乳腺叶状肿瘤临床病理观察

目的 探讨乳腺叶状肿瘤的临床、病理特点。方法 复习15例乳腺叶状肿瘤的临床、病理资料。结果 15例均为女性，年龄28岁～57岁，平均42.2岁。所有病例均表现为乳腺肿块，以单侧单发性为主，肿块直径3cm～18cm，平均7．8cm。良性叶状肿瘤8例，交界性4例，恶性3例。镜下见肿瘤由良性的上皮成分和丰富的间质细胞组成，大部分形成叶状结构。均未见腋下淋巴结转移。1例恶性患者术后17个月死于肺转移，4例患者发生局部复发。结论 乳腺叶状肿瘤好发于40岁～50岁女性，很少发生淋巴结转移，可血行转移，易复发。组织学上需与富含细胞的纤维腺瘤、真性肉瘤等鉴别。对良性叶状肿瘤一般选择肿块扩大切除术，肿瘤较大者、交界性及恶性者宜作乳腺切除术。     

乳腺叶状肿瘤的诊断及治疗

目的探讨乳腺叶状肿瘤的诊断和治疗.方法对经手术和病理诊断的48例乳腺叶状肿瘤的临床病理资料进行回顾性分析.结果48例中平均年龄为43.2岁.根据肿瘤生长方式,瘤细胞异型,核分裂和肿瘤坏死进行乳腺叶状肿瘤分级,良性26例,交界性12例,恶性10例.全部病例采用手术治疗,肿瘤单纯切除术23例,良性、交界性、恶性复发分别为3/18、2/3、2/2;肿瘤扩大切除术15例,良性、交界性、恶性复发分别为0/8、1/5、1/2;乳房切除术10例,交界性、恶性复发转移分别为0/4、2/6.结论乳腺叶状肿瘤可分良性、交界性和恶性三种类别,确诊和分级主要依靠病理组织检查.提示首次肿瘤彻底切除是治疗的关键,应根据组织分级及肿瘤大小决定手术方式.     

乳腺叶状肿瘤17例诊疗分析

目的:探讨乳腺叶状肿瘤的治疗原则和影响预后因素。方法:对经手术和病理诊断确诊的17例乳腺叶状肿瘤的临床资料进行回顾性分析。结果:17例患者中良性叶状肿瘤9例,交界性叶状肿瘤5例,恶性3例。行局部肿块切除7例,单纯乳房切除术6例,改良根治术3例,姑息性肿块切除术1例。其中随访13例,平均随访时间21(5~84)个月,1例行乳腺癌改良根治术后2.5年死于远处转移,2例行局部肿块切除术后复发。结论:乳腺叶状肿瘤的预后与手术方式有关,良性和交界性应首选扩大区段切除术,切除肿瘤边缘不少于2cm;复发的交界性和恶性应尽早行单纯乳房切除术。     

乳腺叶状肿瘤93例临床病理分析

目的探讨乳腺叶状肿瘤的临床病理特征。方法回顾性分析93例乳腺叶状肿瘤患者临床病理资料。结果93例患者中,肿瘤性质良性63例,交界性24例,恶性6例,平均年龄39岁,其中I〉40岁者47例,为发病率最高的年龄组,各年龄组均表现为良性叶状肿瘤发病率高,其次为交界性叶状肿瘤,恶性叶状肿瘤发病率最低。病理形态示肿瘤由良性上皮和富于细胞的间质组成,上皮成分包括腺上皮和肌上皮,不同分化程度的间质细胞增生。随访71例,6例恶性患者5例生存,未发现肿瘤复发或转移,定期复查,1例于术后1年死亡（为28岁患者,全身多脏器转移）;23例交界性肿瘤患者及42例良性肿瘤患者均生存并未见复发。结论乳腺叶状肿瘤好发于40岁以上妇女,良性叶状肿瘤最常见,叶状肿瘤由上皮和增生的间质两种成分构成,应注意与纤维腺瘤等其他乳腺肿瘤鉴别,选择扩大1cm的局部广泛切除方法可以减少复发。     

