Recurrent giant fibroadenomas with transformation to cystosarcoma phyllodes in a 17-year-old girl: a rare case report from Syria

Background Fibroadenoma is the most prevalent benign breast lesion that generally affects middle-aged women; it is rare in adolescents and younger children. The transformation into malignancy is not common. However, multiple recurrences of rapidly enlarging fibroadenomas suggest a high possibility of transforming into phyllodes tumors, which are uncommon fibroepithelial lesions that account for 0.3–0.5% of female breast tumors and typically present in premenopausal women. Case presentation We report a case of a 17-year-old Syrian girl who previously had three episodes of recurrence of multiple rapidly enlarging fibroadenomas in her left breast and underwent three operations for complete resection of the lesions. However, a few months later, she was readmitted with multiple large masses in the same breast, and pathological findings confirmed a surprising combination of multiple fibroadenomas for the fourth time with a malignant phyllodes tumor (cystosarcoma phyllodes). The patient underwent lumpectomies followed by adjuvant radiotherapy. Long-term follow-up was recommended. Conclusion Our patient had an extraordinary number of episodes of recurrence at a young age and a rare combination of malignant and benign lesions in the same breast with multiple recurrences. We present her unique, very challenging case with the aim of highlighting the importance of clinical correlation, detailed diagnosis, and careful follow-up.

Bone metastasis from malignant phyllodes of the breast

Cystosarcoma phyllodes was described first in 1838 and originally was considered to be a benign tumor. It was not until 1931 that metastasis from a cystosarcoma phyllodes was reported. The incidence of cystosarcoma phyllodes is estimated to be 0.3% to 0.9% of all breast tumors. Sites most commonly affected by metastases are the lungs and bones. We present a case report 29-year old female patient presented with a voluminous breast mass at both of them which was completely resected. The right side presented of malignant phyllodes and the left side is borderline phyllodes. Six months later, both of her legs became paralyzed and accompanied by swelling over her right upper arm. Biopsy was performed, and the diagnosis was metastatic malignant phyllodes tumor. Histologic review of the breast tumor revealed stromal overgrowth.

The quintessence of breast leiomyosarcoma

Sarcoma of the breast is a rare condition. The biological differences from other primary breast tumours necessitate a corresponding difference in approach to diagnostic and management strategies. The rarity of the condition has made clinicopathological study difficult. Authors report a case of primary leiomyosarcoma in a 40-yr-old-women, with a 15x9 cm bosselated swelling, involving all 4 quadrants of the left breast. Her clinical features, sonography and trucut biopsy were compatible with cystosarcoma phyllodes and she underwent a left mastectomy for the same. Later the histological and imunohistochemical studies established the diagnosis of leiomyosarcoma, grade 2.