乳腺微创旋切术在乳房良性肿瘤诊疗中的应用

目的评价乳腺微创旋切术在乳腺良性肿瘤诊断及治疗中的价值。方法2006年5月～2009年2月对查体和超声体检发现的205例乳腺肿物（单发肿瘤142例,多发肿瘤63例,其中58例为超声发现的不可触及病灶）行乳腺微创旋切术,应用Mammotome乳房活检系统及11G/8G穿刺针（美国强生公司）,术后常规病理检查。结果205例共切除356个肿瘤,直径0.3～3.5cm。手术时间1～50min,平均10.2min。术后局部瘀斑22例,血肿19例（3例行血肿穿刺）。术后病理：纤维腺瘤98个,乳腺增生246个,其中154个伴纤维腺瘤样结构,导管内乳头状瘤7个,管状腺瘤1个,囊肿4个。132例随访2～36个月,肿瘤残余4例（3.0%）,肿瘤局部及切口美容效果满意。结论体检及超声发现的乳房内良性肿瘤（尤其是同一乳房内多发肿瘤）及超声发现的乳房内不可触及病灶,超声引导下乳腺微创旋切术可以准确可靠切除,明确诊断,减少漏诊或避免过度手术,操作简单,术后美容效果好。     

National Surgical Patterns of Care for Primary Surgery and Axillary Staging of Phyllodes Tumors

Abstract: Phyllodes tumors (PT) are rare and unique in their suspected stromal and epithelial origin, and their propensity to recur despite surgical resection. Current surgical treatment of PT does not include sampling of regional lymph nodes (LNs) as malignant PT infrequently spread to LNs. We hypothesize that, because of substantial experience with common epithelial lesions of the breast, surgeons are more prone to sample LNs in PT patients. We reviewed national surgical patterns of care of axillary LN sampling for PT using the Surveillance Epidemiology & End Results (SEER) registry. SEER data for LN evaluation are available from 1988. The public‐access SEER data‐base was queried for patients presenting over all 17 registries between 1988 and 2003 with PT of the breast. Data were collated by type of surgery and number of LNs examined, and further analyzed by tumor size of the primary lesion where available; 1,035 cases of PT were identified for the 16‐year period. Patients had a median age of 50 (range 12–96). Of the specimens with SEER grade listed, 117 were well‐differentiated, 186 moderately differentiated, 79 poorly differentiated, and 132 undifferentiated; 612 (59.1%) cases had specific surgical procedures reported: 191 partial, 251 simple, 5 subcutaneous, 154 modified radical, and 6 radical mastectomies, with 5 mastectomies (NOS) documented. The remainder of cases had surgery that was coded as “undocumented” or unknown. When surveyed by LNs examined, 25.5% of patients (n = 264) underwent some degree of regional lymphadenectomy; the median number of LNs examined in these patients was 7 (range 1–37). Of all PT patients, 9.0% of patients underwent axillary sampling of 10 LN or more. Only nine patients (3.4%) had positive LNs. When assessing axillary sampling rate by tumor size, smaller lesions were less likely to undergo sampling than larger lesions (19.3% for lesions <2 cm, 20.5% for lesions 2–4.9 cm, 27.9% for 5–9.9 cm); although this was nonsignificant. In spite of the lack of supporting data for LN examination axillary staging continues to be performed for many cases of PT.     

脏器保留原则下胰腺良性肿瘤的外科治疗

目的:讨论胰腺良性肿瘤的脏器保留原则指导下外科治疗价值。方法:对45例胰腺良性肿瘤分别行脏器保留原则指导下手术治疗,其中术式包括肿物摘除术、胰腺节段性切除术、胰体尾加脾切除、保留脾脏胰体尾切除及胰十二指肠切除术后临床经过和胰瘘的发生率加以分析。结果:胰漏发生率分别为55%(11/20),33.3%(3/9),25%(1/4),0(0/6),33.3%(2/6)。胰瘘发生率30.8%(17/45),脏器保留原则指导手术未增加胰瘘发生率(P=0.449)并且与传统手术组相比术后未增加糖尿病发生率(P=0.515)。结论:脏器保留原则指导下手术胰腺切除是一种安全、有效的手术方式,生长抑素不能预防胰瘘的发生,但是可以缩短胰瘘闭合的时间。     

