A rare case of fungating phyllodes tumor of the breast

Abstract

Phyllodes tumor of the breast is an uncommonly encountered disease. They are rare fibroepithelial tumors that constitute <1% of all known breast neoplasms. These tumors were first characterized by Johannes Muller in 1838, and he coined the term cystosarcoma phyllodes to describe them, based on the "leaf-like" projections into cystic spaces and sarcomatous stroma. However, this is a misleading term as 70% of these tumors are benign in nature and only rarely demonstrate cystic features. These tumors may appear as benign fibroadenoma-like lesions, locally recurrent aggressive tumors, or widely metastatic malignant forms. When these advanced tumors ulcerate, they reduce the quality of life dramatically because of associated pain, infection, malodor, profuse discharge, and bleeding. The standard of care for the treatment of phyllodes tumor entails complete surgical excision with a margin of >1 cm. They most commonly metastasize through hematogenous spread; thus, there is no role for axillary lymph node dissection for the staging of these tumors. Local recurrent rates have been shown to decrease with the administration of adjuvant radiation therapy for borderline or malignant tumors following wide local excision. The tumor presenting as a fungating breast mass or "ruptured" breast is an even more rare presentation of an unusual disease. We report a case with an atypical presentation of a 60-year-old female with a huge exophytic fungating mass of the left breast infected with maggots. Cytology was suggestive of malignancy, so left mastectomy was performed. The final pathology report was consistent with phyllodes tumor. Our aim is to highlight the features of this rare breast cancer and the challenges in obtaining a definitive diagnosis.

Use of fly larva (Maggots) in Cancer Treatment: A systematic review

“…There have been cases, in whom skin cancers have been associated with spontaneous myiasis. In one case, a person with fibroepithelial cell neoplasia of the breast (phyllodes) who had been associated with myiasis lived for 15 years (24). There have been other reports of involuntary myiasis associated with skin neoplasms in humans.…”