Case Report: Diagnostic pitfalls and individualized surgical management of borderline and malignant phyllodes tumors: a three-case series
- 1Department of Breast Surgery, The Second Affiliated Hospital of Shandong First Medical University
- 2Department of Medical Imaging, The Second Affiliated Hospital of Shandong First Medical University
Abstract
Phyllodes tumors (PTs) can overlap with fibroadenomas clinically and radiologically, and incomplete preoperative characterization can alter surgical planning. We describe three women with borderline or malignant PTs who declined preoperative core needle biopsy; clinical underestimation of malignancy also contributed to proceeding directly to excision. Case 1, a 36-year-old woman with long-standing bilateral masses, had a 63-mm malignant PT with heterologous chondroid and osseous differentiation and osteoclast-like giant cells; two contralateral lesions were fibroadenomas. An involved margin prompted re-excision, with no residual tumor and a final closest histological margin of 20 mm, permitting breast conservation. Case 2, a 68-year-old woman with a 75-mm malignant PT, had mildly prominent ipsilateral axillary nodes on mammography but no abnormal enlargement on axillary ultrasonography. Following malignant PT interpretation on frozen section, wide local excision was converted to total mastectomy; sentinel lymph node biopsy was negative (0/3), and the closest margin was the deep margin at 20 mm. The patient declined postoperative radiotherapy. Case 3, a 53-year-old woman with previous right breast fibroadenoma excision, had a right borderline PT involving the inked margin and contralateral pseudoangiomatous stromal hyperplasia. Re-excision approximately 2 cm beyond the previous surgical margin found no residual tumor. All three patients had satisfactory postoperative wound healing, with no reported complications or recurrence during the reported 6-month follow-up. These cases highlight the need for preoperative tissue diagnosis, attention to discrepant axillary imaging, individualized margin-directed surgery, and long-term surveillance.
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BibTeX
@article{wang2026case,
title = {{Case Report: Diagnostic pitfalls and individualized surgical management of borderline and malignant phyllodes tumors: a three-case series}},
author = {Chao Wang and Xiaowen Liu and Yuhang Wang and Xin Miao},
journal = {Frontiers in Oncology},
year = {2026},
month = oct,
doi = {10.3389/fonc.2026.1966376},
url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1966376/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Case Report: Diagnostic pitfalls and individualized surgical management of borderline and malignant phyllodes tumors: a three-case series
AU - Chao Wang
AU - Xiaowen Liu
AU - Yuhang Wang
AU - Xin Miao
PY - 2026
DA - 2026/10/23
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1966376
UR - https://www.frontiersin.org/articles/10.3389/fonc.2026.1966376/full
AB - Phyllodes tumors (PTs) can overlap with fibroadenomas clinically and radiologically, and incomplete preoperative characterization can alter surgical planning. We describe three women with borderline or malignant PTs who declined preoperative core needle biopsy; clinical underestimation of malignancy also contributed to proceeding directly to excision. Case 1, a 36-year-old woman with long-standing bilateral masses, had a 63-mm malignant PT with heterologous chondroid and osseous differentiation and osteoclast-like giant cells; two contralateral lesions were fibroadenomas. An involved margin prompted re-excision, with no residual tumor and a final closest histological margin of 20 mm, permitting breast conservation. Case 2, a 68-year-old woman with a 75-mm malignant PT, had mildly prominent ipsilateral axillary nodes on mammography but no abnormal enlargement on axillary ultrasonography. Following malignant PT interpretation on frozen section, wide local excision was converted to total mastectomy; sentinel lymph node biopsy was negative (0/3), and the closest margin was the deep margin at 20 mm. The patient declined postoperative radiotherapy. Case 3, a 53-year-old woman with previous right breast fibroadenoma excision, had a right borderline PT involving the inked margin and contralateral pseudoangiomatous stromal hyperplasia. Re-excision approximately 2 cm beyond the previous surgical margin found no residual tumor. All three patients had satisfactory postoperative wound healing, with no reported complications or recurrence during the reported 6-month follow-up. These cases highlight the need for preoperative tissue diagnosis, attention to discrepant axillary imaging, individualized margin-directed surgery, and long-term surveillance.
SN - 2234-943X
ER -