gms | German Medical Science

Objective: Phylloides tumors (PT) – also known as Cystosarcoma phylloides – are an extremely rare entity of fibroepithelial breast tumors. With an incidence of 0.3–1.0% of all breast tumors PT are characterized by a high local recurrence rate of 28–46% after local excision. PT tend to present with an unpredictable clinical course as even histologically benign PT may lead to recurrence and fatal disease. Because of their very low incidence and its difficult treatment, we report on a case of giant phylloides tumor in a 52-year-old female patient.

Methods: This patient was admitted into our hospital with a history of proliferation of the left breast for a few months. Physical examination showed a sturdy tumor of the left breast, fixated to the chest wall, extending 23.0 x 16.0 x 8.5 cm. Staging revealed no lymphonodal or distant metastases. The patient underwent an interdisciplinary radical tumor resection including parts of the chest wall followed by reconstruction with alloplastic mesh, a regional transposition flap and mesh graft transplantation.

Results: Histological examination showed a malignant phylloides tumor with resection margins free from disease.

Conclusion: The low incidence hinders to determine definitive recommendations for the treatment of PT. With background to the limited evidence in literature, the treatment should be interdisciplinary, involving fields of expertise in breast surgery, general and thoracic surgery, plastic surgery, oncology, pathology and radiation therapy. A standardized approach is still missing. This case report is an attempt to provide recommendations for a more standardized treatment of PT and thereby achieve a better outcome.

See Figure 1 [Fig. 1], Figure 2 [Fig. 2], Figure 3 [Fig. 3], Figure 4 [Fig. 4].