Malignant Phyllodes Tumour, Grade 3 [Thailand]

My wife has recently been diagnosed with having had a rare form of breast cancer, a Grade 3 (Malignant) phyllodes tumour, which was removed on July 23, 2018 at Brumrumgard Hospital in Bangkok. We were informed that the extraction was successful, and the margins where “uninvolved” however we told a 2nd surgery was needed because the cancer was discovered post-operation the extraction was not planned to remove enough margin to reduce the risk for re-occurance of a Phyllodes tumour. The doctor recommended 2cm margin, and said must remove more.

As of august 3rd, 2018, we are now seeking support on what to do next.

Summary cancer data:
Procedure: Wide excision
Specimen Laterally: Single Left
Tumor Size: 5.5 x 4.5cm
Histologic Type: Phyllodes Tumour
Histologic Grade: Grade 3 of 3 (Malignant)
Mitotic Count: 20 per 10 high power field
Tumor Extension:
Skin: n/a
Nipple: n/a
Skeletal Muscle: n/a
Margins: Uninvolved
Regional Lymph Nodes: n/a
Treatment Effect: n/a
Pathologic Stage Classification (oTNM, AJCC 8th Edition): p T3NXMX

Clinical History: 58 year old female. Left breast mass for 9 months

Gross Description: The specimen is received in formalin, labeled with the patient’s name, and accession number, and additional labeling as “Left breast”. It consist of an irregularly shaped fibroadipose tissue fragment measuring 7.5 x 6 x 5.5 cm. The specimen is oriented as follow; long suture; lateral, short suture: superior. The specimen is serially sectioned. The specimen is inked as follow: anterior-red, posterior-black, superior-blue, inferior-green, medial-purpole, lateral yellow. The cut surface reveals a well-circumscribed firm, gray-white and yellow-tan mass measuring 5.5x4.5x3.5cm. The mass is located at 0.1cm from the anterior margin (red), 0.1cm from the inferior margin (green), 0.1cm from the posterior margin (black), 0.1cm from the medial margin (purple), 0.7 cm from the superior margin (blue), 0.1 cm from the lateral margin (yellow). The remaining breast parenchyma is grossly unremarkable without any other masses. (See gross photo (s), press BIH form # Scanned from list# Lab – Surgical Pathology Report)