Ciclosporin
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De novo phyllodes tumour?: case report A 15-year-old girl developed a de novo phyllodes tumour while receiving ciclosporin. The girl had undergone a liver transplant in February 2003 and had been maintained on a ciclosporin based immunosuppressive regime [route and dosage not stated]. Her blood ciclosporin concentration was maintained at 200-250 ng/mL during the first month, then at 100-150 ng/mL. In March 2008, she presented with a lump in her left breast, which had been present for more than a year. An ulceration with a 2-week-old flavescent exudate was found in her ipsilateral nipple-areola complex, and her left breast was significantly larger than her right. Well-defined and well-dispersed masses consisting of multiple nodes were found during physical examination, with the largest mass in the left breast. Several homogeneous echo shadows were seen in a breast ultrasound, translating into nodes of different sizes showing encapsulation with well-defined margins. Compartmentalising and honeycombing were also observed. An MRI showed multiple nodular shadows with ill-defined lobes. Two large cysts filled with fluid were located in the left breast. Her blood ciclosporin concentration was significantly elevated. An operation showed a multilobed mass filling almost the entire left breast, as well as three well-defined masses in the right. A mastectomy of the mass located in the left breast excised the pectoral fascia. A wide local excision was performed to remove the masses in the right breast. Pathological findings revealed a bilateral borderline phyllodes tumour. Necrosis and focal haemorrhage were present. The girl recovered and ciclosporin treatment was replaced with tacrolimus. At an 8-month follow-up, there was no evidence of a recurrence. Author comment: "[O]ne cannot be certain if the phyllodes tumor described in our present case arose from the fibroadenoma caused by [ciclosporin] or not." Cheng F, et al. De novo phyllodes tumor in an adolescent female after liver transplantation. Pediatric Transplantation 15: E12-E14, No. 1, Feb 2011. Available from: URL: http://dx.doi.org/10.1111/j.1399-3046.2009.01221.x 803049936 China
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Reactions 26 Feb 2011 No. 1340
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