PDCA 循环管理护理对乳腺良性肿瘤切除术后术区美容效果的影响

目的 分析针对乳腺良性肿瘤切除术患者实施PDCA循环管理护理对术区美容效果的影响。方 法 选取我院2022年1月-11月收治的80例乳腺良性肿瘤患者为研究对象,采用随机数字表法分为对照组 和试验组,每组40例。对照组开展常规护理,试验组开展PDCA循环管理护理,比较两组心理状 况、生活质量、护理满意度及术区美容效果。结果 试验组出院时HAMA评分、HAMD评分低于 对照组（P＜0.05）;试验组出院时生活质量各项评分高于对照组（P＜0.05）;试验组护理满意度 为100.00%,高于对照组的82.50%（P＜0.05）;试验组乳房形状、切口瘢痕、色素沉着、乳头（晕）感觉评分 均高于对照组（P＜0.05）。结论 对乳腺良性肿瘤切除术患者实施PDCA循环管理护理的效果良好,可有效改善 患者的焦虑、抑郁情绪,提高其生活质量,有利于提高术区美容效果,且患者对护理工作的满意度较高。     

Clinicopathologic Features and Long-Term Outcomes of 293 Phyllodes Tumors of the Breast

BACKGROUND: Phyllodes tumors (PT) are rare fibroepithelial neoplasms of the breast with unpredictable behavior. We reviewed our single institution experience with PT over 51 years to identify factors predictive of local recurrence (LR) and metastasis. METHODS: From 1954 to 2005, a total of 352 cases of PT were identified; 293 had follow-up. All available pathology slides (90%) were rereviewed for margins, borders, fibroproliferation in the surrounding breast tissue, stromal pattern, stromal cellularity, frequency of mitoses, and necrosis. RESULTS: All cases occurred in women, with a median age of 42, with 203 originally categorized as benign and 90 as malignant. Median follow-up was 7.9 years. A total of 35 patients developed LR at a median of 2 years. In univariate analyses, a higher actuarial LR rate was associated with positive margins (P = .04), fibroproliferation (P = .001), and necrosis (P = .006). PT classified as malignant did not have a higher risk of LR (P = .79). Five patients developed distant disease at a median of 1.2 years. These patients constituted 71% of the seven patients who had uniformly aggressive pathologic features, including large tumor size (>or=7.0 cm), infiltrative borders, marked stromal overgrowth, marked stromal cellularity, high mitotic count, and necrosis. CONCLUSIONS: Positive margins, fibroproliferation in the surrounding breast tissue, and necrosis are associated with a marked increase in LR rates. Efforts should be made to achieve negative surgical margins to reduce risk of LR. Death from PT is rare (2%), and only PT that demonstrate uniformly aggressive pathologic features seem to be associated with mortality.     

PDCA循环管理对乳腺良性肿瘤切除术后术区美容效果的影响

目的:探讨分析PDCA循环管理模式对乳腺良性肿瘤切除术后美容效果的影响。方法:选择2016年4月-2017年3月在笔者医院行乳腺良性肿瘤切除术患者78例作为对照组,选择2017年4月-2018年3月83例患者作为观察组。在相同的乳腺良性肿瘤切除术下,对照组采取常规护理措施,观察组采取PDCA循环管理护理方案。比较两组患者手术前后抑郁、焦虑状态,出院时对护理满意度以及术后6个月乳房美容效果。结果:出院时两组患者HAMA、HAMD评分均较术前显著降低,且观察组患者HAMA、HAMD评分显著低于对照组,差异有统计学意义(P<0.05)。观察组患者护理满意度显著高于对照组,差异有统计学意义(P<0.05)。术后6个月,观察组患者乳房形状、切口瘢痕、色素沉着、乳头(晕)感觉评分均显著高于对照组,差异有统计学意义(P<0.05)。结论:PDCA循环管理模式可有效改善乳腺良性肿瘤切除术患者术后不良心理情绪,有助于术后美容效果的提高,并提高患者护理满意度,值得临床推广。     

Oncoplastic Approach to Giant Benign Breast Tumors Presenting as Unilateral Macromastia

Benign breast tumors attaining large size constitute an important cause of unilateral macromastia. Their usual treatment involves enucleation or excision with a margin based on pathology and waiting for spontaneous retraction of skin envelope. In very large tumors, this will leave the residual breast deflated and unaesthetic, with spontaneous skin retraction giving unpredictable results. Application of the principles of oncoplastic surgery are helpful in this situation. Here, we present two cases of benign giant tumors—a giant fibroadenoma and a giant lipoma—managed by reduction mammaplasty approach to restore the breast symmetry and aesthetics.     

