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Disorders of the Pleura |

Is It Mass or Effusion: A Case of a Large Pleural Metastasis of Malignant Phyllodes Tumor of the Breast

Jennifer Kaya, MD; Alan Betensley, MD
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Henry Ford Health System - Pulmonary and Critical Care Medicine, Detroit, MI


Chest. 2013;144(4_MeetingAbstracts):484A. doi:10.1378/chest.1690478
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Abstract

SESSION TITLE: Pleural Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Phyllodes tumors of the breast account for less than 1% of breast tumors. Pathologically they range from benign to high-grade malignant tumors. The risk of metastases following resection of malignant phyllodes tumors is reported to approach 26%. Although the lungs are frequent sites of metastases, there are only several described cases of large metastases to the pleura.

CASE PRESENTATION: We report the case of a 48-year-old female presenting with a large, refractory left pleural effusion. She had undergone a simple left mastectomy and adjuvant radiation for a 15-centimeter high-grade malignant phyllodes tumor of the breast approximately 19 months prior. The surgical margins were negative. The patient was admitted for progressive dyspnea and underwent multiple thoracenteses with initial improvement. The pleural fluid reaccumulated, and VATS-assisted pleurodesis was performed. The fluid was hemorrhagic and exudative, but cytology was repeatedly negative for malignant cells. On her third admission for a similar presentation, imaging suggested a large heterogeneous left pleural effusion occupying the majority of the left hemithorax. After attempts to place an indwelling pleural catheter were unsuccessful, direct visualization revealed a large pleural mass had grown to occupy the left hemithorax. Pleural biopsies were consistent with recurrent phyllodes tumor. The patient underwent chemotherapy in an attempt to improve the resectability of the mass, but she died from her disease 21 months after diagnosis.

DISCUSSION: A malignant phyllodes tumor of the breast is a rare etiology for a large pleural mass. Features of this patient that were found in the literature to be predictive of metastasis include the very large primary tumor, high-grade features on pathology, and stromal overgrowth. Pleural metastases of phyllodes tumor presenting first as a recurrent pleural effusion has not been reported to our knowledge. Although not previously studied, cytology of the pleural fluid did not appear to be helpful in predicting the presence of pleural metastases of phyllodes tumor.

CONCLUSIONS: This case describes pleural metastases of phyllodes tumor of the breast developing within a refractory pleural effusion. Despite repeatedly negative pleural fluid cytology results, the index of suspicion for metastasis should remain high with such an unpredictable tumor.

Reference #1: Parker SJ, Harries SA. Phyllodes tumours. Postgrad Med J. 2001;77:428-435.

Reference #2: Asoglu O, Ugurlu MM, Blanchard K, et al. Risk factors for recurrence and death after primary surgical treatment of malignant phyllodes tumors. Ann Surg Oncol. 2004;11(11):1011-1017.

DISCLOSURE: The following authors have nothing to disclose: Jennifer Kaya, Alan Betensley

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