![]() The role of chemotherapy is debatable based on a small observational study, whereas radiotherapy should be reserved for patients with malignant tumour and positive surgical margins. Given the rarity of the disease, the validity of adjuvant radiotherapy and chemotherapy are often not evidence based. ![]() Clinicians should cater management on a case-by-case basis taking patient factors into consideration. This again outlines the complexity of managing rare gigantic PT in a patient who is non-compliant and at high risk of absconding. ![]() The decision to proceed for level 1 and 2 axillary clearance was made after discussion with the radiologist, given that the lymph nodes were highly suggestive of malignancy on imaging. Clinically, the lymph nodes were palpable and preoperative lymph nodes biopsy was not attainable due to patient factors and the dilemma of possible diagnosis of metaplastic carcinoma based on core biopsy. However, in our case, wide excision was not achievable due to the significant size of the tumour, with the entire breast parenchyma being replaced by the stromal tumour and negative resection margins was impossible to achieve without a mastectomy. The National Comprehensive Cancer Network guideline has recommended wide excision with margins ≥1 cm and axillary lymph node clearance is not required. Due to the overlapping histological features, the pathological diagnosis of PT in the present case was made on the examination of the surgical specimen. The main differential diagnosis for our case includes PT, metaplastic carcinoma and mesenchymal tumours such as atypical/malignant solitary fibrous tumour. However, the role of core needle biopsy in diagnosing PT and differentiating it from stromal tumours remains unclear, given the relatively high false negatives and false positive rates. Core needle biopsies have been used extensively in the diagnostic workup of breast lesions. Undoubtedly, it is rare to encounter such an extreme case.ĭiagnosis of PT remains a work in progress. In contrary to developed countries, the population is well educated therefore, cancers are commonly found at an early stage. The infrastructure and resources for routine screening mammography are often sparse in developing countries and thus leading to PT being diagnosed at a later stage and gigantic size. ![]() Data are scarce on giant PT and most of the cases are from developing countries. ![]()
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