卵巢良性肿瘤宫腔镜辅助经阴道手术与腹腔镜手术的比较

目的探讨宫腔镜辅助经阴道切除卵巢良性肿瘤的可行性。方法 2010年3月～2011年10月我院65例需要保留子宫的直径<10 cm卵巢良性肿瘤,其中28例采用经阴道切开后穹隆,撑开器暴露子宫直肠陷凹,联合宫腔镜行卵巢肿瘤切除术(研究组),37例行腹腔镜手术(对照组)。比较2种手术方式的术中出血量、手术时间、术后疼痛、术后病率、肠功能恢复时间、术后住院时间、住院费用。结果研究组手术时间(40.1±4.5)min显著短于对照组(60.2±6.0)min(t=-14.837,P=0.000),术后肠功能恢复时间(13.4±8.5)h显著短于对照组(23.5±9.5)h(t=-4.351,P=0.000),术后疼痛明显轻于对照组(Z=-8.525,P=0.002),住院费用(4231.2±103.2)元明显低于对照组(5442.7±123.2)元(t=-42.038,P=0.000);研究组术后病率与对照组无统计学差异(0例vs.5例,P=0.053),术中出血量(55.2±5.2)ml与对照组(53.2±5.8)ml差异无显著性(t=1.439,P=0.155),术后住院时间(4.5±1.5)d与对照组(5.0±1.5)d差异无显著性(t=1.331,P=0.188)。结论宫腔镜辅助经阴道切除卵巢良性肿瘤可行,具有创伤小、恢复快、腹部无瘢痕、无须气腹、标本完整取出等优点,但要选择适当的病例。     

Surgical Management of 121 Benign Proximal Fibula Tumors

Background  

Tumors of the fibula comprise only 2.5% of primary bone lesions. Patients with aggressive benign tumors in the proximal fibula may require en bloc resection. Peroneal nerve function, knee stability, and recurrence are substantial concerns with these resections. The incidence and fate of these complications is not well-known owing to the small numbers of patients in previous reports.     

A Case of a Giant Borderline Phyllodes Tumor Early in Pregnancy Treated with Mastectomy and Immediate Breast Reconstruction

Breast tumors in pregnancy are often times diagnosed at advanced stages secondary to difficulty distinguishing between pathologic from normal physiologic changes. Often benign, phyllodes tumors are rare fibroepithelial stromal tumors of the breast, most commonly diagnosed in the 4th and 5th decades of life. However, these tumors may be characterized by malignancy with metastases in 10% of cases. In this paper, we report a novel case of a young woman presenting at 8 weeks gestation with a large borderline phyllodes tumor. An exceedingly rare condition, with only nine previously reported cases, phyllodes tumors in pregnancy frequently display more aggressive characteristics with larger median tumor size, more malignant potential, and more rapid growth rate. Here, we describe our experience safely and effectively treating this rare condition in a young gravid women with mastectomy and immediate breast reconstruction in the second trimester.     

