Malignant phyllodes tumor with chondro and osteosarcomatous differentiation and secondaries in lungs

Phyllodes tumor is a rare breast tumor, with neoplastic epithelial and stromal components for <1% of all breast neoplasms. Phyllodes tumors form a spectrum from benign tumors, similar to fibroadenomas, of malignant tumors with a propensity for rapid growth and metastatic spread. High-grade malignant phyllodes tumor is a very rare, but aggressive breast malignancy and forms approximately 25% of all phyllodes tumors. We report a case of a 44-year-old female who presented with a painless left breast lump for 4 months duration. The mass was >10 cm in size and firm in consistency. She underwent left mastectomy. The histopathology revealed a malignant phyllodes tumor with sarcomatous stromal overgrowth and heterogeneous chondro and osteosarcomatous differentiation. At 2 months after surgery, she reported to us with secondaries in bilateral lungs. We planned palliative chemotherapy in view of good general condition of the patient and lung metastasis. Chemotherapy included ifosfamide, adriamycin and cisplatin as per standard regimen every 3 weekly. After three cycles, her lung metastasis cleared completely. It was planned to continue same chemotherapy for six cycles.