Giant benign phyllodes breast tumour with pulmonary nodule mimicking malignancy: A case report

Table 1 Case reports of giant benign phyllodes tumours with a diameter ≥ 20 cm

Ref.	Age	Disease duration	Size/weight	Clinical characteristics	Pectoral muscle adherence	Pre-op diagnosis/core biopsy	Surgery/margins	Recurrences
Miyaguni et al[20]	43	5 mo	20 cm/unknown	Ulceration, bleeding	No	Malignant/Unknown	Mastectomy/unknown	Unknown
Udapudi et al[21]	21	3 mo	45 cm/6.5 kg	Ulceration	No	Benign PT/Benign PT	Mastectomy/unknown	None for 2 yr
Liang et al[22]	64	2 yr	36 cm/unknown	No	Yes, suggested invasion	Malignancy not excluded/Highly atypical cells	Mastectomy, partial PME /< 1 cm	None for 7 yr
Zhao et al[23]	63	2 yr	45 cm/11 kg	No	No	Unknown/Unknown	Mastectomy, peripheral muscle excision /unknown	Unknown
Likhitmaskul et al[24]	35	5 mo	20 cm/unknown	Gestation	No	Benign PT/Benign PT	Mastectomy, LNs removed/unknown	Unknown
Sbeih et al[25]	41	7 yr	25 cm/unknown	Ulceration	No	Malignancy not excluded/Pseudoangiomatous or PT	Mastectomy, skin graft/negative margins	Unknown
Islam et al[4]	44	1 yr	50 cm/unknown	Ulceration, fungating, anaemia, malnourished	No	Benign PT/Benign PT	Mastectomy, partial PME, LN samples, LD flap closure/unknown	Died of MPE after 6 mo
Yan et al[26]	54	6 mo	20 cm/unknown	Non-myoepithelial tumour of the parotid	No	Malignancy not excluded/Fibroepithelial lesion	Mastectomy, PME, LN samples/adequate margins	None for 3 mo
Kallam et al[27]	32	8 mo	20 cm/unknown	Gestation	No	Benign PT/Benign PT	Mastectomy/unknown	None for 4 wk
Rathore et al[28]	25	6 wk	30 cm/5 kg	Fungating, anaemia	Yes	Benign PT/Benign PT	Mastectomy, PME/> 2 cm	None for 10 mo
Benoit et al[29]	40	1 mo	29 cm/4 kg	Ulceration, bleeding, infection	Yes	Benign PT/Adenofibroma or benign PT	Mastectomy/< 1 mm	Unknown
Our case	42	2 mo	30 cm/3.5 kg	Ulceration, bleeding, infection, Lung adenocarcinoma	Yes, suggested invasion	Malignancy not excluded/Benign PT	Mastectomy/< 1 mm	None for 12 mo

PT: Phyllodes tumour; PME: Pectoral muscle excision; LN: Lymph node; Pre-op: Preoperative; LD: Latissimus dorsi breast reconstruction; MPE: Malignant pleural effusion.

Table 2 Histologic features of benign, borderline and malignant phyllodes tumors (adopted from the World Health Organization classification 2012)

Histologic features	Benign	Borderline	Malignant
Stromal hypercellularity	Mild	Moderate	Marked
Stromal mitotic activity	0-4/10 HPF	5-9/10 HPF	≥ 10/10 HPF
Stromal cell atypia	Mild	Moderate	Marked
Stromal overgrowth	Absent	Absent or focal	Often present
Tumour borders	Well-defined	Well-defined focally infiltrative	Infiltrative
Malignant heterologous elements	Absent	Absent	May be present