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。     

42例乳腺叶状囊肉瘤的临床分析

目的 总结乳腺叶状囊肉瘤的诊治情况。方法 回顾性分析42例乳腺叶状囊肉瘤的诊断及治疗的结果。结果 42例均行手术切除。其中低度恶性28例，中度恶性8例，高度恶性6例。术后9例又做了补充手术。2例（4．76％）术后局部复发。结论 乳腺叶状囊肉瘤最主要的诊断依据是组织学检查。手术是首选的治疗方法。术式一般采用局部广泛切除术，乳腺区段切除术及乳腺单纯切除术，肿块单纯切除术不可取。腋淋巴结一般不必常规作清扫。术后须对部分病例做补充手术。     

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。     

乳腺复发性叶状肿瘤临床病理分析

目的:探讨乳腺复发性叶状肿瘤临床及病理特征。方法:收集2011年01月至2019年12月在我院进行手术治疗的叶状肿瘤病例,并找出其中复发的病例,分析复发病例的临床及病理组织学特征。结果:叶状肿瘤137例,共有10例为复发病例,其中9例为单次复发,1例复发两次,复发病例中良性叶状肿瘤7例,交界性叶状肿瘤2例,恶性叶状肿瘤1例。所有的肿物均为局部复发,良性、交界及恶性叶状肿瘤复发率分别为5.9%、15.4%、20%。其中3例（30%）出现组织学升级,1例良性叶状肿瘤复发为交界性叶状肿瘤,1例交界性叶状肿瘤复发为恶性叶状肿瘤,1例良性叶状肿瘤第一次复发为交界性叶状肿瘤,第二次复发为恶性叶状肿瘤。免疫组化标记CD117、CD34、CD10、p53、p16在原发及复发肿瘤中表达无差异。Ki67增殖指数在复发病例中均升高,并且核分裂数也增多。结论:良性、交界性、恶性叶状肿瘤均可复发,其中恶性叶状肿瘤复发率最高,肿瘤多为局部复发,部分肿瘤复发后出现组织学升级,复发后肿瘤细胞增殖活性增强。     

乳腺分叶状肿瘤诊疗及预后的探讨

为了探讨乳腺分叶状肿瘤外科治疗方法的选择,观察其影响预后的因素,对我院2001-01-2008-01收治的65例乳腺分叶状肿瘤的临床资料进行回顾性分析.65例分叶状肿瘤均经手术治疗,病理良性32例,交界性13例,恶性20例;15例肿块切除术复发8例,30例行局部扩大切除术复发3例,15例行乳房单切术复发2例,5例发现腋淋巴结肿大行乳房单切+腋淋巴结清除术,其中2例分别于术后10和18个月死于远处转移.初步研究结果提示,局部扩大切除术是治疗乳腺分叶状肿瘤的首选方案,但应保证组织学上干净的切缘,乳房单切术对恶性分叶状肿瘤没有生存优势,对局部复发的交界性或恶性肿瘤选择乳房单切术,无需行淋巴结清除.     

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.     

乳腺叶状囊肉瘤的36例临床分析

目的总结乳腺叶状囊肉瘤的诊治情况,方法回顾性分析36例乳腺叶状囊肉瘤的诊断及治疗结果.结果36例中良性27例,交界性3例、恶性6例.结论乳腺叶状囊肉瘤最主要的诊断依据是组织学检查.肿瘤转移以血行转移为主,淋巴转移少见.手术是首选的治疗方法.术式一般采用乳腺肿瘤切除术,乳腺区段切除术、乳腺单纯切除术及改良根治乳房切除术.术后化学疗法、放射疗法及内分泌治疗无效.     

