Immediate latissimus dorsi pedicle flap reconstruction following the removal of an eight kilogram giant phyllodes tumour of the breast: a case report

Abstract

IntroductionPhyllodes tumors account for less than 1% of breast tumors in women, and giant phyllodes tumors are those that are larger than 10 cm in diameter. Removal of such large tumors places a huge burden on the surgeon to reconstruct a breast that is aesthetically acceptable by the patient. We report what may be the largest giant phyllodes tumor and, most likely, the first latissimus dorsi flap used to cover such a large defect caused by the resection.Case presentationWe report the case of a 36-year-old Malaysian woman who presented with a three-year history of gradually increasing swelling of the left breast, with skin changes. Examination revealed a huge, globular, lobulated mass measuring 400 mm by 350 mm. The patient had a mastectomy with an immediate latissimus dorsi pedicled myocutaneous flap reconstruction. The breast weighed 8.27 kg, and ex vivo, the tumor measured 280 mm by 250 mm by 180 mm. Histopathologic analysis confirmed the diagnosis as a giant phyllodes tumor. At 12-month follow-up, the patient reports no complications and is satisfied with the aesthetic outcome.ConclusionGiant phyllodes tumors are very rare tumors that can reach up to 40 cm in diameter. Reconstruction of such a defect is a great challenge, and we report what we believe is the first latissimus dorsi flap to cover successfully a defect of approximately 400 mm by 350 mm.

The largest and neglected giant phyllodes tumor of the breast—A case report and literature review

“…In 10–15% cases axillary lymph nodes are palpable but only <1% had pathological positive nodes. In recent years several giant phyllodes tumour have been reported (Hsu et al, 30 × 25 cm; Tarun et al, 50 × 25.2 cm; Juliana Alves De Suza et al, 14 × 10 cm; Ramesh sarvanandan et al, 40 × 35 cm; Junaid Nabi et al, 9 × 8 cm; Mohammed A. Sbeih et al, 25 × 20 cm; Tapanutt Likhitmaskul et al, 20 × 20m; Dong Xia et al, 47.5 × 37 cm; Rumi Khajotia et al, 24 × 22 cm; Banno A. et al, 30 cm) [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] .…”

“…Most experts currently advocate that surgeons obtain at least 1 cm margins on primary excision or re-excision of a tumour removed with close margins, as long as the tumour to breast size will permit [2] , [3] , [10] , [27] , [28] . Mastectomy should be reserved for larger tumours between 5 and 10 cm in diameter [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [24] , [25] and should be considered in recurrent tumours, and especially of the malignant tumours [3] .…”

“…There is no contraindication to immediate reconstruction after mastectomy in cases of giant phyllodes tumour, and this decision can be made solely based upon patient preference. Most often immediate reconstruction of the chest wall was performed with prosthetic implant or chest wall are covered with splits skin graft, marlex mesh or latissimus dorsi muscular/myo-cutaneous flap; if the fascia or muscle is infiltrated [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [25] , [29] , [30] , [31] .…”

A large benign phyllodes tumour of the breast: A case report and literature review

“…Though ulceration and nipple retraction have been reported, they remain uncommon [8] , [9] . The median size of phyllodes tumours are usually 4 cm [1] though recently in the literature there has been reports of large tumour size up to 50 cm and these are mostly malignant [10] , [11] . Palpable axillary lymphadenopathy has been reported in up to 20% of cases but these are often reactive in nature and metastatic involvement of axillary lymph nodes is extremely rare [9] .…”

Total mastectomy and chest reconstruction for a rapidly progressing giant phyllodes tumor with skin necrosis: a case report

“…The Marlex mesh and the latissimus dorsi muscular/myocutaneous flap are the two most commonly recommended methods for reconstruction of the chest wall [ 4 , 2 ]. However, both can have major complications.…”