Ann R Coll Surg Engl 2010; 92: 1

Phyllodes tumours of the breast are rare fibro-epithelialtumours. They form less than 1% of breast neoplasms.1

They are classified as benign, borderline or malignant. Inmost cases, phyllodes are benign and adequately treated bywide local excision.

Metastasis, however, can develop in up to 21% ofpatients.2 This can occur with or without local recurrence.Treatment of metastatic phyllodes should follow guidelinesfor sarcoma rather than breast cancer and the outcome ispoor. The most common sites of metastasis are the lungsand bones.3 Other reported sites of metastasis, including the

liver and brain, are rare. We report on a case of phyllodestumour with metastasis to a site which has not been report-ed before, with an uncommon presentation.

Case history

A 52-year-old woman was referred with a locally advancedand neglected left breast phyllodes tumour. The tumourwas 30 cm in diameter. It involved the entire left breast withimpending skin ulceration. Pre-operative evaluation withchest and abdomen computed tomography (CT) scans didnot reveal any distant metastasis.

The patient underwent a successful, wide, local excision,which included the entire breast with the underlying pec-toralis major and minor muscles. The defect was recon-structed with a transverse rectus abdominis myocutaneous(TRAM) flap. The tumour was completely excised with neg-ative margins.

Thirteen months later, she re-presented with abdominalpain associated with vomiting and constipation. Clinicalexamination revealed right-sided abdominal mass associat-ed with severe localised tenderness. CT scan was donewhich suggested the presence of ileocolic intussusception(Fig. 1). Laparotomy was performed the same day. Theoperative findings were ileocolic intussusception reachingthe transverse colon. She underwent right hemicolectomy.Her postoperative recovery was uneventful. The pathologyreport confirmed the presence of ileocaecal intussusceptionsecondary to metastatic phyllodes tumour to the caecalwall, just adjacent to the ileocaecal valve (Fig. 2). The his-tological features of the tumour were similar to the resect-

ON-LINE CASE REPORTAnn R Coll Surg Engl 2010; 92:doi 10.1308/147870810X12699662981357

KEYWORDSPhyllodes – Metastasis – Caecum – Intussusception

Accepted 9 June 2010; published online

CORRESPONDENCE TOBasem B Morcos, King Hussein Cancer Centre, Queen Rania Al Abdullah Street, PO Box 1269 Al-Jubeiha, Amman 11941, Jordan

E: bmorcos@doctor.com

Ileocaecal intussusception secondary to metastaticphyllodes tumour of the breast

BASEM B MORCOS, BILAL BAKER, SAMEH A HASHEM

King Hussein Cancer Centre, Amman, Jordan

ABSTRACT

A patient with phyllodes tumour of the breast is discussed. During follow-up, she presented with intestinal obstruction caused by ileo-caecal intussusception. The cause of the intussusception was metastatic phyllodes tumour, which is a unique presentation.

Figure 1 CT scan showing ileocaecal intussusception.

MORCOS BAKER HASHEM ILEOCAECAL INTUSSUSCEPTION SECONDARY TO METASTATICPHYLLODES TUMOUR OF THE BREAST

Ann R Coll Surg Engl 2010; 92:2

ed breast tumour, with abundant mitoses (80 MF/10 HPF).The cells were negative for CK, S100, SMA, desmin, CD34and C-kit. Unfortunately, the patient went on to developother metastases to the lungs and limbs (soft tissues) duringthe following months, and finally succumbed to hermetastatic disease 18 months later.

Discussion

Phyllodes tumour metastasis is an uncommon event, occur-ring in up to 21% of cases.2 Most commonly, metastasesoccur to the lungs (84.5%) and bones (39%). Less commonsites include the liver (5%), brain and soft tissues.Treatment of metastasis is usually with chemotherapy.However, in some cases of visceral metastasis, surgicalexcision might be indicated, especially with a localised andresectable disease. Nevertheless, the prognosis remainsvery poor.

The gastrointestinal tract is very rarely involved bymetastatic phyllodes tumours. We found only five casesreported in the literature of metastasis to the gastrointesti-nal tract (excluding the liver).4–8 It is interesting to note thatfour of those cases had metastasis to the region of the pan-creas and duodenum. Most presented with upper gastroin-testinal bleeding. One patient presented with obstructive

jaundice. The fifth case had metastasis to the ileum causingpartial intestinal obstruction.8 Our patient had metastasis tothe caecum. In our literature review, we could not find anycase of metastasis to the colon from phyllodes tumour of thebreast.

Intussusception in adults is usually caused by tumours,9

either primary or secondary. Primary tumours include ade-nocarcinomas, polyps and hamartomas. Secondary tumoursare rare and include melanomas, kidney tumours and lym-phomas. To our knowledge, this is the first case of intussus-ception caused by a metastatic phyllodes tumour.

Surgical resection is the mainstay of treatment of adultintussusception. It is indicated to identify and relieve thecause of obstruction. However, the prognosis dependsmainly on the pathological cause of intussusception.Metastatic phyllodes tumours usually have a dismal prog-nosis. Our patient underwent right hemicolectomy withgood immediate outcome and palliation. Nevertheless, shedeveloped metastases in other organs during the ensuingmonths and succumbed to her metastatic disease about 18months later.

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Figure 2 Phyllodes tumour in the colonic wall (haematoxylin andeosin stain ×100).