乳腺叶状肿瘤局部复发的临床风险因素分析

目的分析乳腺叶状肿瘤局部复发的临床风险因素。方法使用SPSSCox比例风险模型分析2002年12月至2008年12月中国医科大学附属第一医院66例乳腺叶状肿瘤患者各种临床风险因素与局部复发的关系。单因素分析采用X2检验。结果本组患者的发病年龄为17—83岁（中位年龄41岁）,良性40例,交界性24例,恶性2例。局部复发15例,其中12例复发发生于区段切除术。在不同手术方式、不同组织学等级的叶状肿瘤患者之间,复发率的差异均有统计学意义（P〈0．05）。手术方式为保护因素（RR=0．151）,扩大切除术和乳房切除术者的复发风险较区段切除术者下降至66／1000和53／1000;组织学等级为危险因素（RR=5．803）,恶性和交界性叶状肿瘤患者的局部复发风险分别为良性肿瘤者的12．26倍和4．37倍。结论恶性程度高和手术方式选择不当影响预后。叶状肿瘤以手术治疗为首选,应选择切除范围扩大的手术方式,尤其是对恶性程度高的患者。     

乳腺叶状肿瘤17例诊治分析

[目的]总结乳腺叶状肿瘤的诊治情况。[方法]回顾分析17例经病理证实乳腺叶状肿瘤的临床资料。[结果]17例中良性11例,交界性3例,恶性3例。行乳腺肿瘤局部切除3例,乳腺肿瘤扩大切除7例,乳房切除术4例,乳房改良根治术3例,3例乳腺肿瘤术后出现复发。[结论]乳腺叶状肿瘤术前诊断较困难,主要依靠组织学检查,其局部复发与是否手术彻底切除密切相关。     

乳腺叶状肿瘤18例临床病理及免疫组化分析

目的探讨乳腺叶状肿瘤的临床病理学特点。方法对经手术和病理复诊明确结果的18例乳腺叶状肿瘤的临床病理资科进行回顾性分析。结果18例患者中位年龄40．8岁。根据肿瘤生长方式，进行乳腺叶状肿瘤分级，良性13例，交界性4例，恶性1例。免疫组织化学结果：VIM均表达在肿瘤间质细胞（＋＋），SMA亦表达间质细胞（＋），p53及Ki-67定位于细胞核，阳性表达于恶性叶状肿瘤（＋）。结论乳腺叶状肿瘤病理学形态分为三类，良性、交界性和恶性，免疫组织化学对恶性叶状肿瘤有一定表达。治疗上首选手术，不主张作单纯的肿物摘除术，往往由于切缘较近而导致较高的复发率。     

胃肠道间质瘤13例临床病理分析

目的:观察13例胃肠道间质瘤临床病理特点,提高对此类肿瘤的认识.方法:进行病理组织学观察与免疫组化研究,并结合临床资料综合分析.结果:13例中3例交界性胃肠道间质瘤2例复发,1例良性胃肠道间质瘤3年内死于肿瘤,4例恶性胃肠道间质瘤术后半年到3年内死亡,其余均健在.肿瘤组织学特点为肿瘤组织呈结节状、分叶状、多发性.肿瘤细胞以梭形或上皮样细胞为主.免疫组化标记物CD117、CD34.结论:胃肠道间质瘤是一种具有独特临床病理学特征的肿瘤,熟悉该肿瘤的组织学及免疫组化特点,对避免误诊为肌源性、神经源性肿瘤具有重要意义.     

乳腺分叶状肿瘤临床特点与复发危险因素

目的探讨乳腺分叶状肿瘤的临床特点、诊治方法和局部复发的危险因素。方法选取1990年1月至2016年7月间柳州市工人医院收治的48例乳腺分叶状肿瘤患者的临床病理和随访资料作回顾性分析,采用卡方检验分析各临床病理因素、手术方式与局部复发的关系,采用Logrank检验分析上述因素对无病生存率的影响。结果所有患者术后病理诊断结果中,良性乳腺分叶状肿瘤29例,交界性乳腺分叶状肿瘤11例,恶性乳腺分叶状肿瘤8例,无一例发现腋窝淋巴结转移。39例随访患者,1年、3年和5年无病生存率分别为83.8%、69.4%和66.1%,5年总生存率为93.0%。局部复发者10例,其中6例患者为肿块切除术后局部复发。患者是否采用肿块切除术与局部复发关系比较,差异有统计学意义(P=0.01)。结论外科手术是乳腺分叶状肿瘤的主要治疗方法,术式选择不当与局部复发有关,对乳腺分叶状肿瘤应选择局部广泛切除、乳房切除或乳房重建术,不宜采用肿块切除术,不必常规行腋淋巴结清扫术。     

13例乳腺叶状肿瘤临床病理特征分析

目的:探讨乳腺叶状肿瘤的病理特征、诊断、鉴别诊断以及与治疗和预后的关系.方法:对经手术和病理诊断的13例乳腺叶状肿瘤的临床病理资料进行回顾性分析.结果:13例平均年龄为43岁.根据肿瘤生长方式,瘤细胞异型,核分裂和肿瘤坏死进行乳腺叶状肿瘤分级,良性4例,交界性7例,恶性2例.结论:肿瘤的复发率随病理组织学等级递增而升高,随手术范围增大而下降,并与乳腺巨纤维瘤及其他乳腺肉瘤相鉴别.建议不管叶状肿瘤病理组织学分类如何,仍把它看作是低度恶性或恶性病变处理.     

