乳腺叶状肿瘤病理分级与超声表现的关系

目的分析乳腺叶状肿瘤(Phyllodes tumor of breast,PTB)的病理分级与超声声像图特点,并探索二者的关系。方法 回顾性分析哈尔滨医科大学附属肿瘤医院经手术病理证实的54例PTB患者的临床资料、病理分级及声像图特点。结果 54例患者手术病理证实均符合PTB,其声像图多表现为较大、分叶状、边界清晰的低回声实性或囊实性团块。病理所示良性7例,交界性43例,恶性4例。肿块大小、形态、内部回声、血流分级与病理分级均相关,差异具有统计学意义(P＜0.05)。结论 PTB的病理分级与超声表现关系密切,但仍缺乏特异性,确诊仍需穿刺活检或手术。     

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。     

超声造影与磁共振成像对乳腺叶状肿瘤病理亚型的诊断效能对比

目的:探究超声造影与核磁共振成像(contrast-enhanced ultrasound and magnetic resonance imaging, MRI)在诊断乳腺叶状肿瘤(phyllodes tumor of the breast, PTB)良恶性方面的诊断效能。方法:回顾性分析39例PTB(病理诊断)的超声造影和MRI特征,比较两种检查方法的诊断效能。结果:良性叶状肿瘤27例,交界性5例,恶性7例。PTB超声造影多呈向心性不均匀高增强伴灌注缺损、增强后边界清晰,其中增强强度、灌注缺损在三组间差异明显(P=0.015、0.009)。PTB的MRI特征以T₂WI低信号裂隙、强化不均匀及Ⅱ型TIC曲线类型为主;且T₂WI低信号分隔、强化特征及ADC值差异具有统计学意义(P=0.027、0.001、0.042)。MRI对PTB的诊断效能高于CEUS,但差异无统计学意义。结论:超声造影在PTB的表现上具有一定特征性,在诊断PTB良恶性方面与MRI具有较好的一致性。     

乳腺叶状肿瘤的临床病理特征分析

目的探讨乳腺叶状肿瘤的临床病理特征。方法回顾性分析40例乳腺叶状肿瘤患者的临床病理资料。结果乳腺叶状肿瘤瘤体的大小无规律性,且切面为分叶状。40例患者中,12例良性肿瘤,3例恶性肿瘤,其余25例为良恶交界性肿瘤。结论乳腺叶状肿瘤具有独特的组织细胞学特点,病理检查是确诊乳腺叶状肿瘤的主要依据,恶性肿瘤与交界性肿瘤容易反复发作或发生转移,手术治疗可降低肿瘤的复发率。     

乳腺叶状肿瘤的MRI表现及病理学分析

目的 探讨乳腺叶状肿瘤(BPT)MRI特征与病理学分级相关性.方法 选取2014年1月至2019年12月在深圳市龙华区中心医院、深圳市中医院乳腺外科的BPT患者70例,术前均进行乳腺MRI检查和术后病理学分析,采用乳腺影像报告和数据系统标准(BI-RADS)分析不同病理分级BPT患者乳腺病灶的MRI图像进行形态学特征(...     

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。     

乳腺叶状肿瘤

乳腺叶状肿瘤较少见,其命名及病理组织学分型一直以来较为混乱,本文主要依据2003年WHO新分类以及近年来国内外研究进展对本病作一综述。     

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。     

乳腺叶状肿瘤的X线表现

目的探讨乳腺叶状肿瘤X线影像学特点,并与其病理对照,以提高对该病的诊断准确率。方法回顾性分析经手术病理证实有完整乳腺X线资料的乳腺叶状肿瘤50例共54个病灶,其中良性26个、交界性22个、恶性6个。结果 54个病灶中表现为伴或不伴钙化的肿块50个(92.6%),假阴性4个(7.4%)。50个肿块病变中良性23个、交界性21个、恶性6个。形状以分叶状、圆形或卵圆形最多见,分别占62.0%(31/50)、10.0%(5/50)、26.0%(13/50)。肿块边缘主要表现为清楚或部分清楚部分模糊,占80%(40/50),其余肿块呈浸润状及细小分叶状边缘,分别占18.0%(9/50)和2.0%(1/50)。肿块表现为高密度占74.0%(37/50),等密度占26.0%(13/50)。3个病灶肿块内含有钙化。边缘特征在良性与恶性肿瘤、交界性肿瘤与恶性肿瘤之间有明显差异,P_(良-恶)=0.003,P_(良-恶)=0.044。结论乳腺叶状肿瘤主要X线表现为分叶状或圆形、卵圆形的高密度肿块,钙化少见;边缘特征可在一定程度上提示良恶性叶状肿瘤的区别。     

