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Immediate latissimus dorsi pedicle flap reconstruction following the removal of an eight kilogram giant phyllodes tumour of the breast: a case report.

Sarvanandan R, Thangaratnam R, Leong AC - J Med Case Rep (2011)

Bottom Line: We report the case of a 36-year-old Malaysian woman who presented with a three-year history of gradually increasing swelling of the left breast, with skin changes.Examination revealed a huge, globular, lobulated mass measuring 400 mm by 350 mm.At 12-month follow-up, the patient reports no complications and is satisfied with the aesthetic outcome.

View Article: PubMed Central - HTML - PubMed

Affiliation: Northwest Thames Deanery, 118 Sixth Avenue, London, E12 5PU, UK. romesh1985@doctors.org.uk.

ABSTRACT

Introduction: Phyllodes tumors account for less than 1% of breast tumors in women, and giant phyllodes tumors are those that are larger than 10 cm in diameter. Removal of such large tumors places a huge burden on the surgeon to reconstruct a breast that is aesthetically acceptable by the patient. We report what may be the largest giant phyllodes tumor and, most likely, the first latissimus dorsi flap used to cover such a large defect caused by the resection.

Case presentation: We report the case of a 36-year-old Malaysian woman who presented with a three-year history of gradually increasing swelling of the left breast, with skin changes. Examination revealed a huge, globular, lobulated mass measuring 400 mm by 350 mm. The patient had a mastectomy with an immediate latissimus dorsi pedicled myocutaneous flap reconstruction. The breast weighed 8.27 kg, and ex vivo, the tumor measured 280 mm by 250 mm by 180 mm. Histopathologic analysis confirmed the diagnosis as a giant phyllodes tumor. At 12-month follow-up, the patient reports no complications and is satisfied with the aesthetic outcome.

Conclusion: Giant phyllodes tumors are very rare tumors that can reach up to 40 cm in diameter. Reconstruction of such a defect is a great challenge, and we report what we believe is the first latissimus dorsi flap to cover successfully a defect of approximately 400 mm by 350 mm.

No MeSH data available.


Related in: MedlinePlus

Phyllodes tissue H&E staining (×40 magnification). High-power view shows the cellularity of the stroma, with presence of mitosis (arrow) and moderate cellular pleomorphism. The presence of increased mitotic activity (five per 10 high-powered fields (hpfs) in this patient), as well as the moderate cellular pleomorphism, indicates a diagnosis of "borderline" phyllodes tumor.
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Figure 6: Phyllodes tissue H&E staining (×40 magnification). High-power view shows the cellularity of the stroma, with presence of mitosis (arrow) and moderate cellular pleomorphism. The presence of increased mitotic activity (five per 10 high-powered fields (hpfs) in this patient), as well as the moderate cellular pleomorphism, indicates a diagnosis of "borderline" phyllodes tumor.

Mentions: Microscopically, the mass was composed of compressed ducts lined by two-tiered epithelium arranged in clefts and surrounded by an overgrowth of stroma arranged in a leaf-like structure (Figures 4 and 5). A borderline giant phyllodes tumor was diagnosed after the identification of five mitoses per 10 high power fields (hpfs) at the most mitotically active area, and a predominantly expanding border with no overt malignant features (Figure 6). The tumor had a minimum of 4 cm clear surgical margin, and no removed nodes exhibited any evidence of malignancy. Our patient did not receive any adjuvant therapy (post-operative radiotherapy or chemotherapy) because of the absence of malignant features.


Immediate latissimus dorsi pedicle flap reconstruction following the removal of an eight kilogram giant phyllodes tumour of the breast: a case report.

Sarvanandan R, Thangaratnam R, Leong AC - J Med Case Rep (2011)

Phyllodes tissue H&E staining (×40 magnification). High-power view shows the cellularity of the stroma, with presence of mitosis (arrow) and moderate cellular pleomorphism. The presence of increased mitotic activity (five per 10 high-powered fields (hpfs) in this patient), as well as the moderate cellular pleomorphism, indicates a diagnosis of "borderline" phyllodes tumor.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3037889&req=5

Figure 6: Phyllodes tissue H&E staining (×40 magnification). High-power view shows the cellularity of the stroma, with presence of mitosis (arrow) and moderate cellular pleomorphism. The presence of increased mitotic activity (five per 10 high-powered fields (hpfs) in this patient), as well as the moderate cellular pleomorphism, indicates a diagnosis of "borderline" phyllodes tumor.
Mentions: Microscopically, the mass was composed of compressed ducts lined by two-tiered epithelium arranged in clefts and surrounded by an overgrowth of stroma arranged in a leaf-like structure (Figures 4 and 5). A borderline giant phyllodes tumor was diagnosed after the identification of five mitoses per 10 high power fields (hpfs) at the most mitotically active area, and a predominantly expanding border with no overt malignant features (Figure 6). The tumor had a minimum of 4 cm clear surgical margin, and no removed nodes exhibited any evidence of malignancy. Our patient did not receive any adjuvant therapy (post-operative radiotherapy or chemotherapy) because of the absence of malignant features.

Bottom Line: We report the case of a 36-year-old Malaysian woman who presented with a three-year history of gradually increasing swelling of the left breast, with skin changes.Examination revealed a huge, globular, lobulated mass measuring 400 mm by 350 mm.At 12-month follow-up, the patient reports no complications and is satisfied with the aesthetic outcome.

View Article: PubMed Central - HTML - PubMed

Affiliation: Northwest Thames Deanery, 118 Sixth Avenue, London, E12 5PU, UK. romesh1985@doctors.org.uk.

ABSTRACT

Introduction: Phyllodes tumors account for less than 1% of breast tumors in women, and giant phyllodes tumors are those that are larger than 10 cm in diameter. Removal of such large tumors places a huge burden on the surgeon to reconstruct a breast that is aesthetically acceptable by the patient. We report what may be the largest giant phyllodes tumor and, most likely, the first latissimus dorsi flap used to cover such a large defect caused by the resection.

Case presentation: We report the case of a 36-year-old Malaysian woman who presented with a three-year history of gradually increasing swelling of the left breast, with skin changes. Examination revealed a huge, globular, lobulated mass measuring 400 mm by 350 mm. The patient had a mastectomy with an immediate latissimus dorsi pedicled myocutaneous flap reconstruction. The breast weighed 8.27 kg, and ex vivo, the tumor measured 280 mm by 250 mm by 180 mm. Histopathologic analysis confirmed the diagnosis as a giant phyllodes tumor. At 12-month follow-up, the patient reports no complications and is satisfied with the aesthetic outcome.

Conclusion: Giant phyllodes tumors are very rare tumors that can reach up to 40 cm in diameter. Reconstruction of such a defect is a great challenge, and we report what we believe is the first latissimus dorsi flap to cover successfully a defect of approximately 400 mm by 350 mm.

No MeSH data available.


Related in: MedlinePlus