乳腺叶状肿瘤的临床与影像诊断

乳腺叶状肿瘤(PTs)是由乳腺间质和上皮成分构成的纤维上皮型肿瘤,常需要与乳腺纤维腺瘤鉴别.乳腺叶状肿瘤临床手术切除后复发和转移率较高,因此首次术式选择非常重要,强调切除范围应足够大,术前影像学检查可为诊断提供必要的参考.从而提示临床选择恰当的手术方式.就PTs的临床病理特点和影像学表现进行综述.     

乳腺叶状肿瘤的临床与影像诊断

乳腺叶状肿瘤（PTs）是由乳腺间质和上皮成分构成的纤维上皮型肿瘤,常需要与乳腺纤维腺瘤鉴别。乳腺叶状肿瘤临床手术切除后复发和转移率较高,因此首次术式选择非常重要,强调切除范围应足够大,术前影像学检查可为诊断提供必要的参考,从而提示临床选择恰当的手术方式。就PTs的临床病理特点和影像学表现进行综述。     

MRI在乳腺叶状肿瘤与纤维腺瘤鉴别诊断中的价值

目的 分析乳腺叶状肿瘤(PTs)的MRI特征,提高PTs与纤维腺瘤(FAs)的鉴别诊断水平.方法 搜集经手术病理证实、行MRI检查的PTs患者10例及FAs患者33例,分析其MRI表现,并进行统计学分析,比较两者的差异.结果 10例PTs中,术后病理诊断良性2例,交界性8例.叶状肿瘤具有短期内明显增大病史,在最大横径、深分叶、T1WI上存在高信号区域、T2囊性成分、低信号的分隔、不均匀强化、增多的血管、时间-信号强度曲线上,与FAs有统计学差异(P =0.026).在T2WI信号、胆碱(Cho)峰值上,两者没有统计学差异.结论 PTs和FAs在MRI表现上有一定差异,有助于PTs的正确诊断.     

乳腺叶状肿瘤的X线表现及病理对照分析

目的 分析乳腺叶状肿瘤(phyllodes tumors of the breast, PTs)的X线特征,并与病理结果相对照.方法 回顾性分析60例经手术病理证实PTs的X线特征及病理表现.良性PTs 5例,交界性PTs 45例,恶性PTs 10例,其中1例含有软骨肉瘤成分,1例含有脂肪肉瘤成分,其余PTs含有纤维肉瘤成分.结果 (1)60例PTs,53例X线片表现为肿块,7例为肿块伴钙化,包括交界性PTs 4例,恶性PTs 3例.46例有"透亮晕征".(2)肿物圆形6例,卵圆形14例,分叶形35例(其中14例表现为深分叶或多结节样堆积或肿块周围伴发结节),不规则形5例.26例肿块边缘清楚光滑,28例边缘模糊,6例边缘呈浸润性改变. 结论良性PTs常为边缘清楚的分叶状肿块,边缘浸润的分叶状肿块常为恶性.     

乳腺叶状肿瘤的MRI表现及临床病理学分析

目的:分析乳腺叶状肿瘤(phyllodes tumors,PTs)的MRI表现,以提高MRI的诊断价值。方法:回顾性分析8例PTs患者的临床及影像资料,包括肿瘤在T1WI、STIR序列上的信号强度,肿瘤大小、形状、边缘、内部强化方式、早期强化率、时间-信号强度曲线(time-signal intensity curve,TIC)类型及ADC值;比较PTs与正常腺体ADC值的差异。结果:8例乳腺PTs中,3例良性,4例交界性,1例恶性。MRI平扫T1WI呈等及较低信号,STIR呈高信号,3例肿瘤内见低信号未强化分隔,6例见裂隙状高信号;最大径线2.4~7.5cm;2例呈圆形、类圆形,6例呈分叶状;8例边缘均较清晰;增强扫描病灶均呈不均匀强化;7例PTs早期强化率大于100%,1例50%且100%;TIC类型1例为流入型,5例为平台型,2例为廓清型。DWI病灶均呈高信号,且ADC值低于正常腺体,PTs平均ADC值为(1.30±0.25)×10-3 mm2/s,正常腺体ADC值为(1.64±0.12)×10-3 mm2/s,二者差异有统计学意义(t=3.375,P0.05)。结论:乳腺PTs的MRI征象具有一定的特征性,结合其临床特点综合分析,可提高其术前诊断准确率。     