42例乳腺叶状囊肉瘤的临床分析

目的　总结乳腺叶状囊肉瘤的诊治情况。方法　回顾性分析 42例乳腺叶状囊肉瘤的诊断及治疗的结果。结果　 42例均行手术切除。其中低度恶性 2 8例、中度恶性 8例、高度恶性 6例。术后 9例又做了补充手术。 2例 ( 4 76% )术后局部复发。结论　乳腺叶状囊肉瘤最主要的诊断依据是组织学检查。手术是首选的治疗方法。术式一般采用局部广泛切除术、乳腺区段切除术及乳腺单纯切除术 ,肿块单纯切除术不可取。腋淋巴结一般不必常规作清扫。术后须对部分病例做补充手术     

乳腺叶状肿瘤89例临床分析

目的：探讨乳腺叶状肿瘤的临床特点及影响预后的因素。方法：对我院收治的89例经病理确诊的乳腺叶状肿瘤临床资料进行回顾性分析。结果：89例患者均行手术治疗，肿块切除15例；乳腺区段切除16例；乳腺单纯切除26例；改良根治术32例。术后病理腋窝淋巴结转移1例。全组共有13例局部复发，局部复发率为14．6％（13／89）。肿块切除、乳腺区段切除、乳腺单纯切除和改良根治术者的局部复发率分别为60．0％（9／15）、12．5％（2／16）、7．7％（2／26）和0（o／32），差异有统计学意义，P〈0．01。5例有远处转移，其中3例肺转移，1例脑转移．1例胰腺转移。用Cox比例风险模型分析影响生存顸后的因素，远处转移是影响生存预后的主要因素，P〈0.01。结论：乳腺叶状肿瘤确诊有赖术后病理检查。行肿块切除术的复发率较高，必须慎用；腋窝淋巴结转移率低，腋窝清除不需常规进行。顸后较好．远处转移是影响生存预后的主要因素。     

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.     

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.     

Phyllodes tumor of the breast: a multicenter series of 59 cases. Coordinating Center and Writing Committee of FONCAM (National Task Force for Breast Cancer), Italy.

A series of 59 phyllodes tumors of the breast was retrospectively reviewed (average follow-up = 3.9 years). Clinical features (age, size of tumor) and diagnostic tests (palpation, mammography, sonography and cytology) were found to be inaccurate in predicting benign (n = 22), borderline (n = 12) or malignant (n = 25) histological type. Limited surgery was associated with a relatively high proportion of local recurrence (enucleation/enucleoresection = 3/5, wide resection = 12/30) compared with mastectomy (2/24). No significant association was observed between the probability of local recurrence and patient's age, histological type or lesion size. Although the study confirms that limited surgery may cure phyllodes tumor, careful follow-up of all patients is needed, since no reliable risk factors for recurrence are available. In malignant cases, axillary node involvement was nil and distant metastases were infrequently observed (3/25). Axillary dissection and search for asymptomatic metastases is not recommended.     

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。     

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 tumors of the breast diagnostic and therapeutic dilemmas

BACKGROUND: This article compares experiences in the diagnosis and treatment of phyllodes tumors from 2 regional institutions with the relevant literature. PATIENTS AND METHODS: From 1991 to 2005, 2,848 breast cancer patients were treated in our institutions, 36 (1.44%) for phyllodes tumors. The average tumor size was 5.1 cm (range 1.4-19.6). Triple assessment was the standard diagnostic algorithm. Wide excision with tumor-free margins was carried out in 29 (80.5%) cases and mastectomy in 7 (19.4%) cases. Axillary lymphadenectomy was performed in patients with positive lymph nodes. RESULTS: Histology showed the phyllodes tumors to be benign in 27 (75.0%), malignant in 6 (16.6%), and borderline in 3 (8.3%) cases. Follow-up was from 5 months to 16 years. In this period, recurrences of 3 (8.3%) malignant and 2 (5.6%) benign phyllodes tumors were diagnosed and treated. 10 (27.7%) patients treated with wide local excision showed deformities in the form of scarring. The steroid receptor status was of no prognostic value in our patients, and chemotherapy was used in only 1 (2.7%) patient. 5-year survival was 86.2%. CONCLUSION: Our study shows that tumor size, margin infiltration, mitotic activity and degree of cellular atypia are important prognostic factors. Problems in diagnosing this condition arise from its similarity to fibroadenoma. Although wide local excision is usually the treatment of choice, tumor recurrence is common. Axillary lymphadenectomy in malignant phyllodes tumors is, in our opinion, still controversial.