Surgical Management of Carotid Body Tumors

Background  Carotid body tumors (CBT) should be considered when evaluating every lateral neck mass. Methods  A retrospective study was conducted of 52 patients with 57 CBT. The surgical approach and complications were reviewed. All patients were operated on without preoperative embolization. Results  Multifocal paraganglioma (PG) were detected in six cases. A succinate dehydrogenase subunit D (SDHD) mutation was discovered in four patients. Vascular peroperative complication occurred in one case. Vascular reconstruction was decided peroperatively in five cases (8.8%). Vascular reconstruction was 0% for Shamblin 1 or 2 tumors, but 28.5% for Shamblin 3. A postoperative nerve paresis was reported in 24 patients (42.1%) and vagal nerve paralysis persisted in four cases (7.01%). The rate of serious complications, e.g., permanent nerve palsy, preoperative and postoperative complications, was 14.03%; it was 2.3% for Shamblin 1 or 2 tumors and 35.7% for Shamblin 3. One patient had malignant PG with node metastasis and was not referred for radiotherapy. No recurrence or metastasis was reported after 6-year follow-up. Conclusion  Early surgical treatment is recommended in almost all patients after preoperative evaluation and detection of multifocal tumors. Surgical excision of small tumors was safe and without complication, but resection of Shamblin 3 tumors can be challenging. Routine preoperative embolization of carotid body paragangliomas is not required.     

Value of Conventional MRI Texture Analysis in the Differential Diagnosis of Phyllodes Tumors and Fibroadenomas of the Breast

BackgroundThere is substantial overlap in MRI findings between phyllodes tumors (PTs) and fibroadenomas (FAs). Our study was performed to investigate the value of conventional MRI texture analysis in the differential diagnosis of PTs and FAs.MethodsPreoperative MRI data − including axial T1WI, T2WI_FS (T2WI with fat suppression), dynamic contrast-enhanced (DCE)-T1WI_2min and DCE-T1WI_7min (T1WI post-strengthened for 2 and 7 min, respectively, on DCE-MRI) − of 45 patients with PTs and 67 patients with FAs were retrospectively analyzed. MaZda 4.7 software was used to manually draw the maximum ROIs at the same lesion level of the above MRI images. The optimized feature selection methods included Fisher''s coefficient, probability of classification error and average correction coefficient (POE + ACC), and mutual information (MI) as well as a combination of the above 3 methods (F + POE + ACC + MI [FPM]), respectively. The misclassification rates of PTs and FAs were compared between texture analysis and subjective diagnosis by radiologists.ResultsThe DCE-T1WI_7min images had the lowest misclassification rate of 10.71% (12/112). The misclassification rate for the radiologists'' analysis (31.25%, 35/112) was higher than that of all the texture analysis, and there was a statistically significant difference between the radiologists'' misclassification rates and those from the FPM method in terms of the T2WI_FS and DCE-T1WI_2min images (all p < 0.05), and for the DCE-T1WI_7min images by using the Fisher and FPM methods (all p < 0.05).ConclusionTexture analysis of conventional MRI can be used as an assistant tool in providing a certain objective basis for differentiating PTs from FAs.     

Surgical Management of Spinal Intramedullary Tumors: Radical and Safe Strategy for Benign Tumors

Surgery for spinal intramedullary tumors remains one of the major challenges for neurosurgeons, due to their relative infrequency, unknown natural history, and surgical difficulty. We are sure that safe and precise resection of spinal intramedullary tumors, particularly encapsulated benign tumors, can result in acceptable or satisfactory postoperative outcomes. General surgical concepts and strategies, technical consideration, and functional outcomes after surgery are discussed with illustrative cases of spinal intramedullary benign tumors such as ependymoma, cavernous malformation, and hemangioblastoma. Selection of a posterior median sulcus, posterolateral sulcus, or direct transpial approach was determined based on the preoperative imaging diagnosis and careful inspection of the spinal cord surface. Tumor-cord interface was meticulously delineated in cases of benign encapsulated tumors. Our retrospective functional analysis of 24 consecutive cases of spinal intramedullary ependymoma followed for at least 6 months postoperatively demonstrated a mean grade on the modified McCormick functional schema of 1.8 before surgery, deteriorating significantly to 2.6 early after surgery (< 1 month after surgery), and finally returning to 1.7 in the late postoperative period (> 6 months after surgery). The risk of functional deterioration after surgery should be taken into serious consideration. Functional deterioration after surgery, including neuropathic pain even long after surgery, significantly affects patient quality of life. Better balance between tumor control and functional preservation can be achieved not only by the surgical technique or expertise, but also by intraoperative neurophysiological monitoring, vascular image guidance, and postoperative supportive care. Quality of life after surgery should inarguably be given top priority.     

