Malignant phyllodes tumor

Discussion:

A young woman presented to the ER with a massively enlarged left breast which she claimed had been significantly enlarged for the past year or so but had become painful several weeks previously, as well as enlarging further. On examination, the skin of the breast was erythematous. No fever or chills. History notable for Marfan syndrome, iron deficiency anemia, well-controlled schizophrenia, and depressive disorder.

US breasts demonstrated a huge heterogeneous mass with internal flow that was interpreted as having a low likelihood of malignancy, possibly granulomatous mastitis. The breast surgeon suspected phyllodes tumor. She underwent incision and drainage, with removal of necrotic tissue. Histopathology showed the mass to represent a high grade malignant phyllodes tumor. She underwent left mastectomy and received chemoradiotherapy. Despite this, 4 months after commencing treatment, a chest wall mass and lung metastases were seen on imaging.

A year after first presenting with the large breast mass, complained of pleuritic chest pain on the left and shortness of breath. X-ray and CT showed nodules and vascular masses in both lungs, as well as a mass enveloping a left rib. Shortly thereafter, she contracted COVID and being immunocompromised, succumbed to its complications.

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