Khalid Ibtissam Bin, Parvaiz Muhammad Asad, Sarwar Albash, Shaikh Omair Shahid, Javed Nida, Fatima Arooj
Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, 7A Block R-3, M.A. Johar Town, Lahore, Pakistan.
Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, 7A Block R-3, M.A. Johar Town, Lahore, Pakistan.
Int J Surg Case Rep. 2021 Nov;88:106536. doi: 10.1016/j.ijscr.2021.106536. Epub 2021 Oct 23.
Phyllodes tumor is a biphasic fibroepithelial tumor which accounts for less than 1% of all breast neoplasms. We aim to raise awareness among clinicians that a male breast lump may be indicative of underlying sinister pathology and therefore, should be investigated thoroughly.
A 62 year old male presented in clinic with right beast lump for the last 6 weeks. A preoperative diagnosis of spindle cell tumor was made on core needle biopsy. Neoadjuvant chemotherapy was administered in order to downsize the tumor as it was inseparable from underlying muscle. A post-operative diagnosis of malignant phyllodes was made following mastectomy. As the tumor was 1 mm from the deep margin, adjuvant radiotherapy was administered.
Differential diagnoses of malignant phyllodes include metaplastic carcinomas metastatic/primary sarcomas and fibroadenomas. Metaplastic carcinomas are morphologically heterogeneous and include adenosquamous carcinoma, squamous cell carcinoma and spindle cell carcinoma. In some malignant phyllodes, extensive stromal proliferation can make detection of epithelial component very difficult. This highlights the limitation of core biopsy in establishing an accurate preoperative diagnosis. The standard treatment for phyllodes treatment is surgical resection with margins of 1 cm or more. Adjuvant radiotherapy is used in cases with threatened margins.
Malignant phyllodes tumor of breast can exist in men, and its accurate pre-operative diagnosis is difficult given the limitations of core biopsy. This case report draws attention to the challenges associated with the diagnosis of this rare condition and highlights the role of different treatment modalities in its management.
叶状肿瘤是一种双相性纤维上皮性肿瘤，占所有乳腺肿瘤的比例不到1%。我们旨在提高临床医生的认识，即男性乳腺肿块可能提示潜在的严重病变，因此应进行全面检查。
一名62岁男性因右侧乳腺肿块在门诊就诊，该肿块已存在6周。在粗针活检后作出梭形细胞瘤的术前诊断。由于肿瘤与深层肌肉无法分离，因此给予新辅助化疗以缩小肿瘤大小。乳房切除术后作出恶性叶状肿瘤的术后诊断。由于肿瘤距深部切缘1毫米，因此给予辅助放疗。
恶性叶状肿瘤的鉴别诊断包括化生性癌、转移性/原发性肉瘤和纤维腺瘤。化生性癌在形态上具有异质性，包括腺鳞癌、鳞状细胞癌和梭形细胞癌。在一些恶性叶状肿瘤中，广泛的间质增生会使上皮成分的检测非常困难。这突出了粗针活检在建立准确术前诊断方面的局限性。叶状肿瘤的标准治疗方法是手术切除，切缘为1厘米或更多。切缘有风险的病例使用辅助放疗。
男性可发生乳腺恶性叶状肿瘤，鉴于粗针活检的局限性，其准确的术前诊断较为困难。本病例报告提请注意与这种罕见疾病诊断相关的挑战，并强调了不同治疗方式在其管理中的作用。
