Progressive Metastatic Breast Phyllodes Tumor Turns into Spindle Cell Sarcoma: Report of Two Cases and Review of the Literature

Background: Breast fibroepithelial lesions encompass a wide variety of tumors frombenign fibroadenomas to malignant phyllodes tumors (PTs). Local recurrence was reportedin ۲۰% of all subgroups and ۲۰-۲۵% risk of distant metastasis though superaggressivetumors are rare. Two young patients with nonresponsive, frequent recurrences of phyllodestumors turned into the aggressive metastatic sarcoma are presented.Case Presentation: Case ۱: A ۳۴-year-old married woman referred with the chiefcomplaint of a mass and pain in her right breast. There was a ۳cm well defined mass inright breast. An intermediate grade benign phyllodes tumor was confirmed in biopsy.Patient underwent surgical wide excision, radiotherapy. Three weeks later the massrecurred in her right breast with severe pain and nonproductive cough withouthemoptysis. A single lung metastasis is conformed in the CT scan. Total mastectomyand thoracoscopic metastasectomy was performed and spindle cell sarcomas in bothspecimens is confirmed. Chemotherapy was done. Two weeks after chemotherapy shepresented with multiple bilateral lung metastasises and thoracic wall involvement. Noregression in metastasis was seen receiving the second line chemotherapeutic agents.Case ۲: A ۱۷-year-old young girl was referred to the breast clinic with a ۲ cm firmmobile mass in left breast. The histopathology of the mass was benign phyllodes tumor.(۱.۵ cm margins) The tumor recurred ۳ months later treated. During radiotherapy, thepatient referred to the emergency department with the complaint of dyspnea and severpleural effusion. The cytology reported malignant cells. CT-guided biopsy showed ahigh grade sarcoma. During chemotherapy, large ulcer in the site of the breast wasappeared and mastectomy with Latissmus dorsi flap was performed and angiosarcomawas confirmed. Despite the second and third line chemotherapy the disease wasprogressed and multiple lung metastasis were confirmed in chest CT scan.Conclusion: It seems that some subtypes of breast sarcomas could have an extremelyan aggressive behavior which threatens the life of the patients in a short period of time.Further studies is suggested to discriminate the aggressive subtypes at the first step.

کلیدواژه ها:

Phyllodes tumor ، breast sarcoma ، early recurrence