A case of recurrent malignant phyllodes tumor undergoing nipple-sparing mastectomy with immediate breast reconstruction

Akane Aikawa,Miki Noguchi,Mitsuharu Earashi,Masakuni Noguchi,Hiroshi Minato,Emi Morioka,Akihiro Shioya,Masafumi Inokuchi,Ken-ichi Shimada

doi:10.1186/s40792-020-01022-5

Akane Aikawa, Miki Noguchi + Show 7 more

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https://doi.org/10.1186/s40792-020-01022-5

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Abstract

BackgroundAlthough the primary treatment for malignant phyllodes tumor (PT) is complete surgical excision with either breast-conserving surgery or total mastectomy, recent technical advances have led to the adoption of nipple-sparing mastectomy (NSM) with immediate breast reconstruction (IBR).Case presentationA 28-year-old woman noticed a mass in her left breast that was rapidly increasing in size. She underwent tumor excision and a histological diagnosis of marked degenerative and necrotic induration suggested benign PT. One year later, however, she was found to have recurrent masses in the left breast on follow-up mammography and sonography. Needle biopsy was performed and the tumor was diagnosed as borderline or malignant PT. She underwent NSM and sentinel lymph-node biopsy with IBR using a tissue expander. Histological examination of the mastectomy specimen showed multiple fibroepithelial tumors with marked stromal overgrowth, focal necrosis, and hemorrhage. Stromal cells showed pleomorphism and a maximal mitotic rate of approximately 25 per 10 high-power fields. The tumor was diagnosed as malignant PT. She did not receive adjuvant chemotherapy or radiation treatment. At 3-year follow-up, the patient remains free of disease and highly satisfied with the cosmetic results.ConclusionsNSM with IBR is not a contraindication for malignant PT. It is both curative and can offer an appealing cosmetic option for localized malignant PT.

Highlights

The primary treatment for malignant phyllodes tumor (PT) is complete surgical excision with either breast-conserving surgery or total mastectomy, recent technical advances have led to the adoption of nipplesparing mastectomy (NSM) with immediate breast reconstruction (IBR).Case presentation: A 28-year-old woman noticed a mass in her left breast that was rapidly increasing in size
Malignant PT is a rare neoplasm of the breast with an annual incidence of about 2 per million women [14]
Surgery is the primary option for the treatment of malignant PT

Summary

Introduction

The primary treatment for malignant phyllodes tumor (PT) is complete surgical excision with either breast-conserving surgery or total mastectomy, recent technical advances have led to the adoption of nipplesparing mastectomy (NSM) with immediate breast reconstruction (IBR).Case presentation: A 28-year-old woman noticed a mass in her left breast that was rapidly increasing in size. *Correspondence: nogumasa@kanazawa‐med.ac.jp 1 Department of Breast and Endocrine Surgery/Breast Center, Kanazawa Medical University Hospital, 1‐1, Daigaku, Uchinada‐machi, Kahoku‐gun, Ishikawa 920‐0293, Japan Full list of author information is available at the end of the article lesions to highly aggressive malignant lesions. Total mastectomy with or without breast reconstruction may be the preferred option in Morioka et al surg case rep (2020) 6:297 patients with large or recurrent malignant PTs. To date, there have been few reports on the use of implants for immediate breast reconstruction (IBR) after nipple-sparing mastectomy (NSM) for malignant PT [10, 11].

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Conclusion