Malignant phyllodes tumor with synchronous metastases to axillary lymph nodes, lung at the presentation: a case report and literature review

Abstract

Phyllodes tumors are rare mesenchymal tumors of breast. Malignant phyllodes tumors can develop metastases to distal organs with spreading hematogenously to most frequent sites as lungs, bone and brain. Regional lymph node enlargement is common but metastasis to lymph node is a very rare phenomenon with prevalence about 1.1–3.8%. In this report, we introduce a case of malignant phyllodes tumor of breast in 57-year-old female patient. Synchronous metastases to axillary lymph nodes and lung were found at the presentation. She was treated with mastectomy combined with axillary lymph node dissection and adjuvant chemotherapy. Axillary lymph node dissection can be considered in case of proven metastatic or suspiciously palpable lymph nodes.

Malignant phyllodes tumor of the breast with heterologous osteosarcoma and chondrosarcomatous differentiation: A rare case report with imaging findings

“…The definitive treatment for phyllodes tumor is wide surgical excision with at least 1-2 cm of negative margins, or mastectomy, depending on the size of the tumor and the patient's breast size. The role of adjuvant radiotherapy and chemotherapy remains unclear [27 , 28] , although some authors suggest the use of adjuvant therapy in phyllodes tumors greater than 5 cm with more than 20 mitoses per 10 high power fields because such tumors may have a high local recurrence rate [13] , and adjuvant therapy is recommended in patients with a high risk of metastasis, tumor recurrence, or the presence of metastases [29] .…”

“…A previous study found a similar clinical course between pure chondrosarcoma and malignant phyllodes tumor with chondrosarcomatous differentiation [17] , while another study found that phyllodes tumors with osteosarcomatous components were potentially aggressive tumors with distant metastases, and that tumor-related death occurred in 38% of patients [31] . Distant metastasis occurs hematogeneously, with the most common sites being the lungs (66%), bones (28%), and brain (9%), while occurrence in the liver and heart being rare [28] . Since lymphatic spread is a rare phenomenon in these tumors, routine axillary lymph node dissection is not recommended [27 , 32] .…”

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] .…”

“…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] .…”

Rare Case of Phyllodes Tumor of Breast with Cardiac and Pancreatic Metastases: Findings on18F-FDG PET/CT

“…Phyl lodes tumors (PT) are rare mesenchymal tumors arising from the connective tissue of the breast. They are relatively rare, accounting for approximately 0.3%-1% of all breast tumors (1). The World Health Organization classifies PTs into 3 categories (benign, borderline, and malignant) on the basis of histopathologic features including nuclear atypia, stromal cellularity, mitotic activity, tumor margin appearance, and stromal overgrowth (2).…”