Surgical Treatment of Borderline and Malignant Phyllodes Tumors: The Effect of the Extent of Resection and Tumor Characteristics on Patient Outcome

Introduction

Malignant phyllodes tumors are rare fibroepithelial breast neoplasms. Appropriate surgical management remains a subject of debate. The purpose of our study was to define optimal surgical treatment and to identify factors associated with outcome.

Methods

After confirmatory pathology review, we identified 67 patients with borderline (n = 15) and malignant (n = 52) phyllodes tumors treated at our institution between 1971 and 2008. We used Cox proportional hazards models to evaluate associations between treatment, patient and tumor characteristics, and disease-free (DFS) and cancer-specific survival (CSS).

Results

Median patient age was 47 years. For 32 patients, definitive surgical treatment was wide local excision (WLE): 27 with margins ≥1 cm and 5 with margins <1 cm. Thirty-five underwent mastectomy. Two patients received radiotherapy after WLE and two after mastectomy with microscopically positive margins. After 10 years median follow-up, 16 patients (24 %) recurred locally (8 postmastectomy and 8 after WLE). Treatment type and margin extent did not impact local recurrence. Fifteen patients (22 %) developed distant disease. Overall 5-year DFS was 67.9 % and CSS 80.1 %. Tumor size >5 cm, mitotic rate ≥10/10 HPF, stromal overgrowth and cellularity (all p < 0.05) predicted DFS, whereas CSS was associated with the latter three variables. CSS was diminished for mastectomy patients who were significantly more likely to harbor tumors with adverse features.

Conclusions

With long-term follow-up, extent of surgical resection did not affect DFS for patients with borderline and malignant phyllodes tumors. Tumor features, most notably stromal overgrowth, were predictive of recurrence and survival, suggesting these high-risk patients may benefit from additional therapeutic strategies.     

Magnetic Resonance Imaging of a Benign Phyllodes Tumor of the Breast

Summary

Background

The aim of this study was to evaluate a phyllodes tumor of the breast with magnetic resonance imaging (MRI) and magnetic resonance spectroscopy.

Methods

MRI of the breasts was performed using a phased array double breast coil with spectroscopic capability on a 1.5T MR scanner. Post-contrast sequential imaging was done, and the subtracted images were evaluated. Timesignal intensity curves were obtained. MR spectroscopy using BREASE software was also performed.

Results

MRI combined with MR spectroscopy was used in the diagnosis and characterization of a phyllodes tumor of the breast.

Conclusion

MRI and MR spectroscopy may offer an in vivo imaging technique for the characterization of phyllodes tumors of the breast.Key Words: Phyllodes tumor, Magnetic resonance imaging, Magnetic resonance spectroscopy, Slit-like spaces     

Malignant Phyllodes Tumor of the Breast: Treatment and Prognosis

Surgery remains the mainstay of the treatment in patients with malignant phyllodes tumor of the breast (MPTB); however, the extent of surgery (breast conserving surgery [BCS] versus mastectomy) and the role of adjuvant radiotherapy have been controversial. We report a single institution's experience with MPTB. We discuss controversial therapeutic aspects of this rare tumor. Seventy patients with MPTB treated primarily with surgery were evaluated. The mean age was 50 years (21–76), and the mean size of the tumor was 6 cm. Thirty‐four (48.6%) patients were treated with total mastectomy, and 36 (51.4%) were treated with BCS (lumpectomy or wide local excision). Microscopic surgical margins were free of tumor in all cases. In 64 (91.4%) patients, margins were ≥1 cm. Remaining 6 (8.6%) patients treated with BCS margins were <1 cm and subsequently radiotherapy was performed. Among 70 patients, 58 (82.9%) had no evidence of disease (NED) after 5 years. The extent of surgery was not significantly related to the 5‐year NED survival rates (82.4% in patients who underwent mastectomy and 83.3% in patients who underwent BCS only or BCS with adjuvant irradiation). The 5‐year NED survival rates in BCS (tumor‐free margin ≥1 cm) and BCS with irradiation (tumor‐free margin <1 cm) groups were identical (83.3%). Our data support the potential use of BCS in patients with MPTB. Mastectomy is indicated only if tumor‐free margins cannot be obtained by BCS. Adjuvant radiotherapy may be considered if tumor‐free margins are <1 cm.