Histologic features predict local recurrence after breast conserving therapy of phyllodes tumors

Background: Pathologists can distinguish benign phyllodes tumors, which very rarely metastasize, from malignant phyllodes tumors, which metastasize in approximately one fourth of patients. However, whether these same histologic criteria can be used to predict the likelihood that a phyllodes tumor will locally recur after breast conserving therapy remains controversial.Study Design: Since few patients with malignant phyllodes tumors have been treated with breast conserving surgery in any individual series, the literature was reviewed using a Medline search.Results: After local excision, 21 (111/540), 46 (18/39), and 65 (26/40) of patients with benign, borderline, and malignant phyllodes tumors, respectively, recurred in the breast. Following wide local excision, 8 (17/212), 29 (20/68), and 36 (16/45) of patients with benign, borderline, and malignant phyllodes tumors recurred in the breast.Conclusions: Malignant phyllodes tumors are much more likely than benign phyllodes tumors to recur in the breast after breast conserving surgery. This high rate of local recurrence of borderline and malignant phyllodes tumors suggests that wide local excision is less than optimal therapy, and challenges us to look for methods to improve local tumor control.     

Phyllodes tumor of the breast

PURPOSE: To better identify prognostic factors for local control and survival, as well as the role of different therapeutic options, for phyllodes tumors, a rare fibroepithelial neoplasm of the breast. METHODS AND MATERIALS: Data from 443 women treated between 1971 and 2003 were collected from the Rare Cancer Network. The median age was 40 years (range, 12-87 years). Tumors were benign in 284 cases (64%), borderline in 80 cases (18%), and malignant in 79 cases (18%). Surgery consisted of breast-conserving surgery (BCS) in 377 cases (85%) and total mastectomy (TM) in 66 cases (15%). Thirty-nine patients (9%) received adjuvant radiotherapy (RT). RESULTS: After a median follow-up of 106 months, local recurrence (LR) and distant metastases rates were 19% and 3.4%, respectively. In the malignant and borderline group (n = 159), RT significantly decreased LR (p = 0.02), and TM had better results than BCS (p = 0.0019). Multivariate analysis revealed benign histology, negative margins, and no residual disease (no RD) after initial treatment and RT delivery as independent favorable prognostic factors for local control; benign histology and low number of mitosis for disease-free survival; and pathologic tumor size < or = 3 cm and no tumor necrosis for overall survival. In the malignant and borderline subgroup multivariate analysis TM was the only favorable independent prognostic factor for disease-free survival. CONCLUSIONS: This study showed that phyllodes tumor patients with no RD after treatment have better local control. Benign tumors have a good prognosis after surgery alone. In borderline and malignant tumors, TM had better results than BCS. Thus, in these forms adjuvant RT should be considered according to histologic criteria.     

Cystosarcoma phyllodes of the breast: a case report in a 12-year-old girl

Breast tumors in adolescents are very rare and mostly benign. Fibroadenomas are the most frequent, but within the extensive differential diagnosis, the phyllodes tumor must be mentioned, which accounts for about 1% of breast tumors and the diagnosis of which is very rare in patients younger than 20 years. There are no specific symptoms or radiological images to distinguish phyllodes tumor from fibroadenoma; therefore, histological examination is mandatory for diagnosis. Histology also allows the classification of phyllodes tumor into benign, borderline, or malignant types for appropriate surgical treatment: freemargin excision in benign tumors and mastectomy in the other two types. Fortunately, the majority of these tumors are benign, and treatment maximizes breast conservation with free infiltration margins surgery, given that this fact is the most important factor to prevent local recurrence. In this article, we describe a rare case of borderline cystosarcoma phyllodes in a 12-year-old girl.     

