Long-standing phyllodes tumor

Abstract

Introduction: phyllodes tumors are rare fibroepithelial neoplasms, accounting for less than 1% of breast tumors. They are classified as benign, borderline, or malignant, depending on their histology. Standard treatment involves surgical excision with wide margins (≥1 cm) to prevent local recurrence.

Case: a 67-year-old woman had a 20-year history of a breast mass, with accelerated growth, ulceration, and bleeding in the previous six months. Her initial refusal to undergo surgery led to local progression and moderate anemia. She finally underwent a radical mastectomy with free margins, and a benign phyllodes tumor was confirmed.

Discussion: the preoperative histopathological diagnosis of phyllodes tumors may be difficult due to their similarity to other fibroepithelial neoplasms, especially in the case of benign phyllodes tumors. The case presented shows the possible discrepancy between aggressive signs and symptoms (rapid growth and ulceration) and a benign histology. It also highlights the sociocultural factors that negatively affect patient treatment.

Conclusions: a high index of suspicion must be maintained for rapidly growing breast masses to prevent serious complications. Radical mastectomy is a safe option for giant tumors, but strict, prolonged follow-up is needed due to the risk of recurrence and occasionally unpredictable behavior of these tumors.