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。     

Immunohistochemical profile of phyllodes tumors of the breast

The immunohistochemical profiles of 16 cases of phyllodes tumor of the breast (9 benign and 7 malignant) from 15 patients were examined by the labeled streptavidin biotin method. The expression of Ki-67, p53, bcl-2, alpha-smooth muscle actin (alpha-SMA), desmin, S-100 protein, estrogen receptor (ER), and progesterone receptor (PgR) was analyzed. The number of Ki-67-positive stromal cell nuclei of malignant phyllodes tumor were significantly more prominent than the benign tumors. The p53 expression on the stromal cell nuclei showed a significant difference between malignant and benign cases (86% vs 22%; p<0.05). bcl-2 was regularly seen on the luminal cell cytoplasm and stromal cell labeling showed no significant difference between malignant and benign cases (29% vs 33%). Stromal cells were alpha-SMA positive but refractory among cases, and desmin and S-100 protein were negative. PgR was expressed in all 16 cases and ER in most cases (12/16) the expression of which was restricted to luminal epithelial cell nuclei. These findings indicate that the Ki-67 labeling index and p53 expression in the stroma would be a good diagnostic parameter distinguishing benign tumors from malignant tumors. However, the absence of steroid receptor expression in stromal cells suggests the ineffectiveness of hormonal therapy for phyllodes tumor of the breast.     

Surgical treatment of phyllodes tumors of the breast

Eighty-one female patients with phyllodes tumors of the breast, surgically treated from 1974 to 1983, were studied. Their age ranged from 9 to 88 years. According to histology, the series was divided into three groups, of 28 (34.5%) benign tumors, 32 (39.5%) border-line tumors, and 21 (25.9%) malignant tumors. Because ten patients were lost to follow-up, only 71 women could be evaluated. All the patients had received surgical treatment: 51 women had been treated conservatively (11 enucleations, 40 wide resections), and 20 had undergone radical operations (13 underwent total and five underwent subcutaneous mastectomies, whereas one underwent modified and one underwent radical mastectomy). The mean follow-up, for the three groups, was 106 months for benign, 84 months for borderline, and 82 months for malignant tumors; in no case was radical surgery followed by local recurrence: of 51 women conservatively treated, 14 experienced local relapse, i.e., one of 24 women with benign, ten of 22 with borderline, and three of 8 with malignant lesions. Only two of 47 patients (4.2%) with borderline or malignant tumors developed distant metastasis and died from disease. No relationship between tumor size and risk of local recurrence could be demonstrated, and no difference could be identified between borderline and malignant lesions, in terms both of local and distant relapse. Local recurrences do not appear to affect survival: as a consequence, wide resection should be the primary treatment. Enucleation is to be proscribed. Total mastectomy has been indicated for very large tumors and for local recurrences of borderline and malignant lesions. Axillary dissection is not worthwhile.     

乳腺叶状肿瘤临床病理特征分析

目的:探讨免疫表型在各级乳腺叶状肿瘤(PT)及纤维腺瘤(FA)鉴别诊断中的作用。方法:对85例PT和20例FA的临床病理资料进行回顾性分析,同时进行Bcl-2、CD117、CD34、p53和Ki-67免疫表型进行检测,比较观察两者组织学形态和免疫表型差异。结果:部分PT与FA形态相似,两者的免疫标志Bcl-2、CD117、CD34和p53表达有差异,χ2值分别为20.629、13.080、22.579和27.319,P值分别为0.001、0.004、0.001和0.001。Ki-67在FA、良性PT、交界性PT和恶性PT中平均增殖指数分别为1.50±1.100、3.02±5.629、8.00±8.582和21.92±17.916,F=19.776,P=0.001。Bcl-2、p53和Ki-67随着恶性程度增加表达增加,CD34则相反。结论:除了依据形态学以外,免疫组化Bcl-2、CD117、CD34、p53和Ki-67对鉴别诊断PT和FA有一定辅助诊断价值,临床可推广应用。     

Correlation between mammography and the pathology of nonpalpable breast lesions

One hundred consecutive needle localization biopsies were performed for nonpalpable breast lesions discovered on low-dose mammography of asymptomatic women between June, 1984, and August, 1986. Malignant disease was found on 21 biopsies. Four were carcinoma in situ, and 17 were infiltrating carcinomas. Only three of the infiltrating carcinomas had metastasized to regional nodes, as confirmed by subsequent axillary dissection. Two of these metastatic tumors involved two nodes and the third only one. The findings on the remaining 79 biopsies were benign. Forty-eight mammograms were read as "benign"; all (100%) were benign pathologically. Thirty-one mammograms were considered "malignant"; 19 (61%) were malignant pathologically. Only two of the 21 mammograms given "suspicious" interpretations were malignant. Microcalcifications correlated with malignancy only 30% of the time (12/42).     

