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CASE REP O RT Open Access Total mastectomy and chest reconstruc tion for a rapidly progressing giant phyllodes tumor with skin necrosis: a case report Aya Banno , Akihiko Shimada, Kenichiro Aga, Hiroki Harada, Takuji Kaburagi, Hiroaki Seki, Nobutaka Yasui and Hidetoshi Matsumoto Abstract Phyllodes tumors are rare fibroepithelial neoplasms of the breast. In the literature, borderline or malignant tumors have been reported to present with unusual characteristics including a short clinical history and extremely rapid tumor growth. Skin necrosis and infection sometimes accompanies these malignancies. Giant phyllodes tumors have a good prognosis when treated with total mastectomy, but reconstruction of the chest wall has been a challenge because of the need for a wide-range excision. We report a case of a malignant phyllodes tumor that was initially diagnosed as borderline because sudden growth of the tumor contrarily induced sparse to moderate stroma cellularity in the sections of the tumor that were biopsied. Total mastectomy without axillary lymph node resection and chest wall reconstruction using a full-thickness mesh skin graft was performed. The patient has remained free from infection and recurrence for over a year since diagnosis. Keywords: Phyllodes tumor; Skin necrosis; Mastectomy Background Phyllodes tumors are relativ ely rar e fibroepit helial neoplasms most prevalent in women in their 40s and 50s [1]. The histology consists of three types: benign, mal igna nt, and the leas t prev alent, bor derl ine. The average size of these tumors is 4 cm, but 20 % are called giant phyllodes tumors because of their abnor- mal diameter, growing to more than 10 cm [2]. In the lite rat ure, bor derl ine or mali gnant tumors have been reported to present with unusual characteristics, including a short clinical history and aggressive growth [3–5]. Skin necrosis and infection sometimes accompanies these malignancies. Giant phyllodes tumors have a good prognosis after tota l maste ctomy, but reco nstr uctio n of the ches t wal l has bee n a challe ng e, as they req uire wide-r ang e excision. We report a case of a malignant phyllodes tumor that was initi ally diagnose d as bord erlin e becau se the rapi d growth contrarily caused sparse to moderate cellularity in portions of the tumor, including the biopsied specimen. Case presentation A 47-yea r-old Japanese hospital employee presente d to our surge ry clin ic wit h the chi ef complai nt of a gia nt mas s in her ri ght br east. Her medic al hi stor y was re- markable only for asthma; her last attack had been more than 20 years ago. The results of the last checkup for breast cancer, 7 years ago, had been negative. She first felt a mass of the size of her thumbnail 5 years prior to the visit. Four years prior to admission, she incidentally palpated the tumor, and not ed sli ght gro wth, aft er the family dog collided with her breast, but she did not seek medical consultation because her breasts were symmet- rical in size. One month before her visit, the size of the right breast st ar ted to increase rapidly. She exper ien ced fati gue, dizziness, and heaviness in the right breast because of the weight of the tumor. One week previously, the skin covering the mass became necrotic and had a foul odor. * Correspondence: [email protected] Department of Surgery, Keiyu Hospital, 3-7-3 Minatomirai Nishiku, Yokohama 220-8521, Japan © 2015 Banno et al. Open Access This article is distributed under the terms of the Creative Commons Attributi on 4.0 International License (http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and repro duction in any medium, provide d you give appropriate credit to the original author( s) and the source, provide a link to the Creative Commons license, and indicate if change s were made. Banno et al. Surgical Case Reports (2015) 1:82 DOI 10.1186/s40792-015-0082-9

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