浅析乳腺叶状肿瘤的诊断与治疗

乳腺叶状肿瘤是一种少见的乳腺肿瘤。好发于40～50岁，体积巨大，平均直径5cm。73％的良性肿瘤在5cm以下，恶性肿瘤几乎全在7cm以上。该肿瘤间质成分高度增生，形成叶状结构，将上皮成分挤压成裂隙状。根据其间质细胞异型程度、密度、核分裂象、肿瘤边缘以及有无坏死出血将叶状肿瘤分为三级。免疫组化ER、RR、Vim、Aetin、S-100可提供一定帮助。乳腺叶状肿瘤主要是与纤维腺瘤相鉴别。术后5年生存率可达90％以上。     

乳腺叶状肿瘤MRI表现特征分析

目的分析乳腺叶状肿瘤(phyllodes tumors,PTs)MRI平扫、动态增强、扩散加权成像(DWI)和磁共振波谱(MRS)表现特征,提高对本病MRI诊断水平。资料与方法搜集2005年1月至2008年12月期间于我院行乳腺MRI检查并经手术病理证实的5例乳腺PTs,按照美国放射学会提出的乳腺影像报告和数据系统磁共振成像(BI-RADS-MRI)标准,回顾性分析病变的MRI表现,包括形态学、平扫T1WI及T2WI信号、动态增强表现及强化曲线类型、DWI信号及表观扩散系数(ADC)值和MRS表现特征。结果5例乳腺PTs病理诊断良性1例,交界性2例,恶性2例。MRI上4例表现为分叶状,1例为卵圆形;5例PTsMRI平扫T1WI均呈较低信号,T2WI呈高信号,其中1例内有低信号分隔;4例行动态增强检查的PTs于动态增强早中期(增强后第一至第三时相)呈快速渐进性强化,动态增强中后期时间-信号强度曲线3例呈平台型,1例呈轻度流出型;5例PTs于DWI上均呈高信号,ADC值低于正常乳腺组织,且低于鉴别乳腺良恶性病变的ADC界值;3例行MRS检查,均可见胆碱(Cho)峰。结论MRI检查有助于乳腺PTs的诊断,但确诊仍需...     

乳腺叶状肿瘤的影像学表现与病理对照分析

目的 探讨不同病理学分级的乳腺叶状肿瘤(PTs)的影像学表现,提高对PTs的认识及诊断水平.方法 回顾性分析65例经手术病理证实为PTs患者的临床及影像学资料,其中61例行超声和MRI检查,44例行X线检查,并与其病理学结果相对照.结果 (1)65例PTs患者,病理类型为良性、交界性和恶性的百分比分别为32.3%(21/65)、43.1%(28/65)和24.6%(16/65);其病灶的平均最大径分别为(4.75±2.62) cm、(5.37±3.11) cm和(4.96±3.82) cm,差异无统计学意义(F=0.247,P=0.782).(2)在44例PTs患者(包括良性16例,交界性18例,恶性10例)的X线图像上,病灶透亮晕及钙化有无在三者中差异有统计学意义(P均<0.05).(3)在61例PTs患者(包括良性19例,交界性26例,恶性16例)的声像图上,不同病理类型病灶形状差异有统计学意义(P<0.05).(4)在61例PTs患者(包括良性21例,交界性24例,恶性16例)的MRI图像上,三者在T2WI上病变内低信号分隔的有无、时间-信号强度曲线(TIC)方面差异有统计学意义(P均<0.05).结论 乳腺PTs的影像学表现有助于明确其病理学分类.     

乳腺叶状肿瘤的超声诊断(附33例分析)

目的探讨乳腺叶状肿瘤的声像图特点和超声诊断价值,以提高诊断水平。方法回顾分析33例经手术病理证实的乳腺叶状肿瘤患者,观察其超声的声像图表现:病变的部位、大小、形态、边界、内部回声与后方回声、有无液化和钙化,利用彩色多普勒超声观察肿块内部及周边的血流分布情况。结果 33例乳腺叶状肿瘤中,良性12例,交界性12例,恶性9例。乳腺叶状肿瘤的二维声像图表现:体积较大的分叶状肿块,边界清晰、规则,内部以实性低回声为主,回声大部分均匀,部分可见散在的无回声区,无或少有钙化,后方回声增强,所有肿块的内部和/或周边均可探及血流信号。结论超声对乳腺叶状肿瘤的定性诊断具有较高的临床应用价值。     

