乳腺叶状肿瘤的诊断和治疗

目的探讨乳腺叶状肿瘤的临床病理特点、治疗原则,选择合理治疗方案。方法回顾性分析1997年3月至2006年6月收治的21例乳腺叶状肿瘤患者的临床资料,包括诊断年龄,临床症状,肿瘤大体及组织学特征,手术方式,术后放射及化学治疗,复发率,死亡率,比较良性、恶性、交界性肿瘤的不同。结果23例患者平均年龄38岁,按WHO分类标准,其中良性11例,交界性4例,恶性8例。14例行局部切除术,5例行乳腺单纯切除术,4例按乳腺癌改良根治术术式。随访18例,平均随访时间22个月(12～96个月),2例按乳腺癌改良根治术术后1年死于远处转移,4例行局部切除术后复发再次按乳腺癌改良根治术手术。结论保证1～2cm切缘的扩大局部切除术是治疗乳腺分叶状肿瘤的首选方案,局部复发的交界性和恶性肿瘤要选择乳房单纯切除术式或按乳腺癌改良根治术。

The diagnosis and treatment of phyllodes tumor of the breast: report of 21 cases

objective To explore the clinical characteristics and the principle of treatment of phyllodes tumor of the breast, to better define appropriate treatment strategies for patients. Methods Twenty one patients treated primarily for phyllodes tumor of the breast were reviewed retrospectively Data, including age at the time of diagnosis, clinical presentation, histological features, type of surgery carried out, clinical progression and characteristics, radiotherapy, chemotherapy, recurrence rate, and mortality. Comparisons were made between those with benign, borderline and malignant tumors. Results The median age was 39 years. According to the histologic criteria of WHO, there were 10 benign cases(47 %), 3 borderline cases (14 %), and 8 malignant cases(38 %) . Thirteen patients underwent local excision, 4 cases did simple mastectomy, and 7 cases did modified radical mastectomy. Follow up was obtained for 18 cases, with an average of 21 months. Two patients died from metastasis 1 year after a modified radical mastectomy. Four patients were treated by local excision presented local recurrence and then did modified radical mastectomy. Conclusions The outcome of phyllodes tumor appears to be determined by the biology of the tumor rather than by treatment modality. A wide local excision, with an adequate margin of normal breast tissue is the preferred initial therapy for phyllodes tumor of the breast, while simple mastectomy or modified radical mastectomy is indicated for locally recurrent phyllodes tumor of borderline and malignan.