Larger than life: A case of a bleeding giant phyllodes tumor in a COVID-19 positive patient

Abstract

Introduction: Phyllodes tumor of the breast, also known as cystosarcoma phyllodes, is a rare fibroepithelial tumor that accounts for about 0.3–1% of all breast tumors. Unlike most breast tumors that start from the ducts and gland, phyllodes tumor originates from the stroma. The classification of phyllodes tumor is less important on assessing the risk of recurrence as compared to the presence of tumor-free margins after surgical treatment. Case Report: A 54-year-old female presented at the emergency room with a large, bleeding, left breast mass. The patient tested positive for COVID-19 and was admitted previously at the isolation ward. After medical management of her current condition, the patient underwent wide excision (total mastectomy), left with en bloc resection of pectoralis major with delayed reconstruction via split thickness skin graft. This case is one of the few reported giant phyllodes tumor in the English literature, measuring 30 cm widest dimension. Conclusion: Malignant phyllodes tumor is a rare form of breast malignancy behaving like a sarcoma. A diagnostic dilemma may be encountered in patients with such tumors due to the rarity of these cases and the different presentation of the tumor. High suspicion shall be entertained for patients with breast masses which tend to appear like benign lesions but with sudden enlargement. Adequate surgical intervention shall be done ensuring tumor-free margins. Adjuvant therapy for malignant phyllodes tumor is still controversial but shall be entertained according to the patient’s actual case needs.