乳腺分叶状肿瘤的超声表现与病理对照分析

目的:分析乳腺分叶状肿瘤的超声表现,提高对该病的认识。方法:回顾性分析我院18例经手术病理证实的乳腺分叶状肿瘤患者的临床及影像资料,探讨其超声表现。结果:18例中,病理为良性者14例,交界性3例,恶性1例。乳腺超声主要表现为分叶状肿块11例;最大径≥3cm 7例;11例内部回声不均匀。乳腺超声与病理诊断的符合率为55.5%。结论:乳腺分叶状肿瘤的超声表现有一定特征性,肿瘤分叶状形态及不均匀内部回声是其特征性表现。     

Predicting the pathological grade of breast phyllodes tumors: a nomogram based on clinical and magnetic resonance imaging features

Objective:To explore the potential factors related to the pathological grade of breast phyllodes tumors (PTs) and to establish a nomogram to improve their differentiation ability.Methods:Patients with PTs diagnosed by post-operative pathology who underwent pretreatment magnetic resonance imaging (MRI) from January 2015 to June 2020 were retrospectively reviewed. Traditional clinical features and MRI features evaluated according to the fifth BI-RADS were analyzed by statistical methods and introduced to a stepwise multivariate logistic regression analysis to develop a prediction model. Then, a nomogram was developed to graphically predict the probability of non-benign (borderline/malignant) PTs.Results:Finally, 61 benign, 73 borderline and 48 malignant PTs were identified in 182 patients. Family history of tumor, diameter, lobulation, cystic component, signal on fat saturated T₂ weighted imaging (FS T₂WI), BI-RADS category and time–signal intensity curve (TIC) patterns were found to be significantly different between benign and non-benign PTs. The nomogram was finally developed based on five risk factors: family history of tumor, lobulation, cystic component, signal on FS T₂WI and internal enhancement. The AUC of the nomogram was 0.795 (95% CI: 0.639, 0.835).Conclusion:Family history of tumor, lobulation, cystic components, signals on FS T₂WI and internal enhancement are independent predictors of non-benign PTs. The prediction nomogram developed based on these features can be used as a supplemental tool to pre-operatively differentiate PTs grades.Advances in knowledge:More sample size and characteristics were used to explore the factors related to the pathological grade of PTs and establish a predictive nomogram for the first time.     

乳腺假血管瘤样间质增生的影像特征与病理表现

乳腺假血管瘤样间质增生（PASH）为一种良性间质细胞增生,属于肌纤维母细胞增生范畴。PASH常发生于绝经前及绝经后使用激素替代治疗的女性,需与低度恶性血管肉瘤、叶状肿瘤及纤维腺瘤鉴别。乳腺X线摄影、B超及核医学诊断PASH价值有限,但在乳腺MRI不同序列上PASH具有一定特点。对于疑诊PASH的病人,分析比较影像表现与穿刺活检病理表现是否一致非常重要。对PASH的临床表现、病理学特点及影像表现等予以综述。     

Phyllodes tumours of the breast: radiological presentation,management and follow-up

Objective:

Phyllodes tumours (PTs) are rare neoplasms accounting for <1% of breast lesions. With increased breast awareness and screening programmes, smaller PTs are being detected. The purpose of this study was to determine the clinical, radiological and pathological presentation of PTs and to evaluate the role of imaging follow-up, for which there are no specific guidelines.

Methods:

A retrospective study of all patients diagnosed with PT in a symptomatic unit between January 2006 and March 2013 was carried out. Patients were identified using breast care and electronic patient record databases.

Results:

53 patients with 54 lesions were diagnosed as having a PT. The median age was 27.5, 35.0 and 38.5 years for benign, borderline and malignant PT, respectively. Borderline and malignant PTs were larger than benign PTs, with mean sizes of 33 and 42 mm compared with 29 mm. 38% of PTs were labelled by the reporting radiologist as fibroadenomas, including two borderline PTs and one malignant PT. In 24% of cases, the radiologist raised the possibility of PT in the report. 17 patients (40%) developed a new fibroepithelial breast lesion during follow-up of which 4 were recurrent PTs.

Conclusion:

Despite adequate surgical management, the development of further fibroepithelial lesions in the ipsilateral breast is common. 3-year clinical surveillance, with the addition of 6-monthly ultrasound is advised for females with initial borderline or malignant PT histology.

