Suschana E, Sta Ines FM, Manrai P, Koelliker S, Gass JS, Tseng YA. Diagnostic and management challenges in a partially infarcted borderline phyllodes tumor in an adolescent female: A case report and review of literature. World J Clin Pediatr 2025; 14(3): 102741 [DOI: 10.5409/wjcp.v14.i3.102741]
Corresponding Author of This Article
Yun-An Tseng, Pathology and Laboratory Medicine, Women and Infants Hospital, Warren Alpert Medical School of Brown University, 101 Dudley St, Providence, RI 02905, United States. yatseng@kentri.org
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Pediatr. Sep 9, 2025; 14(3): 102741 Published online Sep 9, 2025. doi: 10.5409/wjcp.v14.i3.102741
Diagnostic and management challenges in a partially infarcted borderline phyllodes tumor in an adolescent female: A case report and review of literature
Elizabeth Suschana, Flora Mae Sta Ines, Padmini Manrai, Susan Koelliker, Jennifer S Gass, Yun-An Tseng
Elizabeth Suschana, University of Connecticut School of Medicine, University of Connecticut School of Medicine, Farmington, CT 06032, United States
Flora Mae Sta Ines, Padmini Manrai, Yun-An Tseng, Pathology and Laboratory Medicine, Women and Infants Hospital, Warren Alpert Medical School of Brown University, Providence, RI 02905, United States
Susan Koelliker, Diagnostic Imaging, Women and Infants Hospital, Warren Alpert Medical School of Brown University, Providence, RI 02905, United States
Jennifer S Gass, Department of Surgery, Women and Infants Hospital, Warren Alpert Medical School of Brown University, Providence, RI 02905, United States
Author contributions: Suschana E drafted manuscript except for pathology and radiology portion; Sta Ines FM drafted the pathology portion of the manuscript; Koelliker S drafted the radiology portion of the manuscript; Manrai P diagnosed the breast biopsy; Gass JS performed the breast excisions and edited the clinical portion of the manuscript; Tseng YA diagnosed the breast excision, supervised the study, and edited the manuscript.
Informed consent statement: Patients undergoing surgery at our institution sign a consent form for surgery. Within that consent form, there is a statement allowing the hospital to use data and pictures for academic purposes such as teaching or publications. Our institution does not require a separate ethical approval for de-identified information and images. We obtained verbal assent from the patient and their guardian to discuss their case within our case report.
Conflict-of-interest statement: All authors have no conflict of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yun-An Tseng, Pathology and Laboratory Medicine, Women and Infants Hospital, Warren Alpert Medical School of Brown University, 101 Dudley St, Providence, RI 02905, United States. yatseng@kentri.org
Received: October 28, 2024 Revised: March 27, 2025 Accepted: April 11, 2025 Published online: September 9, 2025 Processing time: 231 Days and 21.7 Hours
Abstract
BACKGROUND
Fibroadenomas (FA) and phyllodes tumors (PT) are fibroepithelial neoplasms and are difficult to differentiate radiographically and histologically. We present a partially infarcted borderline PT in an adolescent with rapid tumor enlargement within 24 hours. Tumor infarction made the diagnostic work-up difficult. Complete surgical excision is the standard of care for PTs. There is controversy regarding margin re-excision for borderline PTs. In this report, we discuss the diagnostic challenges of PT and the evolving concept of margin status on PT recurrence rate.
CASE SUMMARY
A 14-year-old healthy female with no medical history presented with a painful right breast mass with no nipple discharge, trauma, or skin findings. The mass showed rapid enlargement over 24 hours, prompting a workup with ultrasound and core needle biopsy. The initial biopsy was limited due to large areas of infarction. Based on the scant viable tissue and considering the patient’s age, the mass was favored to be a juvenile FA. The patient underwent excision of the mass. Final pathology confirmed a borderline PT with positive surgical margins. The patient underwent margin re-excision, which did not show any residual tumor. At the 6-month post-op visit, there was a mass-forming lesion on the breast ultrasound. Subsequent core needle biopsy showed benign breast parenchyma with scar formation. The primary goal of evaluation in pediatric breast masses is to do no harm. However, rapidly growing and symptomatic masses require a more extensive work-up including biopsy and surgical excision. We present a rapidly growing breast mass in a 14-year-old female which was diagnosed as a borderline PT on her excision specimen. The mass rapidly enlarged over 24 hours. The initial biopsy pathology was limited due to a large area of infarction. The patient underwent excision of the mass. Final pathology confirmed a borderline PT that extended into the surgical margin, resulting in an additional re-excision procedure. Accurate diagnosis prior to surgical intervention is crucial to avoid additional procedures. Although histological morphology remains the gold standard for diagnosis, immunohistochemistry and molecular studies have recently shown to improve the accuracy of diagnosis of PTs. Long-term clinical and pathologic follow-up of PTs in adolescent patients should be collectively studied to examine whether our current diagnostic criteria for PT can reliably predict tumor behavior in this age group.
CONCLUSION
Accurate diagnosis of PTs requires surgical excision. Tumor infarction may lead to rapid tumor enlargement, hindering the correct diagnosis. More research is needed on margin status and recurrence rate, especially in adolescent patients, to help establish the best possible care for this age group.
Core Tip: The primary goal of evaluation in pediatric breast masses is to do no harm. However, rapidly growing and symptomatic masses require a more extensive work-up, including biopsy and surgical excision. We present a rapidly growing breast mass in a 14-year-old female, which was diagnosed as a borderline phyllodes tumor (PT) on her excision specimen. The mass rapidly enlarged over 24 hours. The initial biopsy pathology was limited due to a large area of infarction. The patient underwent excision of the mass. Final pathology confirmed a borderline PT that extended into the surgical margin, resulting in an additional re-excision procedure. Accurate diagnosis prior to surgical intervention is crucial to avoid additional procedures. Although histological morphology remains the gold standard for diagnosis, immunohistochemistry and molecular studies have recently shown to improve the accuracy of diagnosis of PTs. Long-term clinical and pathologic follow-up of PTs in adolescent patients should be collectively studied to examine whether our current diagnostic criteria for PT can reliably predict tumor behavior in this age group.
