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Monday, November 4, 2013

Phyllodes tumor causing "rupture" of the breast


Phyllodes tumors (the name comes from the Greek word meaning "leaf") are a type of tumor occurring in the breast. These large, fast-growing masses represent less than 1% of all breast neoplasms. Their appearance is quite curious - they resemble a large wad of leaves. Phyllodes tumors are a fibroepithelial tumor (that is, they contain an epithelial and stromal component) and can be considered benign, borderline or malignant, depending on their histological features . Around 60-70% of phyllodes tumors are benign, incapable of metastasizing. Those that do metastasize, usually form metastases to the lungs; other preferred sites of metastasis are the skeleton, heart and liver.

Nabi et al. (2013) have reported a curious case from Bangladesh where a phyllodes tumor grew so large that it broke through the skin of the breast and presented as a big, mushroom-like ulcerated mass hanging from the breast. The patient, a 32-year-old village woman, had been aware of the lump in her breast for a year, but did not seek medical attention, preferring to use homeopathic treatments instead. These did not help at all; the tumor grew, and grew, until it caused her breast to rupture and emerged to the surface - and grew some more. She walked around with the large nodular mass for another 3 months before she finally gathered the courage to see a doctor. She reported pain and occasional bleeding from the ugly growth. The mass was excised surgically under general anesthesia. The resected specimen was a whopping 9.5 x 8.5 x 4.5 cm in size and a histological examination confirmed that it was a benign phyllodes tumor. These benign variants do not metastasize; however, they do have a tendency to grow aggressively, as this case shows. 

If not resected with a wide enough margin, phyllodes tumors have a tendency to recur. This particular patient was lucky - nine months after the removal of the mass, there was still no sign of a recurrence.

And this is the tumor itself. Ugh.



Large phyllodes tumor hanging from the breast. Image from : Nabi et al. (2013)


Phyllodes tumor after resection. Image from : Nabi et al. (2013)


 Source: Nabi J, Qamrul Akhter SM, Authoy FN (2013) A Case of Large Phyllodes Tumor Causing “Rupture” of the Breast: A Unique Presentation. Case Rep Oncol Med. 871292. Published online 2013 May 14. doi: 10.1155/2013/871292

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