Transformation of benign phyllodes to malignant phyllodes tumor

Abstract

Importance of the problem: Malignant phyllodes tumors are rare fibroepithelial neoplasm in which clinical findings remain insufficient to determine a proper preoperative diagnoses and therefore has an unpredictable clinical outcome for optimal treatment. Few cases have been published involving malignant transformation of benign phyllodes to a malignant phyllodes tumor. These tumors should be suspected in patients with rapid-growing breast nodules to avoid incorrect treatment. Aims: Document a case of a transformation of benign to malignant phyllodes. Methods: A 23-year-old female patient presented a two-month history of palpable mass on the left breast, with accelerated growth in last month. There was no personal or family history of breast Cancer. This patient was submitted to the removal of a nodule in the left breast a year and a half prior. The physical exam presented a protruding and hardened palpable mass with a diameter of 5x6 cm and a histologically diagnosis of benign phyllodes tumor and an areolar incision was made. Results: At that time, the physical exam presented the palpable mass occupying the upper quadrants of the left breast with the dimensions of 4.5x2.0 cm. Signs of skin involvement or axillary lymphadenomegaly were not found. During the diagnostic investigation, the patient was submitted to mammogram and ultrasound. Because of the extension of the lesions, the patient underwent a skinspearing mastectomy with protests without axillary dissection. Surgical margins were free of any signs of the tumor. Macroscopy evidenced a lesion measuring 4,5x3,0 cm, and the anatomopathologic analysis of the surgical specimen confirmed the diagnosis of malignant phyllodes tumor. Comments: In our study, malignant transformation was determined one year after operation. The outcome of cases with history of fibroadenoma or benign phyllodes are significantly better than that of cases without history of benign tumor however, patients with malignant phyllodes tumors who exhibit rapid growth within six months require aggressive treatment