Background and clinical significance: Phyllodes tumors (PTs) are rare stromal neoplasms originating in the connective tissue of the breast, distinct from carcinomas that arise from the ducts or lobules. These tumors exhibit a broad spectrum of morphologic features and are traditionally classified as benign, borderline, or malignant. Case presentation: We present the case of a 71-year-old female diagnosed with a malignant PT and treated at our hospital. The patient noticed a gradually enlarging lump in her right breast over several months. Mammography was inconclusive, but an ultrasound later revealed a lobulated, firm mass, classified as BIRADS 5. Physical examination identified a 20 cm mass, and core needle biopsy suggested a borderline PT. Following lumpectomy, pathology confirmed a malignant tumor with narrow surgical margins (0.1 cm). Although mastectomy was recommended to achieve wider margins, the patient opted for adjuvant radiotherapy. She received 50 Gy in 25 fractions to the whole breast, followed by a 16 Gy boost to the tumor bed in 8 fractions. The treatment was well tolerated and completed successfully. Initially, the patient’s therapeutic management was delayed due to a combination of personal and organizational factors. However, the process was later streamlined through the use of a novel digital tool developed to facilitate the entire patient journey within our hospital system. Conclusions: This case highlights the diagnostic complexities of PTs, the critical need for effective collaboration between specialties, and the importance of timely treatment planning for optimal patient outcomes.

Background/Objectives: Colon interposition, or esophagocoloplasty, remains an important reconstructive option when the native esophagus cannot be preserved or when the stomach is unsuitable for reconstruction. Malignant transformation within the interposed colon is rare but clinically relevant, because the transposed colonic mucosa retains the potential to develop adenomatous lesions and adenocarcinoma in the long term. Methods: We reviewed reported cases of malignancies arising in a colonic interposition after esophagocoloplasty. PubMed and Web of Science Core Collection were searched using the query “(Esophag*) AND ((Esophagectomy) OR (Esophagocoloplasty) OR (Interpos*) OR (Transpos*)) AND (Colon) AND (Cancer OR Adenocarcinoma) NOT (“Esophageal cancer” OR “Esophageal adenocarcinoma” OR “Gastric cancer” OR “Gastric Adenocarcinoma”)”. The search was limited to publications from 2005 to 2026. Results: After duplicate removal and eligibility screening, 20 case reports were included. We also present a 67-year-old man who underwent isoperistaltic coloesophagoplasty in 1979 after caustic ingestion during a suicide attempt and developed metastatic colon adenocarcinoma in the interposed graft approximately 44 years later. The disease was initially metastatic to the liver and subsequently progressed locoregionally in the cervical graft segment. Management included FOLFOX plus bevacizumab, de-escalation to FUFOL plus bevacizumab, FOLFIRI plus bevacizumab, cervical intensity-modulated radiotherapy with adaptive replanning, and later regorafenib. Conclusions: This case highlights the diagnostic and therapeutic complexity of adenocarcinoma arising in a cervical colonic graft and supports long-term vigilance, multidisciplinary evaluation, and individualized management in patients with prior esophagocoloplasty.