International Surgery Journal

Bhasin SK et al. Int Surg J. 2014 Nov;1(3):177-180

http://www.ijsurgery.com pISSN 2349-3305 | eISSN 2349-2902

DOI: 10.5455/2349-2902.isj20141115
Case Report

Bilateral benign giant phyllodes tumor in an adolescent female: a rare

case report
Sanjay Kumar Bhasin*, Sunita Kumari, Vijay Kumar, Paras Saini, Gopal Sharma,
Mubashir Akram

Department of Surgery, Government Medical College, Jammu, Jammu and Kashmir, India

Received: 20 October 2014

Accepted: 02 November 2014

*Correspondence:
Dr. Sanjay Kumar Bhasin,
E-mail: [email protected]

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the
terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use,
distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Cystosarcoma phyllodes or phyllodes tumor are rare fibroepithelial neoplasm accounting for only about 1% of the breast
lesions in children and adolescents. Whether benign, borderline or malignant, they have high potential of recurrence.
These biphasic tumors are having very low rate of bilateral occurrence and in that event they tend to be asynchronous. The
definitive treatment of the benign entity is either wide local excision or mastectomy depending upon size and age of the
patient. Ours is a case of 16 years old, orphan low socio-economic status female having bilateral giant phyllodes tumors
that were confirmed on Fine needle aspiration cytology of both breasts. Wide local excision of the tumor could be done
on the right side, and patient was discharged on 10th post-operative day with advice to report after 6 weeks for possible
surgery on the left enlarged breast. The histopathology report was consistent with the findings of benign phyllodes of
the breast. Patient reported for the second surgery after 10 months of the first surgery and was subjected in wide local
excision on the left side also. The case under report finds rarity due to its huge size, bilateral presentation in an unmarried
adolescent female where the decision making regarding its definitive management becomes extremely difficult.

Keywords: Giant phyllodes, Bilateral, Benign phyllodes, Malignant phyllodes, Adolescent female

INTRODUCTION These biphasic tumors are having very low rate of bilateral
occurrence and in that event they tend to be asynchronous.8,9
Cystosarcoma phyllodes or phyllodes tumor are rare The definitive treatment of the benign entity is either wide
fibroepithelial neoplasm accounting for only about 1% of local excision or mastectomy depending upon size and age
the breast lesions in children and adolescents.1 The median of the patient.10,11
age of occurrence of the disease is 40-50 years, having an
estimated incidence of about 2.1 per million. The tumor is The case under report finds rarity due to its huge size,
rarely found in adolescents and elderly.2,3 multiple tumors with bilateral presentation in an unmarried
adolescent female where the decision making regarding its
In 1982, World Health Organization declared the term definitive management becomes extremely difficult.
“phyllodes tumor” as the most appropriate among
more than 60 synonyms. Furthermore, World Health CASE REPORT
Organization sub-classified them histologically as benign,
borderline or malignant.4 Benign variants constitute 35-64% A 16-year-old, an orphan low socio-economic status female
while malignant tumors comprise 25%, and the rest are of the remote village presented to the hospital with a history
borderline.5-7 Whether benign, borderline or malignant, they of progressive enlargement of the breast since the age of
have high potential of recurrence. 13 years. The enlargement of the breast increased rapidly

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 Bhasin SK et al. Int Surg J. 2014 Nov;1(3):177-180

in last 4-6 months. Sensing it the curse of some deity or to be benign until 1943, when Cooper and Ackerman
unnatural force, the guardians of the female took her to a reported on the malignant biological potential of this
local tantric, who used some local medicine and hot iron tumor. In 1981 the World Health Organization adopted
rods on both the breasts of the female. Instead of getting any the term phyllodes tumor and as described by Rosen sub
relief (expected decrease in size of the breast), the female classified them histologically as benign, borderline, or
suffered multiple ulcers in right breast. The guardians took malignant according to the features such as tumor margins,
the female to the local doctor in the dispensary, who in stromal overgrowth, tumor necrosis, cellular atypia, and
view of multiple non-healing ulcers in the breast referred number of mitosis per high power field.2,15 The majority of
her to the higher center. The age at menarche was 13 years, phyllodes tumors have been described as benign (35-64%),
and there was no history of menstrual disturbances. On with the remainder divided between the borderline and
examination of the patient, except mild pallor nothing malignant subtypes. The term phyllodes tumor represents
significant was detected on general physical examination a broad range of fibro epithelial diseases and presence
and systemic examination. Local examination of the breast
on the right side revealed multiple non-healing crusty
ulcers. The size of the breast in cranio-caudal dimension
was 56 cm by 44 cm. There were five lumps in the right
breast ranging from 12 cm to 6 cm.

Left sided breast was 52 cm by 42 cm with uniform

enlargement having firm consistency. Patient was
admitted in the hospital and all the investigations for
general anesthesia were done in addition to fine needle
aspiration cytology (FNAC)of both breasts. FNAC both
breast revealed bilateral benign phyllodes tumor with fibro
epithelial hyperplasia, without any atypia.

The management plan was discussed with the attendants of Figure 1: Bilateral giant phyllodes tumor in an
the patient, including consent for mastectomy, which they adolescent.
gave with reluctance. Only wide local excision of the tumor
could be done on the right side, the attendants refusing to
give consent for mastectomy in spite of the fact that there
was hardly any normal breast tissue in the operated breast.
The patient was discharged on 10th post-operative day
with advise reporting after 6 weeks for possible surgery
on the left enlarged breast. The histopathology report was
consistent with the findings of multiple benign phyllodes
of the right breast. The patient lost the follow-up and
reported 10 months after the first surgery. This time she
had complained of further increase in size of the left breast
and no recurrence on the right side. Again FNAC of the
left breast was done to rule out malignant transformation
of the earlier benign variant. The FNAC finding was
consistent with benign phyllodes. After investigations for Figure 2: Right breast with multiple ulcers.
general anesthesia, patient was subjected to wide local
excision of the tumor on the left side also as the attendant
refused to give consent for mastectomy. Post-operative
histopathological examination was consistent with findings
of benign phyllodes of the breast. Patient was discharged
on 10th post-operative day with advice to remain in regular
follow-up. Patient remained in follow-up for 4 months
(Figures 1-4).

DISCUSSION

Although today’s phyllodes tumors find their description

as a giant type of fibro adenoma as early as 1774 yet
it was Chelius who described this tumor in 1827. 12,13
Furthermore, Johannes Muller (1838)was the first person
to use the term cystosarcoma phyllodes.14 It was believed Figure 3: Completion right breast surgery.

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 Bhasin SK et al. Int Surg J. 2014 Nov;1(3):177-180

The possibility of local recurrence is 6-10% in benign,

25-30% in borderline and over 25% in malignant variants.
Lung and bone are affected by metastasis commonly.27,28
The overall 5 year survival in benign and malignant
phyllodes reported in the surgical literature is 91% and
82% respectively.29

We in our case had no recurrence on the right side that was

operated 18 months back and on the left side after 6 months
of surgery. Patient is still under regular follow-up.

Funding: No funding sources

Conflict of interest: None declared
Figure 4: 6 months after first surgery. Ethical approval: Not required

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Saini P, Sharma G, Akram M. Bilateral benign giant
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