Advances in knowledge:

We propose a follow-up protocol with ultrasound based on the grade of the PT diagnosed for 3 years to detect recurrence.Phyllodes tumours (PTs) are rare biphasic fibroepithelial neoplasms accounting for <1% of all breast lesions.¹ In the literature, they have been described as occurring in females aged 35–55 years, typically 15–20 years older than females with fibroadenomas (FAs) and with a higher incidence in Asian females.^2,3 Imaging findings of PT and FA overlap and as such lesions may be misdiagnosed.⁴ Histologically, PTs can be identified by their distinctive leaf-like architecture and increased stromal cellularity.⁵ Typically, PTs present as a palpable breast lump and were traditionally differentiated from FAs based on their larger size at presentation.⁶ However, with increased breast awareness and screening programmes, smaller and incidental lesions are being found on imaging.⁶ In symptomatic breast clinics, including this institution, “triple assessment” consisting an initial physical examination, followed by radiological imaging (ultrasound and/or mammography) and histological sampling either by fine-needle aspiration cytology (FNAC) or core biopsy is the standard diagnostic pathway for palpable breast lesions. The purpose of triple assessment is to provide a more accurate pre-operative diagnosis to ensure proper surgical planning and avoiding re-excision or tumour recurrence.⁷According to the World Health Organization criteria, there are two grading systems for PTs; a two-tiered system or a three-tiered system.⁸ Our institution employs the three-tiered system, the subgroups being benign, borderline and malignant. Grading is based on semi-quantitative assessment of stromal cellularity, cellular pleomorphism, mitotic activity, margin appearance and stromal distribution. The standard procedure for treatment, no matter what the grade of the PT, is surgical wide local excision, preferably with clear margins of at least 1 cm. However, owing to the fact that most PTs are not fully diagnosed pre-operatively, initial surgery does not always provide adequate margins necessitating frequent post-operative re-excision of the margins.³The purpose of our study was to determine the radiological findings in females diagnosed with PT in our institution, including both initial presentation and subsequent representations. Based on the findings of the study and review of the literature, a suitable protocol for the imaging follow-up of these females was to be proposed.     

Differentiation between benign phyllodes tumors and fibroadenomas of the breast on MR imaging

Purpose

The purpose of this study was to determine the factors that contribute to the differentiation between phyllodes tumors (PTs) and fibroadenomas (FAs) on MR imaging.

Materials and methods

This retrospective study included 19 PTs and 18 FAs with ≥2 cm diameter. The presence or absence of a capsule and internal septum, the extent of lobulation, and the apparent diffusion coefficient (ADC) values were determined. The presence or absence of a cystic component, the time–intensity curve, and the signal intensity on delayed-phase contrast-enhanced T1WI were also evaluated in 31 patients (16 PTs and 17 FAs) who underwent a contrast-enhanced study.

Results

Cystic components were seen in 10 of the 16 PTs (63%) and in 4 of the 17 FAs (24%; P = 0.03). The PTs showed strong lobulation more frequently compared to the FAs (14/19 [74%] vs. 7/18 [39%], respectively; P = 0.04). Though there was no significant difference, PT tended to be heterogeneous more frequently on the delayed phase of the contrast-enhanced T1WI compared to the FA (11/16 [69%] vs. 7/17 [41%], respectively). No significant difference was found in the other findings.

Conclusions

Although PTs and FAs show similar MR findings, the presence of a cystic component, strong lobulation, and heterogeneity on delayed-phase contrast-enhanced T1WI suggests a PT.     

乳腺叶状肿瘤的MRI特征及鉴别诊断

乳腺叶状肿瘤（PT）是一类少见的乳腺肿瘤,具有上皮和间叶细胞双向分化的特点,表现多样,在临床及影像上可与纤维腺瘤、边缘光整的乳腺癌或乳腺肉瘤相似,在治疗及预后方面则明显不同。传统影像学诊断PT价值有限,而在乳腺增强MRI及功能成像上,PT的影像表现具有一定特征性,对术前诊断及活检穿刺定位有重要意义。就PT的临床表现、病理、MRI特征及鉴别诊断予以综述。     

Role of ultrasound and sonographically guided core biopsy in the diagnostic evaluation of ductal carcinoma in situ (DCIS) of the breast

