Recurrent giant phyllodes tumour in a 17-year-old female: A
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A 17 year old female was brought as an outpatient in the department of general surgery with a 2-year history of a huge ulcerating, painful and tender right breast mass. On physical examination, she was ill-looking, febrile and mildly wasted. She reported four different excisions in the past 2 years. Two excisions were done at a health centre and unfortunately the excised tumour masses were not evaluated histologically due to lack of pathology laboratory. The subsequent two excisions after recurrence were done at two different private hospitals.

One histological report indicated fibroadenoma and the fourth report revealed benign PT. The right breast was very huge with ulcerating skin surface and was forming nodules. Ultrasound revealed a tumour, which measured 31 × 30 × 21 cm, calcified with regular borders and not fixed to the underlying tissue, but the left breast was normal. Chest X-ray showed clear lungs. Both fine-needle aspiration cytology and mammography could not be done because were not available.

Modified radical mastectomy was performed by involving a significant amount of pectoralis major muscle. Macroscopically, the tumour was extensively necrotic, haemorrhagic and nodular. Grossly, the surgical margins were 3.4 cm far from the tumour. On microscopic examination, the tumour was hypercellular and was composed of uniform and slender spindle cells, and it was forming fascicles. The cells had uniform vesicular nuclear chromatin and abundant eosinophilic cytoplasm. A few mitotic figures less than 5 per 10 high-power fields were also seen.

All ER, PR, HER2, SMA, S-100, vimentin and P53 antibodies were negative except Ki67 that showed proliferation labelling index of less than 10%. After a postoperative period of 8 months, she was found to be free from local recurrence or metastasis following evaluation with chest and abdominal computed tomography scan.

In summary, PTs are extremely rare in adolescents and they grow rapidly with a high risk of local recurrence. Ensuring wide excision during surgery is of utmost importance for obtaining negative surgical margins in order to prevent possibility of local recurrence.

Source: https://academic.oup.com/omcr/article/2020/10/omaa089/5936346
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