Discussion

PTs account for <1% of all breast neoplasms, and only 10%–15% are classified as malignant, making giant malignant PTs exceptionally uncommon. Their rarity limits the availability of robust evidence and poses challenges in diagnosis and management, particularly in resource-limited settings [9, 10].

Our patient presented with a giant malignant PT measuring 15 cm on histopathological examination, associated with skin infiltration and rapid growth. These features are recognized markers of locally aggressive disease and have been associated with an increased risk of local recurrence and distant metastasis [3]. As reported in previous studies, differentiating malignant PTs from other rapidly growing breast lesions remains difficult because clinical and imaging findings are often nonspecific.

In this case, ultrasonography identified a suspicious fibroepithelial lesion but underestimated its biological aggressiveness. Conversely, computed tomography demonstrated central necrosis, neovascularization, and close contact with the pectoral and intercostal muscles, findings that influenced surgical planning. Although preoperative core needle biopsy suggested a malignant fibroepithelial neoplasm, definitive diagnosis and risk stratification were only achieved after histopathological evaluation of the surgical specimen. This highlights the limitations of preoperative assessment and the importance of integrating imaging, pathology, and clinical findings when planning treatment [4].

Complete surgical excision with negative margins remains the cornerstone of treatment for malignant PTs. In our patient, total mastectomy achieved clear margins, although subsequent widening of the deep margin was performed because of its proximity to the underlying muscle. Given the uncertainty regarding margin status and the moderate size of the postoperative defect, delayed reconstruction with a split-thickness skin graft was selected. This strategy provided satisfactory wound coverage while allowing confirmation of adequate oncological control before definitive closure.

A limitation of this report is its single-case design and short follow-up. However, 6-month postoperative computed tomography showed no local recurrence or distant disease, and no adjuvant therapy was needed. This case demonstrates that giant malignant PTs can be successfully managed in resource-limited settings, with delayed skin graft reconstruction serving as an effective alternative when advanced reconstructive options are unavailable.