Recurrent Giant Malignant Phyllodes Tumor of the Breast
A 34-year-old woman was admitted with a 7 cm diameter localized in the medial quadrants of the right breast. Subsequent tumor extirpation and final histological results showed a malignant PT with a mitotic activity of 15 mitotic figures per 10 high-power fields (mf/10 hpf) but without heterologous structures. The patient had a total score of 57 points in the PT evaluation according to the Singapore nomogram and had an estimated five-year recurrence-free survival of 53%. The patient refused any subsequent surgical treatment despite the presence of a positive margin at the base of the primary tumor.

Approximately two years later, the patient was consulted again for the surgical treatment of a huge tumor with a diameter of 20cm that completely consumed the entire right breast. The tumor had no signs of ipsilateral axillary lymphadenopathy. Computed tomography (CT) of the thorax, sonography of the liver, and bone scan were all negative for staging. Total mastectomy was performed with partial resection of the pectoral muscle due to tumor infiltration. The final histological finding was recurrent PT with solid and cystic components and highly accelerated mitotic activity (40mf/10hpf). Despite the presence of a positive margin, the patient refused any subsequent treatment.

Finally, the patient returned 14 months after the second surgery with an exulcerated gigantic tumor of the right breast that grew towards the axilla. The CT and magnetic resonance imaging (MRI) scans of the patient showed that the tumor substantially compressed the thorax and had necrotic areas and gas bubbles. In addition, the tumor infiltrated the thorax at the sternal edge of the third and fourth ribs. The final surgical treatment conferred a high risk of damage to the venous and lymphatic drainage systems of the upper extremity with severe lymphedema. The author performed a total extirpation of the tumor with subsequent plastic reconstruction using a cutaneous flap from the region of the latissimus dorsi muscle. The axillary nerves and vessels remained intact. A total of three separate tumor masses were resected, and significant sarcomatous overgrowth and mitotic activity exceeding 50 mf/10hpf were histomorphological revealed. The base of the thorax was completely infiltrated by the tumor remnants that could not be removed. The patient refused any subsequent treatment and died a few months later due to multiorgan failure.