Analysis of phyllodes tumor recurrence according to the histologic grade

Local recurrence of phyllodes tumor (PT) of the breast is an adverse outcome that can result in sarcomatous degeneration. The aim of this study was to investigate the histologic and surgical factors associated with local recurrence. A total of 193 PT cases were studied: 145 (75.1 %) benign cases, 33 (17.1 %) borderline cases, and 15 (7.8 %) malignant cases. Stratifying our analysis according to histologic grade, we investigated the relationship between disease-free survival (DFS) and both histologic and surgical factors, including histologic grade, stromal cellularity, stromal atypia, stromal mitosis, stromal overgrowth, tumor margin, type of surgical procedure (local excision, wide excision, and mastectomy), surgical margin status, and radiation therapy. In the case of benign PT, all patients with local recurrences (3.4 %) had been treated with local excision, and all recurrent tumors were also benign. The local recurrence rate for locally excised benign PTs was not associated with surgical margin status or radiation therapy. In the case of borderline PT, local excision was associated with an increased local recurrence rate (P = 0.046). In malignant PT, small tumor size (≤4.0 cm) was associated with an increased local recurrence rate (P = 0.041). Univariate analyses indicated that surgical procedure (mastectomy < local excision < wide excision; P < 0.001) was significantly associated with shorter DFS in borderline PT. A positive surgical resection margin (P < 0.001) was associated with DFS in malignant PT. The factors associated with local recurrence differed with the histologic grade of PT, as did the features of local recurrence itself. In particular, benign PT had very low rate of local recurrence regardless of surgical margin status or radiation therapy, even when treated with local excision. In the case of benign PT, no recurrent tumors had worse histologic grades than the initial tumors.     

The extent of surgery and prognosis of patients with phyllodes tumor of the breast

In an attempt to clarify the controversial issues related to prognosis and therapeutic aspects of phyllodes tumors (PT), we retrospectively reviewed all cases of PT treated in our hospital during the last fifteen years. Re-examining the pathology material we found 84 cases, while thirteen more cases which had been initially classified as fibroadenomas with areas of phyllodes tumor were rejected from the analysis because they were classified as fibroadenomas. Based on the criteria proposed by Azzopardi and Salvadori and adopted by WHO, we found 55 benign PT (65.14%), 14 borderline PT (16.6%), and 15 malignant PT (17.8%). The median age of the patients with benign PT was 34 years, compared to 46.5 years for those with borderline tumors and 52 years for those with malignant. The median size of benign tumors was 3 cm, 9.5 cm for borderline, and 7.25 cm for malignant. Out of 55 patients with benign PTs, 37 underwent wide local excision and the remaining 18, with small tumors, underwent enucleation. In this group of patients, there was no recurrence after a median interval of 6.65 years. Eleven patients with borderline PT underwent wide local excision and three mastectomy; one immediately after an incomplete PT excision and the remaining two 8 months and 2 years later due to a locally recurrent PT (the last one proven histologically in the permanent biopsy of the recurrence to be malignant). Twelve patients with malignant PT underwent mastectomy, either during the same operation or following the results of the permanent section biopsy. Three more patients with malignant PT underwent wide local excision. The size of the tumor in these patients was relatively small and the pathology report indicated clear margins with normal breast tissue surrounding the tumor. One patient with 8 cm diameter malignant PT, who underwent mastectomy, passed away sixteen months later from widely spread metastases. Applying the criteria of Azzopardi and Salvadori, each case of PT can be managed successfully avoiding unnecessary mastectomies.     

Phyllodes tumor of the breast: an update

Phyllodes tumor is an uncommon biphasic breast tumor, with the ability to recur and metastasize, and it behaves biologically like a stromal neoplasm. Traditionally, phyllodes tumors are graded by the use of a set of histologic data into benign, borderline, and malignant. In most series, all phyllodes tumors may recur, but only the borderline and malignant phyllodes tumors metastasize. On the basis of histologic features, prediction of behavior is difficult. The expression of many biological markers, including p53, hormone receptors, proliferation markers, angiogenesis group of markers, c-kit, CD10 and epidermal growth factor receptor have been explored, and many have been shown to be variably expressed, depending on the grade of the tumor. These markers are, however, of limited value in predicting the behavior of the tumor. Recently investigators have reported a plethora of genetic changes in phyllodes tumors, the most consistent of which seems to be 1q gain by comparative genomic hybridization. Some candidate genes have been mapped to various sites, and preliminary data suggest that some of these changes may be related to recurrence. It is foreseeable that more exciting data will be generated to help us to understand the etiology and pathogenesis of phyllodes tumor.     

Phyllodes tumors of the breast: natural history, diagnosis, and treatment

Phyllodes tumors of the breast are unusual fibroepithelial tumors that exhibit a wide range of clinical behavior. These tumors are categorized as benign, borderline, or malignant based on a combination of histologic features. The prognosis of phyllodes tumors is favorable, with local recurrence occurring in approximately 15% of patients overall and distant recurrence in approximately 5% to 10% overall. Wide excision with a greater than 1 cm margin is definitive primary therapy. Adjuvant systemic therapy is of no proven value. Patients with locally recurrent disease should undergo wide excision of the recurrence with or without subsequent radiotherapy.