Case reports Rare case of malignant phyllodes in a young female.

Rare case of malignant phyllodes in a young female

Abstract

Introduction:

Phyllodes tumors (PTs) of the breast are rare fibroepithelial tumors that constitute 0.3%–0.5% of primary breast tumors. Incidence is maximum in women aged 45 to 49 years. Majority of PTs have been described as benign (35% to 64%). We are presenting a case of a 21year female with bilateral breast lumps one of which turned out to be malignant PT.

Case report:

We report a rare case of young female who presented with slowly progressive, minimally painful lump in the left breast along with multiple small painless lumps in right breast. On examination, there was a left sided 4*3cm tender, globular firm lump under the nipple areolar complex with nipple retraction with no axillary lymphadenopathy. Right breast showed multiple, non-tender lumps. Ultrasonography suggested a complex fibroadenoma on left breast with multiple fibroadenomas on right. FNAC from left breast suggested a highly atypical cytology and patient underwent excision of both breast lumps. Histopathological examination suggested a left sided Malignant PT with high grade sarcoma with resected margins positive for malignant cells and right sided fibroadenomas. IHC report was positive for Progesterone receptors and Vimentin tumor cells. Whole body PET scan showed no FDG avid lesions in either breast or anywhere else.  Patient is now currently under follow-up and a wide local excision is being planned.

Discussion: PTs occur most commonly during the late fifth decade of life in females. Our case adds to the data pool where malignant PTs are found in a younger age group. Surgical management is the mainstay but type of surgery has always been a source of debate. The use of radiation therapy and adjuvant chemotherapy is controversial.

Conclusion:

Accurate preoperative diagnosis and vigilance for Malignant PTs irrespective of the age group of the patient is vital for the appropriate treatment and a disease-free survival.