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Correspondence
Cardiopulmonary thromboembolism of epithelioid angiosarcoma arising from malignant phyllodes tumour of the breast
  1. Chin Hong Ronald Goh1,
  2. Yeong Phang Lim2,
  3. Jang Wen Su2,
  4. Kei Siong Khoo3,
  5. Angula Thomas4,
  6. Kesavan Sittampalam1,
  7. Puay Hoon Tan1
  1. 1 Department of Pathology, Singapore General Hospital, Singapore, Singapore
  2. 2 Gleaneagles Medical Centre, Singapore, Singapore
  3. 3 Parkway Cancer Center, Singapore, Singapore
  4. 4 Parkway Laboratory, Mount Elizabeth Hospital, Singapore, Singapore
  1. Correspondence to Chin Hong Ronald Goh, The Academia—Diagnostics Tower, Department of Pathology, Histopathology Lab, Level 10, 20 College Road, Singapore General Hospital, Singapore 169856, Singapore; ronald.goh.c.h{at}sgh.com.sg

https://doi.org/10.1136/jclinpath-2013-202118

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    Introduction

    Phyllodes tumour is an uncommon fibroepithelial neoplasm of the breast with potential for aggressive biological behaviour manifesting as local recurrence or distant metastasis. Based on semiquantitative assessment of a constellation of histological parameters focusing on the stromal component, stromal cellularity and overgrowth, cellular atypia, mitotic activity and nature of tumour margin, these tumours are categorised into benign, borderline and malignant grades.1 Disease recurrence is mainly local, but malignant and rarely borderline tumours may develop distant metastases in a relatively small number of patients. While most metastases occur in the lung and skeleton, they have been described in almost every organ system. In this report, we document a rare case of cardiopulmonary tumour thromboembolism from a malignant phyllodes tumour with unusual histology and clinical course that posed diagnostic, clinical and management dilemmas.

    Case report

    This was a patient who first presented with a left breast lump to another institution in February 2012, which was investigated with core biopsy that disclosed a phyllodes tumour. A lumpectomy ensued, which confirmed a 9.5 cm malignant phyllodes tumour that abutted the resection margin. Completion mastectomy was performed 2 months later, and CT scans did not show any metastatic lesions.

    She was seen in October 2012 for prolonged fever and was diagnosed with left-sided pneumonia as well as lobar thromboembolism. Echocardiogram and thrombophilia scan were within normal limits and did not identify any deep vein thrombosis or cardiac thrombus. CT scans of her thorax, abdomen and pelvis were also negative for tumour recurrence. She was commenced on warfarin anticoagulation. She continued to have intermittent low-grade fever but was otherwise well. However, she developed sudden onset of cough with shortness of breath, and her fever worsened 3 months later. CT thorax showed no change in the left-sided pulmonary thromboembolism; however, a mass was detected in the right atrium and ventricle associated …

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    Footnotes

    • Contributors GCHR (guarantor) participated in literature review, is the principal writer of the manuscript and responsible for obtaining the microscopic pictures of the case. LYP is the principal surgeon managing the patient, responsible for performing the patient's cardiac surgery, participated in literature review and provided relevant scans and gross pictures. SJW is the surgeon involved in the care of the patient and responsible for performing lobectomy. KKS is the primary oncologist managing the patient. KS is responsible for review of the histology slides and provided professional advice in the interpretation of the histology. AT is responsible for identifying the case and work-up of the pathology specimen, and also provides professional advice on the histology. TPH is responsible for the work-up and interpretation of the pathology specimen, and also provides professional opinion on the histological findings as well as discussion of the case. TPH is also the principal editor of the manuscript.

    • Competing interests None.

    • Provenance and peer review Not commissioned; internally peer reviewed.