Gaint phyllodes tumour with axillary & interpectoral lymph node metastasis; A rare presentation

Area of Science:

• Oncology
• Surgical Pathology
• Breast Neoplasms

Background:

• Phyllodes tumors are rare fibroepithelial neoplasms of the breast, accounting for less than 1% of all breast neoplasms.
• Lymph node metastasis in phyllodes tumors is exceptionally rare, and routine axillary dissection is generally not recommended.
• Malignant phyllodes tumors have a significant risk of distant metastasis, reported in approximately 20% of cases.

Observation:

• A 45-year-old female presented with a large, long-standing right breast mass and ipsilateral axillary lymphadenopathy.
• Core biopsy suggested a phyllodes tumor; CT revealed bilateral pulmonary metastasis.
• Pathology confirmed a malignant phyllodes tumor with osseous and chondroid metaplasia, and positive axillary lymph nodes (6/25).

Findings:

• This case presents a rare instance of phyllodes tumor with both lymph node and distant pulmonary metastasis.
• Despite palliative surgery and adjuvant chemo-radiotherapy, the patient's pulmonary disease progressed.
• Axillary lymph node metastasis, though rare (<1%), occurred in this patient, challenging standard management guidelines.

Implications:

• Core tissue biopsy and advanced imaging (CT, MRI) are crucial for accurate pre-operative diagnosis and staging.
• Management requires careful consideration, with simple mastectomy often sufficient, but lymph node dissection should be reserved for pathologically confirmed involvement.
• This case underscores the unpredictable behavior of malignant phyllodes tumors and the need for individualized treatment strategies.