Abstract
An unusual multifocal recurrent phyllodes tumor turned into malignant was reported with a review of the literature. A 46-year-old woman had a small lump 2×1 cm in size in the area C of the right breast. The lump was excised and found to be fibroadenoma. Two years and 8 months later, a local recurrence (8×7 cm) occurred in the same area and was excised. It was a benign phyllodes tumor. Further 15 months later, multifocal local recurrences in the different 3 areas, namely, 4×2 cm tumor in area C, 4×4 cm one in area AB, and 6×5 cm one in area D, were recognized. Total breast tissues were resected and breast reconstruction with silicon prosthesis was performed. Nine months thereafter, multifocal local recurrences were found in the similar areas, namely, 6×5 cm recurrence in area AB, 8×5 cm in area DB, and 6×5 cm in area E, which rapidly enlarged. By intraoperative microscopical diagnosis, these recurrences were found to be malignant with the evidence of major pectral muscle invasion and swelling of axillary nodes. Standard radical mastectomy was carried out.
In a review of the literature during the past 32 years, there are 136 cases of malignant phyllodes tumor, and another 19 cases in which benign phyllodes tumor of the breast recurred to be malignant. Malignant phyllodes tumors often metastasize hematogenously and have a high mortality. Even in a patient having a benign phyllodes tumor, entertaining a possible recurrence with malignant change, it is important to excise widely including surrounding tissues and to follow up the patient minutely.
