Akhtar Ahmad Naeem, Ali Asim, Gohar Ali, Ali Masab, Rehman Abdul, Bajwa Furqan Abbas, Haseeb Muhammad, Ahmad Muhammad Husnain
Lahore General Hospital Lahore Punjab Pakistan.
Department of Internal Medicine Punjab Medical College Faisalabad Punjab Pakistan.
Clin Case Rep. 2025 Sep 4;13(9):e70842. doi: 10.1002/ccr3.70842. eCollection 2025 Sep.
Malignant phyllodes tumors of the breast are rare fibroepithelial neoplasms with aggressive behavior and high recurrence rates. They pose significant diagnostic and therapeutic challenges due to their overlap with other malignancies, necessitating accurate diagnosis and a tailored treatment approach to improve patient outcomes. A 29-year-old Asian female initially underwent a lumpectomy for a right breast mass diagnosed as a phyllodes tumor on histopathology. Six months later, she developed a recurrent mass with pain, bleeding, and nipple-areolar distortion, leading to a modified radical mastectomy. Histopathology unexpectedly revealed metaplastic carcinoma, giant cell variant. No adjuvant therapy was administered. Two years post-mastectomy, she presented with a recurrent axillary mass associated with necrosis and purulent discharge. Imaging revealed a large necrotic soft tissue mass confined to the chest wall and axilla with subcentimeter lung nodules. No muscle invasion or intrathoracic extension was noted. Wide local excision of the axillary mass confirmed recurrent malignant phyllodes tumor. This case highlights the aggressive and recurrent nature of malignant phyllodes tumors, emphasizing their diagnostic overlap with other malignancies such as metaplastic carcinoma. Despite multiple surgical interventions, the high recurrence risk underscores the importance of precise diagnostic techniques and individualized treatment strategies.
乳腺恶性叶状肿瘤是罕见的纤维上皮性肿瘤，具有侵袭性且复发率高。由于它们与其他恶性肿瘤存在重叠，给诊断和治疗带来了重大挑战，因此需要准确诊断并采取量身定制的治疗方法以改善患者预后。一名29岁的亚洲女性最初因右乳肿块接受了肿块切除术，组织病理学诊断为叶状肿瘤。六个月后，她出现了复发性肿块，伴有疼痛、出血和乳头乳晕变形，遂接受了改良根治性乳房切除术。组织病理学意外发现为化生癌，巨细胞型。未给予辅助治疗。乳房切除术后两年，她出现了复发性腋窝肿块，伴有坏死和脓性分泌物。影像学检查显示，一个巨大的坏死软组织肿块局限于胸壁和腋窝，伴有小于1厘米的肺结节。未发现肌肉侵犯或胸腔内扩展。对腋窝肿块进行广泛局部切除，证实为复发性恶性叶状肿瘤。该病例突出了恶性叶状肿瘤的侵袭性和复发性，强调了它们与化生癌等其他恶性肿瘤在诊断上的重叠。尽管进行了多次手术干预，但高复发风险凸显了精确诊断技术和个体化治疗策略的重要性。
