Excision of 13 phyllodes bilateral breast tumors in one patient

Abstract

11584 Background: Phyllodes tumors are rare fibroepithelial breast tumors, classified as benign, borderline, or malignant. The prognosis is favorable, with a local recurrence rate of 15% and distant recurrence of 5–10%. Phyllodes tumors require wide excision with negative margins to prevent recurrence. We report a case of multiple bilateral tumors in one patient, an occurrence not yet reported in the world literature. Methods: The medical records of a patient diagnosed with multiple bilateral phyllodes tumors and fibroadenomas of the breast were reviewed. Results: A 16-year old girl reported the presence of palpable bilateral breast masses over the past few years. An initial ultrasound at age 14 revealed “indeterminate” solid masses. Her family history was significant for a grandmother with premenopausal breast cancer. On exam, she had multiple masses palpable bilaterally, with the largest masses of the right breast measuring 8 cm and 5 cm. The largest mass on the left was approximately 9 cm. No lymphadenopathy was present. Ultrasound revealed multiple masses bilaterally, some increased in size, with many suspicious for malignancy, with a BI-RADS score of 4b. Mammography revealed multiple bilateral masses, with many suspicious for cancer. A core biopsy of a left breast mass revealed a possible fibroadenoma, while core biopsy of the right suggested giant juvenile fibroadenoma versus low-grade phyllodes tumor. The patient underwent bilateral excision of multiple breast masses with breast reduction. Final pathology confirmed 15 right breast masses. The dominant mass on the right was a low-grade phyllodes tumor. The other masses consisted of a low-grade phyllodes tumor, 8 benign phyllodes tumors, and 5 fibroadenomas. On the left, 12 breast masses were excised: 3 benign phyllodes tumors, 8 fibroadenomas, and 1 complex fibroadenoma. Conclusions: To our knowledge, we present the first reported case of multiple, bilateral phyllodes breast tumors in an adolescent girl. Multiple bilateral breast masses in a young patient do not always represent benign fibroadenomas or fibrocystic disease. Young patients with multiple bilateral breast masses should receive a thorough evaluation to rule out malignancy. No significant financial relationships to disclose.