 40 cm, 3.3 kg phyllodes tumor

With a peak incidence in women of 45–49 years old, phyllodes tumors (PT) are uncommon fibroepithelial neoplasms that make up less than 1 % of all breast tumors. Based on histological features, these tumors are categorized into benign, borderline, and malignant subtypes, with the malignant subtype having the worst prognosis and highest chance of recurrence. Diagnosing PT remains challenging due to its similarities with fibroadenomas (FA), necessitating the use of core needle biopsy for accurate differentiation. Our 59-year-old female patient described in this report had a borderline PTs that had grown to a remarkable 40 × 35 × 10 cm size and was causing serious clinical issues, such as skin ulceration. Following a modified mastectomy, an intermediate-grade PT with negative surgical margins was verified by histological examination. Since the tumor was within 1 mm from the posterior margin, adjuvant radiation therapy was recommended. A comprehensive review of the literature was performed to explore the diagnostic challenges, imaging modalities, histopathological features, and treatment approaches for PT, including surgical resection, the role of radiation therapy, and the limited efficacy of chemotherapy. To guarantee the best possible results for patients with PTs, this case emphasizes the need of early detection and the necessity for precise surgical intervention.