Coexisting invasive ductal carcinoma arising within a benign phyllodes tumour.

A woman in her 40s presented to the breast clinic with a 2-year history of an enlarging right breast lump. Examination revealed a 10 cm firm mass in the upper outer quadrant of the right breast. MRI and ultrasonography results revealed an 8 cm mass in the right breast and suspicious axillary nodes. Biopsy results of this mass revealed a sclerosed fibroadenoma (B2). Excision of the right breast lump had shown a benign phyllodes tumour, containing an incidental invasive ductal carcinoma and high-grade ductal carcinoma in situ. The patient underwent a right breast cavitectomy and sentinel lymph node biopsy, which revealed no further disease. She received adjuvant radiotherapy, chemotherapy and anti-HER2 treatment, and has remained disease-free at 20-month follow-up. The coexistence of an invasive carcinoma arising within a benign phyllodes tumour is rare. This case report underscores the importance of thoroughly examining excised specimens for phyllodes tumour to exclude malignant components.

Extramammary breast cancer of the vulva.

A woman in her 70s was seen in the gynaecology outpatient clinic with a swelling on the right side of the vulva. Surgical excision of the lesion revealed unexpectedly an extensive ductal carcinoma in situ with a focus of a grade 2 invasive ductal carcinoma arising in extramammary breast tissue of the vulva. Postoperative staging studies showed normal breasts, with no evidence of disease elsewhere. The patient underwent a wider excision of the right vulva and sentinel node biopsy of the right inguinal region, which revealed no further disease. The patient is currently taking adjuvant hormonal therapy and has remained disease free at 2-year follow-up. This case underscores the importance of considering rare presentations of vulvar malignancies and the necessity for a multidisciplinary approach in managing such cases.