Diagnosis and management of liposarcomatous differentiation in a phyllodes tumor: a rare clinical conundrum

Abstract

The solitary variant of rapidly growing large breast masses consisting of both epithelial and stromal components with no nodal involvement is called a phyllodes tumor and they are rare neoplasms of the breast. They constitute about 1% of all breast masses, with a slightly higher incidence in the Asian population. Although 10-30% of phyllodes tumors eventually undergo malignant transformation, which can either be in the epithelium or the stroma. However, heterologous transformation of phyllodes is an extremely rare entity. Here, we reported the case of a 60-year-old woman with an expeditiously growing breast mass for six months, which on biopsy raised a suspicion of malignant mesenchymal neoplasm. The patient underwent mastectomy with axillary sentinel lymph node biopsy (SLNB) and the final histopathological and immunohistochemistry examination revealed a phylloides tumor with a pleomorphic variety of liposarcomatous differentiation. Even with a typical mammographic appearance, liposarcomatous differentiation in phyllodes tumors can present a diagnostic dilemma on histopathology. Axillary sentinel lymph node biopsy (SLNB) forms a middle path in such cases of diagnostic challenge, which not only avoids the unnecessary morbidity of axillary lymph node dissection but also, at the same time, addresses the axilla in case the final histopathology shows evidence of invasive carcinoma.