Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2020; 8(16): 3591-3600
Published online Aug 26, 2020. doi: 10.12998/wjcc.v8.i16.3591
Giant benign phyllodes breast tumour with pulmonary nodule mimicking malignancy: A case report
Ting Zhang, Liang Feng, Jie Lian, Wei-Li Ren
Ting Zhang, Liang Feng, Wei-Li Ren, Department of Breast Disease Center, People's Hospital of Shangyu, Shaoxing 312300, Zhejiang Province, China
Jie Lian, Department of Pathology, People's Hospital of Shangyu, Shaoxing 312300, Zhejiang Province, China
Author contributions: Zhang T was the patient’s oncologist, reviewed the literature and contributed to manuscript drafting; Feng L collected the patient’s clinical data; Lian J performed the pathologic analyses and reviewed the histological sections of this case; Ren WL reviewed and revised the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Wei-Li Ren, MBBS, Surgical Oncologist, Department of Breast Disease Center, People’s Hospital of Shangyu, No. 517 Baiguan Street, Shangyu District, Shaoxing 312300, Zhejiang Province, China. yar201810@163.com
Received: April 9, 2020
Peer-review started: April 9, 2020
First decision: April 29, 2020
Revised: May 11, 2020
Accepted: July 16, 2020
Article in press: July 16, 2020
Published online: August 26, 2020
Processing time: 137 Days and 17.2 Hours
Abstract
BACKGROUND

Phyllodes tumours (PTs) are fibroepithelial breast tumours, which can be classified as benign, borderline or malignant, according to their histological characteristics. While various huge borderline or malignant PTs have been previously described, a benign PT with a pulmonary nodule mimicking malignancy has not yet been reported. In order that doctors may have a comprehensive understanding of super-giant benign PTs (≥ 20 cm), we also performed a literature review to summarize the clinical features, differential diagnosis, and treatment of this disease.

CASE SUMMARY

A 42-year-old woman with severe anaemia presented with a rapidly enlarging right breast mass, measuring approximately 30 cm × 25 cm × 20 cm that was first noticed 1 year previously. A region of skin ulceration and necrosis (20 cm × 15 cm) was observed on the lateral side of the mass. Computed tomography (CT) of the chest revealed a pulmonary nodule, which initially suggested a diagnosis of metastasis. CT showed that the boundaries between the pectoralis major and the mass were blurred, which was presumed to be due to tumour invasion. However, two core needle biopsies of the mass showed no evidence of malignancy. Following these results, the tumour was removed by mastectomy of the right breast. Interestingly, postoperative pathology finally proved the diagnosis of a benign PT. After 1 year of follow-up, wedge resection of the small pulmonary nodule was performed, and it was confirmed that the lung nodule was actually adenocarcinoma rather than metastatic breast cancer. The patient recovered very well without any postoperative treatment.

CONCLUSION

This case is unique in that the giant breast mass initially mimicking a malignant clinical presentation was eventually pathologically confirmed to be a benign PT, which misled the diagnosis and complemented the atypical features of benign PTs. The pathological and immunohistochemical results were important in the differential diagnosis. In addition, total mastectomy should be recommended due to difficulty in the precise diagnosis of PTs, especially in large breast masses. In the literature, almost one-half of super-giant benign cases were thought to be malignant tumours before surgery. This finding is a reminder to consider all conditions in order to make an accurate diagnosis and avoid excessive treatment.

Keywords: Phyllodes tumour; Pulmonary neoplasms; Diagnosis; Treatment; Recurrence; Case report

Core tip: Phyllodes tumours (PTs) are fibroepithelial breast tumours. We report the unique case of a female patient who presented with a rapidly expanding breast PT. This case shows that a giant benign PT may reveal malignant features. The clinical manifestations and imaging examinations led us to misdiagnose this mass as a malignant tumour. However, pathological diagnosis of the tumour after complete excision confirmed the tumour to be a benign PT. The lung nodule was found to be adenocarcinoma rather than metastatic tumour. We also summarized and analyzed 12 cases and the results demonstrated that we should not to be fooled by appearances. All conditions should be considered to make an accurate diagnosis, in order that patients are given the appropriate treatment and avoid excessive treatment.