Phyllodes tumor of the breast is a rare entity in clinical practice, and benign (most common), borderline, or malignant variants exist in the literature [1]. Contrary to the majority of breast malignancies that develop in the glandular and ductal tissues, this tumor originates in the fibroepithelial connective tissue and is most frequently described in middle-aged women between 35-55 years of age, although females of all ages may be affected [1] [2] [3] [4] [5] [6]. The presentation is distinguished by the presence of a rapidly growing, mobile, painless, and round mass (lump) that is approximately several centimeters in diameter [1] [3] [7]. However, a growing number of reports documented very large diameters of the phyllodes tumor of the breast, reaching up to 40 centimeters, in which case the term giant phyllodes tumor is used [1] [3]. The lesion is almost always confined to a single breast, and the outer upper quadrant is identified as the predominant location [3]. Additional signs include dilation of skin and cutaneous veins overlying the tumor, sometimes accompanied by ulceration of the skin [3]. The sudden growth of the tumor after several years of relatively stable diameter increase is typically reported by many patients [3] [7]. A bilateral occurrence and retraction of the nipple are rare, but possible manifestations of this tumor [3]. In approximately 10-15% of cases, proximal axillary lymphadenopathy is observed [3].

• Plethora

  Recently investigators have reported a plethora of genetic changes in phyllodes tumors, the most consistent of which seems to be 1q gain by comparative genomic hybridization. [ncbi.nlm.nih.gov]

• Unconsciousness

  A 38-year-old non-diabetic, non-hypertensive female patient had an episode of drowsiness followed by brief unconsciousness on the morning of August 9, 2015. [omicsonline.org]

• Axillary Mass

  Axillary mass was not found. Laboratory data revealed that CBC (complete blood count), PT, PTT, Blood Sugar, Urea, Cr, AST, ALT, Alkaline phosphatase, Albumin, Bilirubin, Na, K and Ca were normal. The patient underwent surgery on April 27 th, 2017. [pubs.sciepub.com]

• Breast Mass

  A 43-year-old woman was referred to our institute because of a left breast mass which was diagnosed as FA clinically. During the follow-up, the mass gradually enlarged and excisional biopsy was performed to rule out malignant lesion. [ncbi.nlm.nih.gov]

• Neglect

  The largest and neglected giant phyllodes tumor of the breast-A case report and literature review. Int J Surg Case Rep. 2016; 26: 96 100. In article View Article PubMed [8] Testori A, Meroni S, Errico V, Travaglini R, Voulaz E, Alloisio M. [pubs.sciepub.com]

• Giddiness

  CNS metastasis of phyllodes tumor is rare and associated with a poor prognosis. [1], [2] Case report A 41-year-old female patient presented with progressively increasing headache, vomiting, and giddiness for 7 days. [cancerjournal.net]

The initial diagnosis of a breast lump can be made during a properly performed physical examination, during which inspection and systematic palpation of both breasts are crucial for early recognition. If supported by a thorough patient history, important for gathering information about the progression of the lump and the appearance of additional symptoms, the physical exam provides sufficient clues to further investigate the lump through imaging studies. Ultrasonography and mammography are the optimal methods for the evaluation of breast tumors, typical findings being a well-defined, round or lobulated lesion with a heterogeneous appearance [3] [6] [8] [9]. A more solid diagnosis of phyllodes tumor of the breast can be made when the lump possesses an echogenic rim and contains fluid-filled clefts without microcalcifications [3]. Doppler ultrasonography is also advocated by some authors [3], together with computed tomography and magnetic resonance imaging (CT and MRI, respectively) [1] [7] [8] [9]. To confirm the exact type, a histopathological evaluation is necessary. Fine needle aspiration and core needle biopsy are two options for obtaining a viable sample for testing [7].

• Lymphocytic Infiltrate

  BRCA1-associated carcinomas are poorly differentiated infiltrating ductal carcinomas frequently exhibiting morphologic features of typical or atypical medullary carcinomas such as prominent lymphocytic infiltrate and pushing margins. [ncbi.nlm.nih.gov]

1. Testori A, Meroni S, Errico V, Travaglini R, Voulaz E, Alloisio M. Huge malignant phyllodes breast tumor: a real entity in a new era of early breast cancer. World J Surg Oncol. 2015;13:81.
2. Tan BY, Acs G, Apple SK, et al. Phyllodes tumours of the breast: a consensus review. Histopathology. 2016;68(1):5-21.
3. Mishra SP, Tiwary SK, Mishra M, Khanna AK. Phyllodes Tumor of Breast: A Review Article. ISRN Surg. 2013;2013:361469.
4. Ossa CA, Herazo F, Gil M, et al. Phyllodes tumor of the breast: a clinic-pathologic study of 77 cases in a Hispanic cohort. Colomb Med (Cali). 2015;46(3):104-108.
5. Majeski J, Stroud J. Malignant Phyllodes Tumors of the Breast: A Study in Clinical Practice. Int Surg. 2012;97(2):95-98.
6. Benhassouna J, Damak T, Gamoudi A, et al. Phyllodes tumors of the breast: a case series of 106 patients. Am J Surg. 2006;192(2):141–147.
7. Zhou Z-R, Wang C-C, Yang Z-Z, Yu X-L, Guo X-M. Phyllodes tumors of the breast: diagnosis, treatment and prognostic factors related to recurrence. J Thorac Dis. 2016;8(11):3361-3368.
8. Wurdinger S, Herzog AB, Fischer DR, et al. Differentiation of phyllodes breast tumors from fibroadenomas on MRI. AJR Am J Roentgenol. 2005;185(5):1317–1321.
9. Feder JM, de Paredes ES, Hogge JP, Wilken JJ. Unusual breast lesions: radiologic-pathologic correlation. Radiographics. 1999;19: S11–S26.