Life threatening bleeding from untreated phyllodes tumor following earthquake induced follow up delay

Abstract

Phyllodes tumors, representing 0.3%–0.5% of breast masses, are infrequent and sophisticated neoplasms of the breast. Based on their histological features, they are classified into three categories: benign, borderline, or malignant; preoperative diagnosis is challenging, and surgical removal with clear margins is the primary treatment option. This report describes the case of a 35-year-old woman whose longstanding breast mass underwent rapid transformation. The patient missed her follow-up appointment due to the February 6, 2023, earthquake in Hatay and presented with hemorrhagic shock from bleeding caused by the tumor eroding the internal thoracic artery.

Keywords

• Phyllodes tumor
• breast tumor
• hemorrhage
• emergency surgery

References

1. Liang MI., Ramaswamy B, Patterson CC, et al. Giant breast tumors: surgical management of phyllodes tumors, potential for reconstructive surgery and a review of literature. World J Surg Oncol 2008;6:117. DOI: 10.1186/1477-7819-6-117
2. Lawton TJ, Argani P, Goldstein N, et al. Interobserver variability by pathologists in the distinction between cellular fibroadenomas and phyllodes tumors. Int J Surg Pathol 2014;22:695-8. DOI: 10.1177/1066896914548763
3. Wurdinger S, Marx C, Herzog AB, Fischer DR, Schneider A, Raabe G, Kaiser WA. Differentiation of Phyllodes Breast Tumors from Fibroadenomas on MRI. AJR Am J Roentgenol 2005;185:1317-21. DOI: 10.2214/AJR.04.1620
4. Reinfuss, M., Mituś, J., Duda, K., Stelmach, A., Ryś, J. and Smolak, K. The treatment and prognosis of patients with phyllodes tumor of the breast: An analysis of 170 cases. Cancer 1996;77:910-6. DOI: 10.1002/(SICI)1097-0142(19960301)77:5<910::AID-CNCR16> 3.0.CO;2-6.
5. Matsushima H, Matsushima H, Kikuchi M, Miyabe R, Atsuta K, Shintan T. Emergency Resection of a Bleeding Ruptured Malignant Phyllodes Tumor of the Breast. Cureus 2024;16(1):e52775. DOI: 10.7759/cureus.52775
6. Meher S, Mishra TS, Sasmal PK, Rath S, Sharma R. An Ulcerated Giant Malignant Phyllodes Tumour Presenting in Septic Shock. J Clin Diagn Res 2016;10(12): PJ01-PJ02. DOI: 10.7860/JCDR/2016/20252.8945
7. Nabi J, Akhter SQ, Authoy FN. A Case of Large Phyllodes Tumor Causing “Rupture” of the Breast: A Unique Presentation. Case Rep Oncol Med 2013;2013:871292. DOI: 10.1155/2013/871292
8. Bruce NR, Carlson J, Barnard KJ, Henry-Tillman R. Phyllodes tumor masquerading as a fungating breast mass. J Surg Case Rep 2017;2017(12):rjx220. DOI: 10.1093/JSCR/RJX220

9. Ditsatham C, Somwangprasert A, Watcharachan K, Wongmaneerung P. “Ruptured” malignant phyllodes tumor of the breast: a case report. Int Med Case Rep J [Internet] 2016;9:35–7.DOI - 10.2147/IMCRJ.S96115
10. Wijeyaratne SM. Breast “rupture” due to a phyllodes tumour. BMJ Case Rep 2010; 2010:bcr0320102790. DOI: 10.1136/BCR.03.2010.2790
11. Yang M, Cui RBJ, Perera R. Emergency resection of large, ulcerating phyllodes tumour with active bleeding. ANZ J Surg. 2022;92(3):601-2. DOI: 10.1111/ANS.17110
12. Cantürk AÖ. Unexpected Clinical Status of Phyllodes Tumor of the Breast: Massive Bleeding. Cureus 2024; 16(8):e65923. DOI: 10.7759/cureus.65923
13. Barth RJ, Wells WA, Mitchell SE, Cole BF. A prospective, multi-institutional study of adjuvant radiotherapy after resection of malignant phyllodes tumors. Ann Surg Oncol 2009;16(8):2288-94. DOI: 10.1245/S10434-009-0489-2