A Case Report of Two Malignancies in Breast with Short Review of Literature: Phyllodes and Ductal Type

Abstract

A 54-year-old female presented with a recurrent mass in the right breast for eight months, associated with pain and discolouration of the skin for two weeks. Past history revealed a wide local excision of a tumour in the same breast 10 months ago, which was reported as a benign phyllodes tumour. Local examination revealed a bosselated mass of size 20×20×10 cm occupying all four quadrants of the right breast, along with another firm lump of size 3×3 cm in the lower inner quadrant. Magnetic Resonance Imaging (MRI) of the breast showed two separate lumps: the large lump involved all four quadrants of the right breast and was suggestive of malignant transformation of a recurrent phyllodes tumour-BIRADS V (Breast Imaging-Reporting and Data System), and another smaller lump was noted in the lower inner quadrant. A Tru-cut biopsy of the larger lesion was reported as a possibility of a phyllodes tumour with mild nuclear atypia. The total mastectomy specimen showed both solid and cystic areas with necrotic material, haemorrhagic fluid, and blood clots in the larger lump. A separate lump from the lower inner quadrant of the ipsilateral breast showed a firm, solid lesion. Microscopic examination of both lesions revealed the simultaneous presentation of a malignant phyllodes tumour with chondrosarcomatous differentiation and infiltrating ductal carcinoma. This case highlights the unpredictable co-existence of two separate malignant lumps in the ipsilateral breast, which is an extremely rare event.