A case report of coexistence of invasive ductal carcinoma and malignant phyllodes tumor in a single breast mass

Document Type : Case report


1 Assistant professor, Department of Pathology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Pathologist, Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.


Introduction: Coexistence of malignant phyllodes tumor and invasive ductal carcinoma in a breast lesion is a very rare medical condition. In this study, a case of coexistence of invasive ductal carcinoma and malignant phyllodes tumor in a single breast mass was reported.
Case presentation: The patient was a 39-year-old woman with a mass in left breast. On the requested ultrasound, the image of a heterogeneous hypovaco mass with an irregular margin with size of 30 × 17 × 24 mm was seen. The patient was candidate for complete removal of the breast and axillary lymph nodes. In the histologic evaluation, an invasive ductal carcinoma with malignant phyllodes component was diagnosed which was confirmed by immunohistochemistry. In immunohistochemical study, ER, PR, HER2 were negative in carcinomatous component and CK was negative in phyllodes stromal component, also KI67 index was 35%. In the evaluation of axillary lymph nodes, one out of 7 lymph nodes involved by invasive ductal carcinoma. The patient was referred for adjuvant chemotherapy using four cycles of doxorubicin, cyclophosphamide every two weeks, and four cycles of paclitaxel every two weeks and then adjuvant radiotherapy. In 20 month follow-up, she was alive with no evidence of disease recurrence.
Conclusion: Although coexistence of malignant phyllodes and invasive ductal carcinoma of the breast is very rare, but in breast carcinoma with abnormal microscopic findings, due to the diagnostic and therapeutic importance, the concurrent presence of other breast neoplasms such as phyllodes tumor should be considered.


  1. Nafissi N, Khayamzadeh M, Zeinali Z, Pazooki D, Hosseini M, Akbari ME. Epidemiology and histopathology of breast cancer in Iran versus other Middle Eastern countries. Middle East Journal of Cancer 2018; 9(3):243-51.
  2. Bernstein L, Deapen D, Ross RK. The descriptive epidemiology of malignant cystosarcoma phyllodes tumors of the breast. Cancer 1993; 71(10):3020-4.
  3. Buchanan EB. Cystosarcoma phyllodes and its surgical management. The American surgeon 1995; 61(4):350-5.
  4. Chaney AW, Pollack A, Mcneese MD, Zagars GK, Pisters PW, Pollock RE, et al. Primary treatment of cystosarcoma phyllodes of the breast. Cancer: Interdisciplinary International Journal of the American Cancer Society 2000; 89(7):1502-11.
  5. Parker SJ, Harries SA. Phyllodes tumours. Postgraduate Medical Journal 2001; 77(909):428-35.
  6. Macdonald OK, Lee CM, Tward JD, Chappel CD, Gaffney DK. Malignant phyllodes tumor of the female breast: association of primary therapy with cause‐specific survival from the Surveillance, Epidemiology, and End Results (SEER) program. Cancer: Interdisciplinary International Journal of the American Cancer Society 2006; 107(9):2127-33.
  7. Wu DI, Zhang H, Guo L, Yan XU, Fan Z. Invasive ductal carcinoma within borderline phyllodes tumor with lymph node metastases: A case report and review of the literature. Oncology letters 2016; 11(4):2502-6.
  8. Merck B, FJ LG, Calpena R. Infiltrating ductal carcinoma and synchronous malignant phyllodes tumour. Diagnostic and therapeutic approaches. Clinical & translational oncology: official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico 2006; 8(11):830-2.
  9. Kefeli M, Yildiz L, Akpolat I, Balci P, Ozen N. The coexistence of invasive ductal carcinoma and malignant phyllodes tumor with liposarcomatous and chondrosarcomatous differentiation in the same breast in a post-osteosarcoma case. Pathology-Research and Practice 2008; 204(12):919-23.
  10. Co M, Gary MT, Chen C, Wei J, Kwong A. Coexistence of ductal carcinoma within mammary phyllodes tumor: a review of 557 cases from a 20-year region-wide database in Hong Kong and Southern China. Clinical breast cancer 2018; 18(3):e421-5.
  11. Vajpeyi R. WHO classification of tumours: pathology and genetics of tumours of the breast and female genital organs. Journal of Clinical Pathology 2005; 58(6):671-2.
  12. Sheen-Chen SM, Hsu W, Eng HL, Huang CC, Ko SF. Intratumoral hemorrhage of mammary phyllodes tumor after menstrual induction: a puzzling presentation. Tumori Journal 2007; 93(6):631-3.
  13. Bassermann R, Eiermann W. Cystosarcoma phyllodes mammae und doppelseitiges Mammakarcinom. Pathologe 1980; 1:155-8.
  14. Klausner JM, Lelcuk S, Ilia B, Inbar M, Hammer B, Skornik Y, et al. Breast carcinoma originating in cystosarcoma phyllodes. Clinical oncology 1983; 9(1):71-4.
  15. Deodhar KK. Cancerization of phyllodes tumour. Histopathology 1997;30:98-9.
  16. Kulkarni MM, Khandeparkar SG, Joshi AR, Kothikar V, Nasare A, Patil S, Niraspatil S, Dhande B. Role of CD10 immunoexpression in grading phyllodes tumour of the Breast. Journal of clinical and diagnostic research: JCDR. 2017 Jan;11(1):EC14-EC16.
  17. Ilić I, Ranđelović P, Ilić R, Katić V, Milentijević M, Veličković L, et al. An approach to malignant mammary phyllodes tumors detection. Vojnosanitetski pregled 2009; 66(4):277-82.
  18. Fazilat-Panah D, Roudi SV, Keramati A, Fanipakdel A, Sadeghian MH, Shandiz FH, et al. Changes in Cytokeratin 18 during Neoadjuvant Chemotherapy of Breast Cancer: A Prospective Study. Iranian journal of pathology 2020; 15(2):117-26.