Skin-reducing mastectomy and direct-to-implant reconstruction in giant phyllodes tumour of breast: case report.
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ABSTRACT: Background
The phyllodes tumour of the breast comprises about 0.5% of all neoplasms of the breast.Case report
we present the case of a female patient (55 years old) suffering from giant phyllodes tumour (>10cm) of the left breast, who underwent Skin Reducing Mastectomy (SRM) and reconstruction with silicone breast implant (Bostwick Technique).Discussion and conclusion
In selected patients with large sized breasts (C-D cup) and poor surface area of skin involved, a valid technique in the treatment of this pathology is the Skin-Reducing Mastectomy and immediate reconstruction with implants (DTI=direct to implant).
SUBMITTER: Ciancio F
PROVIDER: S-EPMC5695607 | biostudies-literature | 2017
REPOSITORIES: biostudies-literature
Publications
Skin-reducing mastectomy and direct-to-implant reconstruction in giant phyllodes tumour of breast: case report.
Ciancio Francesco F Innocenti Alessandro A Cagiano Luigi L Portincasa Aurelio A Parisi Domenico D
International journal of surgery case reports 20171113
<h4>Background</h4>The phyllodes tumour of the breast comprises about 0.5% of all neoplasms of the breast.<h4>Case report</h4>we present the case of a female patient (55 years old) suffering from giant phyllodes tumour (>10cm) of the left breast, who underwent Skin Reducing Mastectomy (SRM) and reconstruction with silicone breast implant (Bostwick Technique).<h4>Discussion and conclusion</h4>In selected patients with large sized breasts (C-D cup) and poor surface area of skin involved, a valid t ...[more]
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Project description:BackgroundPhyllodes tumours (PTs) are fibroepithelial breast tumours, which can be classified as benign, borderline or malignant, according to their histological characteristics. While various huge borderline or malignant PTs have been previously described, a benign PT with a pulmonary nodule mimicking malignancy has not yet been reported. In order that doctors may have a comprehensive understanding of super-giant benign PTs (≥ 20 cm), we also performed a literature review to summarize the clinical features, differential diagnosis, and treatment of this disease.Case summaryA 42-year-old woman with severe anaemia presented with a rapidly enlarging right breast mass, measuring approximately 30 cm × 25 cm × 20 cm that was first noticed 1 year previously. A region of skin ulceration and necrosis (20 cm × 15 cm) was observed on the lateral side of the mass. Computed tomography (CT) of the chest revealed a pulmonary nodule, which initially suggested a diagnosis of metastasis. CT showed that the boundaries between the pectoralis major and the mass were blurred, which was presumed to be due to tumour invasion. However, two core needle biopsies of the mass showed no evidence of malignancy. Following these results, the tumour was removed by mastectomy of the right breast. Interestingly, postoperative pathology finally proved the diagnosis of a benign PT. After 1 year of follow-up, wedge resection of the small pulmonary nodule was performed, and it was confirmed that the lung nodule was actually adenocarcinoma rather than metastatic breast cancer. The patient recovered very well without any postoperative treatment.ConclusionThis case is unique in that the giant breast mass initially mimicking a malignant clinical presentation was eventually pathologically confirmed to be a benign PT, which misled the diagnosis and complemented the atypical features of benign PTs. The pathological and immunohistochemical results were important in the differential diagnosis. In addition, total mastectomy should be recommended due to difficulty in the precise diagnosis of PTs, especially in large breast masses. In the literature, almost one-half of super-giant benign cases were thought to be malignant tumours before surgery. This finding is a reminder to consider all conditions in order to make an accurate diagnosis and avoid excessive treatment.