PURPOSE: The aim of this study was to evaluate the role of ultrasound (US)-guided core biopsy in the diagnosis of ductal carcinoma in situ (DCIS) and to correlate the histological results on percutaneous biopsy and surgical excision. MATERIALS AND METHODS: Out of 2,423 consecutive core biopsies performed under US guidance, we evaluated 65 lesions with a histological diagnosis of DCIS. All patients underwent mammography, high-frequency broadband US and percutaneous breast biopsy with a 14-gauge needle and a mean number of five samples (range 4-7 passes). Surgical excision was performed in all cases, and the histological results on the surgical specimen were correlated with those on core biopsy samples. The sonographic features of DCIS lesions were described, comparing pure DCIS (those confirmed by definitive histology) and DCIS with invasive component at surgical excision. RESULTS: Twenty-seven out of 65 DCIS at core biopsy were found to have an invasive or microinvasive component at surgical excision, leading to rate of histological underestimation of core biopsy of 41.5%. The most frequent sonographic appearances were: (a) mass without microcalcifications (47.4% of pure DCIS, 63% of DCIS with invasive component); (b) mass with microcalcifications (23.7% of pure DCIS, 22% of DCIS with invasive component); (c) isolated microcalcifications (10.5% of pure DCIS); (d) ductal abnormalities (18.4% of pure DCIS, 15% of DCIS with invasive component). CONCLUSIONS: Due to the high underestimation rate of core biopsy, caution is mandatory in the case of DCIS diagnosis on core biopsy. Although some histological features (such as stromal fibrosis, periductal inflammatory infiltrate, high nuclear grade) can suggest the presence of an invasive component, the sonographic appearance of DCIS cannot be used to predict the cases that are underestimated on US-guided core biopsy. Nevertheless, a sonographically detectable solid component, either inside dilatated ducts or associated with microcalcifications, and a size greater than 20 mm are frequently associated with the presence of an invasive component.     

腔外型胃间质瘤的CT诊断

目的:探讨腔外型胃间质瘤的CT表现及其诊断价值。方法:回顾性分析经手术病理证实的15例腔外型胃间质瘤的CT表现。所有患者均行CT平扫和双期(肝动脉期,门静脉期)增强扫描。结果:15例腔外型胃间质瘤均分布在胃的周围,其中与胃之间有密切关系者9例,与胃之间关系不明确者6例。表现为囊性病灶5例、囊实性病灶7例和实性病灶3例,双期增强扫描示肿瘤实质部分均呈明显强化。结论:腔外型胃间质瘤的CT表现有一定特征性,熟悉其表现将能提高对其诊断准确性。     

Cerebellar hemangioblastomas--a study of the immunoprofile of neoplastic stromal component

BACKGROUND: Central nervous system hemangioblastomas (HBs) are uncommon, highly vascularized tumors that are predominantly found in the cerebellum. They occur sporadically or in association with von Hippel-Lindau (VHL) disease. HBs are of unknown histogenesis, and the origin of stromal cells is still a subject of debate. The aim of this study was to investigate the immunoprofile of neoplastic stromal component, and to determine whether the profile of the expression of immunomarkers used can contribute to the elucidation of the histogenesis of HBs. METHODS: A series of eight cerebellar HBs were histochemically examined for the detection of mast cells and immunohistochemically for the expression of factor VIII-related antigen (FVIII-RAg), CD34, vimentin, factor XIIIa (FXIIIa), S-100 protein, glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE), neurofilaments (NF), synaptophysin, chromogranin, and somatostatin. RESULTS: Mast cells were present in all hemangioblastomas, and were particularly abundant in one tumor. Immunohistochemically, intense reactivity for vimentin and NSE in the stromal cells was constantly seen. Immunoreactivity with S-100 protein and FXIIIa was variable, but generally many HBs stromal cells were negative for these markers. However, stromal cells were uniformly negative for FVIII-RAg in all HBs investigated. They were negative for CD34, GFAP, NF, synaptophysin, chromogranin, as well as somatostatin. GFAP-positivity of the occasional stromal type cells, located only peripherally, was interpreted as "pseudopositivity". CONCLUSION: The immunoprofile of neoplastic stromal component in this study suggested a possible origin from undifferentiated multipotential mesenchymal cells. High expression of NSE (glycolytic and hypoxia-inducible enzyme) in the HBs stromal cells might be related to the loss of the VHL protein function.     

Anorectal gastrointestinal stromal tumors: CT and MR imaging features with clinical and pathologic correlation

OBJECTIVE: The purpose of this study was to describe the imaging features of anorectal gastrointestinal stromal tumors with clinical and pathologic correlation. CONCLUSION: Anorectal gastrointestinal stromal tumors are mesenchymal neoplasms that typically arise in the muscularis propria of the intestinal wall. The cross-sectional imaging appearance is that of a well-defined mural mass that may have an exophytic component and may invade adjacent structures. A prominent intraluminal component is a rare feature.