Pulmonary metastasis as late recurrence of borderline phyllodes tumor: A case report and review of long-term surveillance

Phyllodes tumors are uncommon fibroepithelial neoplasms of the breast with heterogeneous biological behavior, ranging from indolent to highly aggressive forms. Borderline phyllodes tumors, in particular, represent a diagnostic and clinical challenge due to their unpredictable clinical course and intermediate metastatic potential. We report the case of a 55-year-old woman with a prior history of breast-conserving surgery for a borderline phyllodes tumor who presented with local recurrence and synchronous pulmonary metastases ten years after the initial diagnosis. Following excisional biopsy confirming recurrence, the patient received adjuvant radiotherapy. Subsequent thoracic computed tomography revealed multiple bilateral pulmonary nodules and mediastinal lymphadenopathy. Video-assisted thoracoscopic surgery (VATS) with wedge resection and lymph node sampling confirmed metastatic phyllodes tumor. The patient was discussed in a multidisciplinary tumor board, and systemic chemotherapy was planned. This case highlights the potential for late recurrence and distant metastasis in borderline phyllodes tumors, underscoring the necessity for prolonged surveillance. Furthermore, it emphasizes the importance of comprehensive systemic evaluation, particularly thoracic imaging, in patients presenting with recurrence. VATS represents a valuable minimally invasive approach for both diagnosis and staging in selected cases.