Case 9 (2023): Malignant Phyllodes Tumor of the Breast
Sakshi Andersen, Matilda Svenning Hunt, Tine M. Engberg Damsgaard
Abstract
A 58-year-old female was referred to the Department of Breast Surgery with a red, swollen and tender right breast. The patient had a medical history of hypertension and benign cysts in the breasts and had undergone augmentation mammoplasty with breast implants 15 years ago. The symptoms debuted 14 days prior to admission, and she was initially treated with antibiotics on the suspicion of an infect
BeforeAfterA 58-year-old female was referred to the Department of Breast Surgery with a red, swollen and tender right breast. The patient had a medical history of hypertension and benign cysts in the breasts and had undergone augmentation mammoplasty with breast implants 15 years ago. The symptoms debuted 14 days prior to admission, and she was initially treated with antibiotics on the suspicion of an infection. The patient had not at any time presented with fever or any other symptoms of illness. According to the patient, no mass in the breast could be palpated initially.
A) MRI-scan and B) PET-CT-scan revealed a tumor measuring 12x12x13 cm in diameter with no deep invasion of the pectoralis muscle and several pathological looking lymph nodes in the left axilla and in the subpectoral area.
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The surgery was initiated by the breast surgeon with a wide incision around the right mamma. Four lymph nodes from the right axillary region were resected and showed no evidence of malignancy with peroperative frozen section analysis.
- Notice the design of the thoraco-abdominal flap marked on the lateral side of the abdomen.
The radical mastectomy was performed in the subcutaneos cleavage to the pectoralis muscle.
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The sarcoma surgeon resected both the major an the minor pectoralis muscles and explanted the right breast implant.
- Notice the breast implant in the center of the image.
The breast, including the pectoralis muscles were excised.
- Notice the costae in the depth of the excision
The defect measured 25 x 30 cm. Two drains were inserted. Primary closure was performed by undermining adjacent tissue. The defect was closed in three layers with vicryl and with nylon.
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The final pathology diagnosis confirmed a malignant phylloides tumor and four lymph nodes with no malignancy. Follow-up is planned with MRI-scans and PET-CT scans every third month in at least five years in the sarcoma section. The patient is awaiting secondary breast reconstruction.
How to cite this article
Sakshi Andersen, Matilda Svenning Hunt, Tine M. Engberg Damsgaard. Case 9 (2023): Malignant Phyllodes Tumor of the Breast. Journal of Plastic, Breast & Reconstructive Surgery. 2023.
Open access. © 2023 The Author(s). Published by the Journal of Plastic, Breast & Reconstructive Surgery. Copyright to this case is shared between the author(s) and the journal; authors may reuse their own case for education, presentations and social media.
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