Mehrdad Payandeh¹, Hooshang Usefi², Edris Sadeghi^{3, 4,}, Masoud Sadeghi^{3, 4}

Background: Phyllodes tumors (PT) have an incidence of 1 per 100,000 women and account for only 0.5% of all breast neoplasms. Herein, we present a case of malignant PT characterized by stromal overgrowth of a high-grade spindle cell sarcoma with marked stromal pleomorphism. Which this disease is rare and the lack of standard care options for it. Case Report: A 36-year-old woman with a metastatic malignant PT presented to our clinic to discuss treatment options. Immunohistochemical analysis showed that the lesion was negative for estrogen and progesterone receptor and HER-2/neu, ki67 > 80% positive and vimentin positive. During a futher evaluation in computed tomography (CT) of the chest revealed multiple lung masses was seen. Pathology review of the mastectomy product at our institution confirmed the diagnosis of a malignant PT characterized by stromal overgrowth of a high-grade spindle cell sarcoma with marked stromal pleomorphism, a high mitotic rate, and areas of necrosis. She treated with chemotherapy regimen for soft tissues sarcoma consist of vincristine, cyclophosphamide, doxorubicine. After three courses of this regimen despite of decease in severity of dyspnea the breast mass lesion progressed and the therapy change to ifosfamide and etoposide combined with Nexavar (Sorafenib). At now, the patient is treating with this policy. Conclusions: We reported a patient with malignant PT should receive adjuvant chemotherapy to reduce the risk of recurrence. We suggest chemotherapy with ifosfamide and etoposide combined with Nexavar (Sorafenib) because it is a good policy for close treatment.

chemotherapy, CT scan, Phyllodes tumors, Sorafenib