Repeat recurrence and malignant transition of phyllodes tumors of the breast

Background

This study aimed to assess their characteristics and clinical course of each histologic type of the behavior of phyllodes tumor (PT).

Methods

We retrospectively reviewed 124 patients with PTs who underwent surgical treatment from 2003 to 2011. PTs were classified as benign, borderline, and malignant using surgical specimens. The clinicopathological characteristics according to solitary and multiple lesions on ipsilateral breast and histological change after local recurrence were examined.

Results

The median patient age was 42 years (range 12–72 years). The final pathologic diagnosis was benign PTs in 95 patients (76.6%), borderline PTs in 21 (16.9%), and malignant PTs in 8 (6.5%). The size of benign PTs [median 4.2 cm (range 1–21 cm)] was significantly smaller than that of malignant PTs [median 11.3 cm (range 6–27 cm)] (p?<?0.001). Eight of the 95 benign PTs (8.4%) had multiple lesions, while all malignant PTs had solitary lesion. With a median follow-up period of 45 months, five patients with malignant PTs (62.5%) developed distant metastases while 13 patients with benign PTs (13.5%) and 6 patients with borderline PTs (28.6%) had local recurrence only without malignant transition. The median overall survival period of those with malignant PTs was 22.5 months (range 5–109 months).

Conclusions

Histologically benign and borderline PTs had a good prognosis without malignant transition even after developing repeat recurrence in contrast with malignant PTs that might be a solitary lesion.

     

Comprehensive genomic profiling of malignant phyllodes tumors of the breast

Purpose

Malignant phyllodes tumors (MPT) are exceptionally rare, and the genomic drivers of these tumors are still being elucidated. We performed comprehensive genomic profiling (CGP) of MPT to identify genomic alterations that will inform approaches to targeted therapy for patients with MPT, including relapsed, refractory, and metastatic disease.

Methods

DNA was extracted from formalin-fixed, paraffin-embedded samples from 24 consecutive patient cases of MPT. CGP was performed using a hybrid capture, adaptor ligation-based next generation sequencing assay to a high, uniform coverage (mean, 582×). Tumor mutational burden (TMB) was calculated from a minimum of 1.14 Mb of sequenced DNA as previously described and reported as mutations/Mb. The results were analyzed for all classes of genomic alterations, including short variants (SV; base substitutions, small insertions, and deletions), rearrangements, and copy number changes, including amplifications and homozygous deletions.

Results

The 24 cases of MPT included 15 patients with localized and 9 with metastatic disease. The median TMB was 2.7 mut/Mb, and no cases had a TMB > 10 mut/Mb. 20 out of 24 cases were evaluable for microsatellite status, and all were microsatellite stable. The most commonly mutated genes were TP53 (58.3%), TERT-promoter (57.9%), NF1 (45.8%), MED12 (45.8%), CDKN2A/B (33.3%), and MLL2 (33.3%). Targetable kinase fusions including KIAA1549-BRAF or FGFR3-TACC3 were identified in 2/24 (8.3%) tumors.

Conclusions

This study identifies clinically relevant genomic alterations that suggest novel targeted therapy approaches for patients with MPT.

     

The expression of glutamine-metabolism-related proteins in breast phyllodes tumors

The aim of this study was to investigate the expression of glutamine-metabolism-related proteins according to the histologic grade of phyllodes tumors (PTs) and to assess its clinical implication. We generated tissue microarrays of 224 PTs and performed immunohistochemical staining and western blot analysis of glutamine-metabolism-related molecules, including GLS1, GDH, and ASCT2. The associations between immunohistochemical results and clinicopathologic parameters were evaluated. The expression of GLS1 (p?<?0.001), GDH (p?<?0.001), and ASCT2 (p?=?0.005) in stromal components significantly increased with worsening PT histological grade. GDH expression in epithelial components significantly increased in high-grade PT (p?=?0.026). In western blot, stromal expression of GLS1, GDH, and ASCT2 increased as histologic grade increased. By univariate analysis, stromal GLS1 expression (p?=?0.022) and stromal GDH expression (p?=?0.009) were independent predictors of shorter DFS. Stromal GLS1 expression (p?<?0.001) and stromal GDH expression (p?<?0.001) were independent predictors of shorter OS. This study demonstrated that the stromal expression of the glutamine-metabolism-related proteins GLS1, GDH, ASCT2 increases with worsening histological PT grade.