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Project description:IntroductionThe emphasis on aesthetic outcomes and quality of life (QoL) has motivated surgeons to develop skin-sparing or nipple-sparing mastectomy (SSM/ NSM) for breast cancer treatment or prevention. During the same operation, a so-called immediate breast reconstruction is performed. The breast can be reconstructed by positioning of a breast implant above (prepectoral) or below (subpectoral) the pectoralis major muscle or by using the patients' own tissue (autologous reconstruction). The optimal positioning of the implant prepectoral or subpectoral is currently not clear. Subpectoral implant-based breast reconstruction (IBBR) is still standard care in many countries, but prepectoral IBBR is increasingly performed. This heterogeneity in breast reconstruction practice is calling for randomised clinical trials (RCTs) to guide treatment decisions.Methods and analysisInternational, pragmatic, multicentre, randomised, superiority trial. The primary objective of this trial is to test whether prepectoral IBBR provides better QoL with respect to long-term (24 months) physical well-being (chest) compared with subpectoral IBBR for patients undergoing SSM or NSM for prevention or treatment of breast cancer. Secondary objectives will compare prepectoral versus subpectoral IBBR in terms of safety, QoL and patient satisfaction, aesthetic outcomes and burden on patients. Total number of patients to be included: 372 (186 per arm).Ethics and disseminationThis study will be conducted in compliance with the Declaration of Helsinki. Ethical approval has been obtained for the lead investigator's site by the Ethics Committee 'Ethikkommission Nordwest- und Zentralschweiz' (2020-00256, 26 March 2020). The results of this study will be published in a peer-reviewed medical journal, independent of the results, following the Consolidated Standards of Reporting Trials standards for RCTs and good publication practice. Metadata describing the type, size and content of the datasets will be shared along with the study protocol and case report forms on public repositories adhering to the FAIR (Findability, Accessibility, Interoperability, and Reuse) principles.Trial registration numberNCT04293146.
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Project description:Phyllodes tumor (PT) is a special type of breast tumors, including three types: malignant, borderline, and benign. Most of these tumors form unilateral disease and can rapidly increase in size. The occurrence of axillary lymph node metastasis is rare. Tumor-associated hypoglycemia can be divided into non-islet cell tumor and insulinoma. In non-islet cell tumor hypoglycemia (NICTH), a considerable high molecular weight form of insulin like growth factor 2 (IGF-2) is formed, which abnormally binds to insulin receptors in the tissues and causes hypoglycemia. Breast phyllodes tumors with NICTH are rare and first reported in 1983. Surgical resection is the main treatment and hypoglycemia symptoms usually resolve after surgery. Nevertheless, prior to surgery, intravenous glucose infusion is used to maintain blood glucose levels. A female patient presented with a rapidly growing breast mass and was diagnosed with a phyllodes tumor with NICTH at our hospital in August 2020; she was successfully treated through surgical resection. We reviewed the relevant literature to investigate and analyze the relationship between NICTH and phyllodes tumors, as well as optimize its diagnosis and treatment.
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Project description:IntroductionPhyllodes tumors are uncommon biphasic fibroepithelial neoplasms of the breast of varying malignant potential occurring in middle aged women. They exhibit diverse biological behavior. Margin free excision is the mainstay of treatment.Case presentationA 27 year-old lady was referred with a painless ulceroproliferative right breast lesion which had rapidly progressed over six months. Three years back, she had been diagnosed with a borderline phyllodes tumor and underwent a wide local excision followed by a right mastectomy for recurrence. The resection margins were positive hence she underwent postoperative radiation. We performed a radical resection of the chest wall and reconstruction using a composite mesh (inner PTFE and outer vypro), pedicled latissimus dorsi flap and a split skin graft for the recurrent malignant tumor. She recovered uneventfully thereafter.DiscussionMalignant phyllodes tumor is uncommon and treatment principles are from case reports and retrospective studies. Aggressive resection of the lesion and reconstruction of the chest wall with bone cement and two meshes-a composite mesh (inner layer -polytetrafluroethylene and outer layer of polypropylene) and a Vypro mesh is a possibility. This case highlights the challenges encountered in managing these patients and presents a radical solution.ConclusionTreatment of phyllodes tumor necessitates adequate excision of the tumor and adjacent tissues to ensure tumor free margins. Pathological evolution from intermediate to malignant histology may be exhibited. A full-thickness chest wall resection and reconstruction although radical is a feasible option as these tumors rarely respond to other modalities of cancer management.
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