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

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 mimi...

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Autores principales: Zhang, Ting, Feng, Liang, Lian, Jie, Ren, Wei-Li
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457108/
https://www.ncbi.nlm.nih.gov/pubmed/32913869
http://dx.doi.org/10.12998/wjcc.v8.i16.3591
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author Zhang, Ting
Feng, Liang
Lian, Jie
Ren, Wei-Li
author_facet Zhang, Ting
Feng, Liang
Lian, Jie
Ren, Wei-Li
author_sort Zhang, Ting
collection PubMed
description 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.
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spelling pubmed-74571082020-09-09 Giant benign phyllodes breast tumour with pulmonary nodule mimicking malignancy: A case report Zhang, Ting Feng, Liang Lian, Jie Ren, Wei-Li World J Clin Cases Case Report 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. Baishideng Publishing Group Inc 2020-08-26 2020-08-26 /pmc/articles/PMC7457108/ /pubmed/32913869 http://dx.doi.org/10.12998/wjcc.v8.i16.3591 Text en ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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.
spellingShingle Case Report
Zhang, Ting
Feng, Liang
Lian, Jie
Ren, Wei-Li
Giant benign phyllodes breast tumour with pulmonary nodule mimicking malignancy: A case report
title Giant benign phyllodes breast tumour with pulmonary nodule mimicking malignancy: A case report
title_full Giant benign phyllodes breast tumour with pulmonary nodule mimicking malignancy: A case report
title_fullStr Giant benign phyllodes breast tumour with pulmonary nodule mimicking malignancy: A case report
title_full_unstemmed Giant benign phyllodes breast tumour with pulmonary nodule mimicking malignancy: A case report
title_short Giant benign phyllodes breast tumour with pulmonary nodule mimicking malignancy: A case report
title_sort giant benign phyllodes breast tumour with pulmonary nodule mimicking malignancy: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457108/
https://www.ncbi.nlm.nih.gov/pubmed/32913869
http://dx.doi.org/10.12998/wjcc.v8.i16.3591
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