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Case Report Open Access

Giant malignant phyllodes tumor with ulceration: A case report and brief review of the literature

  • Authors:
    • Abdulwahid M. Salih
    • Lana R.A. Pshtiwan
    • Ari M. Abdullah
    • Shaban L. Tofiq
    • Sakar O. Arif
    • Rebaz O. Mohammed
    • Hiwa O. Baba
    • Hawkar A. Nasralla
    • Masty K. Ahmed
    • Shko H. Hassan
    • Fahmi H. Kakamad
  • View Affiliations / Copyright

    Affiliations: Department Scientific Affairs, Smart Health Tower, Sulaymaniyah 46001, Iraq
    Copyright: © Salih et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].
  • Article Number: 124
    |
    Published online on: November 3, 2025
       https://doi.org/10.3892/wasj.2025.412
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Abstract

A phyllodes tumor (PT) is a rare breast neoplasm characterized by variable biological behavior, ranging from benign to malignant. A number of PTs exhibit a rapid growth and are classified as fibroepithelial tumors with a notable risk of local recurrence. Of note, ~10‑15% of cases are malignant and may recur locally in up to 30% of instances. The present study describes a case of a rapidly growing, giant, ulcerative malignant PT. A 40‑year‑old female patient presented with a rapidly enlarging left breast mass over period of 2 months. An examination revealed a hard, irregular, fixed mass measuring ~24x20x17 cm, with a skin ulceration. She underwent a wide local excision followed by adjuvant radiotherapy. Histopathological analysis confirmed a malignant PT with myoid differentiation. At the 1‑year follow‑up, recurrent PT was diagnosed, and a modified radical mastectomy was performed. In a review of the literature, a total of seven case reports on malignant PTs of the breast were identified. The patients were all female, with ages ranging from 19 to 73 years. Of note, 5 of the cases involved tumors in the right breast, while 2 cases involved tumors in the left breast. Tumor sizes varied widely, from 7.5x7x4.5 cm to as large as 55.5x36x50 cm. The diagnosis and management of malignant PTs may be challenging due to their rarity and unpredictable clinical behavior. Even with aggressive treatment, these tumors carry a significant risk of recurrence, highlighting the importance of vigilant clinical follow‑up and multidisciplinary care.
View Figures

Figure 1

Clinical image demonstrating: (A) A
markedly enlarged, pendulous left breast with pronounced asymmetry
relative to the right breast; (B) close-up of the ulcerated
surface, demonstrating extensive necrosis with purulent exudate,
granulation tissue and hemorrhage, findings consistent with an
infected, ulcerated tumor mass.

Figure 2

Immunohistochemical staining
demonstrating: (A) p63 positivity in myoepithelial cells
surrounding the ducts (black arrows) and negativity in the adjacent
stromal cells (magnification, x10). (B) AE1/AE3 displaying a
cytoplasmic staining pattern in the epithelial cells lining the
ducts (arrows) and negative staining in the surrounding stroma
(magnification, x40). (C) Smooth muscle actin-positive in stromal
cells (large arrows) and myoepithelial cells encircling the ducts
(small arrows), but negative in the epithelial component
(magnification, x40). (D) Smooth muscle myosin heavy chain
exhibiting cytoplasmic staining in myoepithelial cell layers around
the ducts (black arrows) and stromal cells (yellow arrows), with no
staining in the epithelial cells lining the ducts (magnification,
x40).

Figure 3

Sections from different areas of the
mass: (A) Leaf-like projections with an epithelial component
(magnification, x4); (B) skin ulceration adjacent to normal
epidermis (magnification, x10); (C) infiltrative tumor border
invading surrounding adipose tissue (magnification, x10); and (D)
stromal overgrowth with cytologic atypia (magnification, x40). The
sections were stained with hematoxylin and eosin.
View References

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Related Articles

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Copy and paste a formatted citation
Spandidos Publications style
Salih AM, Pshtiwan LR, Abdullah AM, Tofiq SL, Arif SO, Mohammed RO, Baba HO, Nasralla HA, Ahmed MK, Hassan SH, Hassan SH, et al: Giant malignant phyllodes tumor with ulceration: A case report and brief review of the literature. World Acad Sci J 7: 124, 2025.
APA
Salih, A.M., Pshtiwan, L.R., Abdullah, A.M., Tofiq, S.L., Arif, S.O., Mohammed, R.O. ... Kakamad, F.H. (2025). Giant malignant phyllodes tumor with ulceration: A case report and brief review of the literature. World Academy of Sciences Journal, 7, 124. https://doi.org/10.3892/wasj.2025.412
MLA
Salih, A. M., Pshtiwan, L. R., Abdullah, A. M., Tofiq, S. L., Arif, S. O., Mohammed, R. O., Baba, H. O., Nasralla, H. A., Ahmed, M. K., Hassan, S. H., Kakamad, F. H."Giant malignant phyllodes tumor with ulceration: A case report and brief review of the literature". World Academy of Sciences Journal 7.6 (2025): 124.
Chicago
Salih, A. M., Pshtiwan, L. R., Abdullah, A. M., Tofiq, S. L., Arif, S. O., Mohammed, R. O., Baba, H. O., Nasralla, H. A., Ahmed, M. K., Hassan, S. H., Kakamad, F. H."Giant malignant phyllodes tumor with ulceration: A case report and brief review of the literature". World Academy of Sciences Journal 7, no. 6 (2025): 124. https://doi.org/10.3892/wasj.2025.412
Copy and paste a formatted citation
x
Spandidos Publications style
Salih AM, Pshtiwan LR, Abdullah AM, Tofiq SL, Arif SO, Mohammed RO, Baba HO, Nasralla HA, Ahmed MK, Hassan SH, Hassan SH, et al: Giant malignant phyllodes tumor with ulceration: A case report and brief review of the literature. World Acad Sci J 7: 124, 2025.
APA
Salih, A.M., Pshtiwan, L.R., Abdullah, A.M., Tofiq, S.L., Arif, S.O., Mohammed, R.O. ... Kakamad, F.H. (2025). Giant malignant phyllodes tumor with ulceration: A case report and brief review of the literature. World Academy of Sciences Journal, 7, 124. https://doi.org/10.3892/wasj.2025.412
MLA
Salih, A. M., Pshtiwan, L. R., Abdullah, A. M., Tofiq, S. L., Arif, S. O., Mohammed, R. O., Baba, H. O., Nasralla, H. A., Ahmed, M. K., Hassan, S. H., Kakamad, F. H."Giant malignant phyllodes tumor with ulceration: A case report and brief review of the literature". World Academy of Sciences Journal 7.6 (2025): 124.
Chicago
Salih, A. M., Pshtiwan, L. R., Abdullah, A. M., Tofiq, S. L., Arif, S. O., Mohammed, R. O., Baba, H. O., Nasralla, H. A., Ahmed, M. K., Hassan, S. H., Kakamad, F. H."Giant malignant phyllodes tumor with ulceration: A case report and brief review of the literature". World Academy of Sciences Journal 7, no. 6 (2025): 124. https://doi.org/10.3892/wasj.2025.412
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