© J PIONEER MED SCI.www.jpmsonline.com Volume 4, Issue 3. July-September, 2014 Page | 143 Giant Malignant Phyllodes Tumor at a Tertiary Care Hospital of Karachi, Pakistan Summaya Saeed 1 , Aun Ali 1 , Amjad Siraj Memon 2 1 Assistant Professor Surgery, Jinnah Medical and Dental College, Karachi, Pakistan 2 Professor of Surgery, Dow University of Health Sciences, Karachi, Pakistan ABSTRACT Keywords: Malignant phyllodes tumor; Surgery; Prognosis; Breast malignancy axial view Conflict of Interest: None declared This article has been peer reviewed. Article Submitted on: 20 th January 2014 Article Accepted on: 26 th May 2014 Funding Sources: None declared Correspondence to: Dr Summaya Saeed Address: Jinnah Medical and Dental College, Karachi, Pakistan Email: summayasaeed@hotmail .com Cite this Article: Saeed S, Ali A, Memon AS. Giant malignant phyllodes tumor at a tertiary care hospital of Karachi, Pakistan. J Pioneer Med Sci. 2014; 4(3): 143-145 INTRODUCTION Phyllodes tumors are rare breast tumors accounting for <1% of all breast malignancies [1]. Most of these tumors are benign, but some have a malignant potential. These tumors commonly occur in females during the 4 th or 5 th decade of life. Patient usually presents with smooth breast lump felt beneath the skin. The breast may become red and warm to touch. These tumors can grow rapidly and the associated symptoms can mimic other types of breast carcinoma, particularly if the mass ulcerates and bleeds. Histopathologically, these tumors are characterized by increased cellularity, enhanced stromal proliferation, intra-canalicular growth (leaf like pattern) and the presence of increased mitotic figures. The only treatment option for these tumors is surgical removal [2, 3]. In this case report, we present a case of a giant malignant phyllodes tumor in a 38 years old young female. CASE REPORT A 38 years old unmarried female presented with a gradually increasing mass in the left breast for one and a half year and bleeding from the ulcerated mass for one and a half months. She had felt a small mass in her left breast that grew in size gradually, until the difference in the size of her breasts became very evident. Three months prior to her presentation, patient noted clear watery discharge from her breast that later became foul smelling. After a month and a half, the mass ruptured and started bleeding. The mass kept bleeding intermittently and became painful for which patient took analgesics and did not contact a physician for her symptoms. When the symptoms became unbearable to her, she presented at our hospital. On presentation, she was alert, conscious and her vital signs were stable. On breast examination, entire left breast was occupied with a huge ulcerating mass (>20cm in diameter) with areas of necrosis at various places. Moreover, the mass was profusely bleeding from different points. There was no axillary lymphadenopathy and no other masses were palpable. Her baseline hemoglobin was 6g/dl and hematocrit 26, while other investigations were within normal limits. As most of the breast was necrotic and actively bleeding, fine needle aspiration biopsy and Tru- Cut biopsy were not performed. Examination of the fluid discharge showed Staphylococcus aureus growth and presence of necrotic cells. Patient received blood transfusion pre- operatively and underwent total mastectomy with axillary sampling, but without axillary clearance. Resected breast tissue measured ~ 20.5 x 17 x 10.9 cm in dimensions (Figure 1A-D). The cut surface of the tumor showed yellowish brown fatty upper half and dark brown hemorrhagic lower half. Several nodular circumscribed masses (measuring ~15 x 10 cm each) were observed. Microscopically, fragments of breast tissue and several circumscribed nodular masses consistent with fibroadenomatous changes (Figure 2A-D) Phyllodes tumor is a rare benign breast cancer that carries malignant potential. Malignant phyllodes tumors are histologically sarcomas as they originate from the connective tissue of the breast. We present a case of a 38 year old female who presented with complaints of a slow growing painful lump in her left breast over for one and a half year that later ruptured and became necrotic. She was operated upon with a provisional diagnosis of a fungating breast growth; however, subsequent histopathology report confirmed the tissue as a malignant phyllodes tumor.