Giant Metastatic Breast Phyllodes Tumour with an Elusive Diagnosis: A Case Report and Literature Review

Abstract

Background: The term phyllodes tumours, which account for less than 1% of breast neoplasms, describes a spectrum of heterogenous tumours with different clinical behaviours. Less than 30% present as metastatic disease. Complete surgical resection is the standard of care so that recurrence rates are reduced. The role of adjuvant chemotherapy or radiation therapy is controversial. Patients with metastatic disease have a median overall survival of around 30 months. Case description: The authors present the case of a 57-year-old woman with an exuberant left malignant phyllodes tumour with bilateral involvement, as well as lung and axillar metastasis. The patient underwent haemostatic radiation therapy and started palliative chemotherapy with doxorubicin, achieving partial response with significant improvement in quality of life. A posterior simple mastectomy revealed a small residual tumour. Discussion: Metastatic malignant phyllodes tumours are rare, so therapeutic strategies rely on small retrospective studies and guidelines for soft tissue sarcoma. Palliative chemotherapy protocols include anthracycline-based regimens, either as monotherapy with doxorubicin or doxorubicin together with ifosfamide. With few treatment options, management of these patients must rely on a continuum of care

Tumor filoides de mama. Reporte de caso clinico y revisión de la literatura

“…Los autores presentan también el caso de una mujer de 57 años de edad con un tumor filoides maligno izquierdo exuberante con afectación bilateral, además de metástasis pulmonares y axilares. La paciente se sometió a radioterapia hemostática e inició quimioterapia paliativa con doxorrubicina, consiguiendo respuesta parcial con mejoría significativa en la calidad de vida (17). En una revisión sistemática y metanálisis que tuvo como objetivo investigar las tasas de recurrencia local (LR) entre los tres tipos de tumores filoides, se obtuvo los siguientes resultados: La revisión incorporó 54 estudios con 9234 casos individuales.…”

“…Un metanálisis informa tasas de recurrencia local del 8 % para los tumores benignos, 13 % para los borderline y 18 % para tumores malignos, respectivamente (16). La afectación de los ganglios linfáticos axilares es rara, incluso cuando los tumores son malignos, por lo que la disección axilar no es obligatoria (17). En los casos de las pacientes con tumores filoides malignos y enfermedad metastásica, la mediana de supervivencia general es de aproximadamente 30 meses.…”

Malignant phyllodes tumor of the breast with metastases to the lungs: A case report and literature review

“…Koh et al [26] showed that a combination of large tumor size (≥90 mm) ant the presence of malignant heterologous elements had a statistically significant association with the development of distant metastasis. Most frequently, malignant PTs metastasize to the lung, bones, brain, and liver [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] . Few rare distant metastatic sites are the adrenal glands [20] , kidney [13] , skin [27] , ovary [28] , heart [29] , pleura [30] , oral cavity [31] , duodenum [32] , pancreas [33] , tonsillar [12] , and para-aortic nodes [34] .…”

“…Adjuvant chemotherapy effects in PTs treatment are lacking because of insufficient data from large prospective studies. In our literature review of patient with distant metastasis to the lungs, the most frequent chemotherapy was with Doxorubicin and ifosfamide [ 7 , 10 , [17] , [18] , [19] ]. In 6 studies [ 8 , 12 , [14] , [15] , [16] , 20 ] adjuvant chemotherapy was not given due to controversial effects or patient's request, detailed descriptions are shown in ( Table 2 ).…”

“…Recent literature reports that 10%-15% of PTs are malignant and approximately 9%-27% of patients with malignant phyllodes tumor have metastasis to distant organs with spreading hematogenously to most frequent sites as lungs, bones, brain, and liver [6] . Recurrence or metastasis of breast PTs predicts a shorter survival time, less than 2 years after diagnosis [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] .…”