MALIGNANT PHYLLODES BREAST TUMOR IN A 16-YEAR-OLD GIRL: A CASE REPORT AND REVIEW

Problem statement 

Phyllodes tumor (PT) of the breast is a rare fibroepithelial neoplasm, accounting for 0.3% to 0.9% of all breast tumors (mean age 40 years). 
Clinical presentation consists in a mobile, non-painful, rapidly enlarging breast lump with great predisposition to recurrence. 

Methods

We report a 16-year-old girl followed in our Breast Unit, who had previously undergone 6cm-left breast adenoepithelioma excision.  
She reconsults 15 months later, due to reappearance of a 3-4cm left retro-areolar lump.  
The ultrasound revealed a 26x15x21mm solid lump with heterogeneous echo pattern, areas of cystic degeneration and increased vascularity, which led to suspicion of adenoepithelioma recurrence (BIRADS 4a).  
A biopsy was performed and the anatomopathologic examination showed a fibroepithelial lesion with an increased mitotic activity, classifying the tumor as borderline/malignant PT. A tumorectomy was performed with a final diagnosis of malignant 34x30mm PT with positive resection margins.  
Finally, a left mastectomy with periareolar access (including recent tumorectomy scar) was done. Immediate breast reconstruction was performed and a 295-cc polyurethane prepectoral implant covered with an acellular dermal matrix was placed .Two surgical drains were left. Anatomopatology study did not show features of malignancy and today she remains disease-free.   

Results

Hystological characteristics are the basis for diagnosis of PT but mammography and ultrasound are useful for its identification. The recommended treatment is complete surgical excision (mastectomy if necessary) with 1 cm margins. Radiation treatment can be an option in selected patients but its use is controversial. The use of routine hormone therapy or chemotherapy is not encouraged. 

Conclusion

MPT is an extremely rare neoplasm that makes its diagnosis and treatment a challenge due to its clinical presentation, rapid evolution and high recurrences rates.

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