Department of General Surgery (Breast Surgery), The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Department of Pharmacy, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Cancer Rep (Hoboken). 2023 Sep;6(9):e1865. doi: 10.1002/cnr2.1865. Epub 2023 Aug 14.
Phyllodes tumor (PT) is a solid fibroepithelial breast lesion with proliferation of stromal and epithelial elements, usually presents with a rapidly expanding feature. Venous thromboembolism (VTE) have been reported to increase the burden in terms of mortality and morbidity of malignant tumor, and associate with worsened survival. However, benign PTs with silent thromboembolism that have not yet been reported, we report an unusual case of massive benign PT that grew on the left side of the breast in a cauliflower-shaped form and presented severe chronic blood loss and deep VTE.
A 37-year-old woman with uncontrolled pain presented a rapidly enlarging left breast mass, measuring approximately 30 × 20 × 15 cm that first started 25 years ago. color Doppler ultrasound showed a large mass lesion on the left breast and deep VTE, several enlarged lymph nodes in the left axilla and mediastinum, which presented a malignant character. However, the biopsies of the mass did not show evidence of malignancy and the pathology result was considered to be benign PT. The patient was treated with an inferior vena cava and anticoagulation, the operation was arranged according to the surgical procedure, the patient recovered very well after mastectomy.
This case is unique in that the giant breast mass presented with malignant character, was eventually pathologically confirmed to be benign PT, and it's rare that the benign tumor accompanied with silent thromboembolism. This finding describes the atypia features of giant benign PT and reminds the surgeon to consider the factor of VTE and risk when encountering ulcerative benign breast tumor and avoid excessive treatment.
叶状肿瘤（PT）是一种具有间质和上皮成分增生的实性纤维上皮性乳腺病变，通常表现为快速扩张的特征。静脉血栓栓塞症（VTE）已被报道会增加恶性肿瘤的死亡率和发病率负担，并与生存率恶化相关。然而，尚未报道过无症状性的良性 PT 合并 VTE，我们报告了一例不寻常的巨大良性 PT 病例，该肿瘤在左侧乳房呈菜花状生长，表现为严重的慢性失血和深部 VTE。
一名 37 岁女性因无法控制的疼痛就诊，其左侧乳房出现迅速增大的肿块，大小约为 30×20×15cm，最初始于 25 年前。彩色多普勒超声显示左侧乳房有一个大的肿块病变和深部 VTE，左侧腋窝和纵隔有几个增大的淋巴结，表现出恶性特征。然而，肿块的活检未显示恶性证据，病理结果被认为是良性 PT。患者接受了下腔静脉和抗凝治疗，根据手术程序安排了手术，患者在乳房切除术后恢复良好。
本例独特之处在于巨大乳腺肿块表现出恶性特征，最终病理证实为良性 PT，良性肿瘤伴有无症状性 VTE 较为罕见。这一发现描述了巨大良性 PT 的非典型特征，并提醒外科医生在遇到溃疡性良性乳腺肿瘤时要考虑到 VTE 因素和风险，避免过度治疗。
