乳腺分叶状肿瘤88例临床诊治分析

目的 探讨乳腺分叶状肿瘤的临床病理特征、诊断、鉴别诊断及治疗与预后的情况.方法 回顾性分析我院经手术和病理诊断确诊的88例乳腺分叶状肿瘤的临床资料.结果 88例患者中良性叶状肿瘤59例,交界性叶状肿瘤25例,恶性叶状肉瘤4例.行单纯乳腺肿块切除术74例,乳腺皮下腺体切除术10例,乳癌改良根治术4例.62例获得随访,随访时间1～8年,12例复发再次行乳腺全切术,1例患者行改良根治术后4年因肺、肝转移死亡.结论 乳腺分叶状肿瘤术前确诊率较低,术后易复发,应根据其生物学行为特点和不同临床病理特征而选择不同的手术切除方式.     

乳腺分叶状肿瘤的手术治疗和预后

对 11年间收治的 77例乳腺分叶状肿瘤的临床资料进行回顾性分析。 77例乳腺分叶状肿瘤均经手术治疗 ,总的 5 ,10年生存率分别为 97.2 %,90 .9%。 5 ,10年复发转移率、肿块切除者为18.2 %,3 7.5 %;局部切除者为 2 .6%,12 .5 %;乳腺单纯切除者为 11.1%,12 .5 %;乳腺全切 低腋淋巴结清除者为 0 .0 %,5 0 .0 %。提示乳腺分叶状肿瘤的预后与手术方式有关 ;局部扩大切除是乳腺分叶状肿瘤的首选术式。     

乳腺叶状囊肉瘤24例临床分析

目的探讨乳腺叶状囊肉瘤的临床特点、外科治疗方法及影响预后的因素。方法对24例乳腺叶状囊肉瘤患者采用局部切除11例,单侧乳房切除术10例,乳房切除并腋窝淋巴结清除3例,其中5例(20%)曾诊断为乳腺腺纤维瘤或巨纤维瘤因术后肿瘤复发而经历2~3次局部切除术。结果术后病检证实:低度恶性11例,中度恶性9例,高度恶性4例。随访1~10年(平均5.2年),局部复发率29.1%,5年生存率97%。结论乳腺叶状囊肉瘤发病率低,易误诊;手术切除是其首选的治疗方法,局部切除术后复发应行乳房切除;多数乳腺叶状囊肉瘤恶性程度较低,进展缓慢,预后较好;乳腺叶状囊肉瘤预后与肿瘤的病理类型、肿瘤大小和手术切除是否彻底有关。     

乳腺分叶状肿瘤11例诊治体会

乳腺分叶状肿瘤是一种双相分化的肿瘤,由良性的上皮成分和富于细胞的间叶成分组成,是一种罕见的纤维上皮性肿瘤.占所有乳腺肿瘤的0.3%～1%[1].2003年WHO<肿瘤国际组织学分类>称该瘤为分叶状肿瘤,分为良性、交界性和恶性三个亚型[2].其治疗方式以手术切除为主,术后复发是治疗失败的主要原因.我院2004年4月至2010年10月间共收治乳腺分叶状肿瘤11例,现报告如下.     

乳房叶状肿瘤53例诊治分析

目的探讨乳房叶状肿瘤的临床表现、诊断和治疗方法。方法对53例乳房叶状肿瘤的资料进行回顾性分析。结果53例患者均进行手术治疗，其中肿块扩大切除34例；保留乳头乳晕的乳腺切除2例；单纯性乳房切除14例；乳房切除加同侧腋窝淋巴结清扫3例。随访1-6年，8例患者术后局部复发行二次手术，其中5例二次手术后行辅助放射治疗。53例患者均健在，无一例远处转移，临床疗效满意。结论乳房叶状肿瘤均以乳房肿块为首发体征，影像学检查可以明确肿瘤的大小、位置、形态，唯有术后病理可以明确诊断，手术切除是该病的主要治疗方法，辅助放疗对术后复发或不能手术切除的叶状肿瘤具有良好的治疗效果，辅助内分泌治疗有其理论依据，但其疗效有待于进一步观察。     

良性与交界性叶状肿瘤局部复发风险的分析

目的探讨良性和交界性乳腺叶状肿瘤的复发率以及手术切缘宽度与复发风险的关系。方法回顾性性分析2008年1月至2015年12月在我院行手术切除的良性及交界性叶状肿瘤的患者。收集的数据包括:年龄、原发肿瘤大小、组织分级、手术方式和局部复发情况。结果共入组118名患者,其中为良性81例,交界性37例。患者平均年龄为48.3岁,肿瘤平均大小为4.6cm,平均随访时间3.5年,共有18例患者出现复发,其中良性肿瘤的复发率为13.5%,交界性肿瘤复发率为18%,但缺少足够的数据说明手术切缘多少最合适。结论交界性比良性叶状肿瘤复发率高,但乳腺肿物广泛切除并不能预防非恶性乳腺叶状肿瘤的复发。     

乳腺叶状肿瘤X射线表现与临床及病理对照分析

目的探讨乳腺叶状肿瘤X射线表现与其临床及病理改变的相关性,以确定其不同特征及其病理组织学基础,达到提高临床诊断率及指导治疗的目的。方法分析我院2010年1月至2013年1月期间经手术病理证实的28例乳腺叶状肿瘤患者的临床及X射线影像学资料,观察其影像表现并与病理结果进行对照分析。结果 28例乳腺叶状肿瘤中,良性17例,交界性8例,恶性3例。X射线摄片显示瘤体26例,另外2例仅显示单侧乳腺非对称致密影,其中23例均归为BI-RADS 4类或4类以上。肿瘤直径约2.8～10.2 cm。以3 cm为界,肿瘤直径≥3 cm者与〈3 cm者相比,出现良性与非良性叶状肿瘤（交界性及恶性）的概率差异无统计学意义（Ρ〉0.05）。良性和非良性叶状肿瘤的分叶状况差异也无统计学意义（Ρ〉0.05）,然而非良性叶状肿瘤多表现为边界模糊肿块（Ρ〈0.05）。2例良性叶状肿瘤见异常血管,1例良性叶状肿瘤见钙化,良性叶状肿瘤（8/17）和非良性叶状肿瘤（2/11）出现＂透明晕＂征象比较差异无统计学意义（Ρ〉0.05）。结论乳腺叶状肿瘤的一些典型X射线表现结合临床改变有利于早期发现病变,但良性与非良性叶状肿瘤的影像学表现无明显差异,该病的确认及组织学分型必须依靠病理学检查。     

乳腺叶状囊肉瘤的钼靶、超声影像表现与病理对照研究

目的:评价乳腺叶状囊肉瘤钼靶X 线及超声影像学表现与手术病理组织学的相关性。材料和方法:回顾性分析12例经手术病理证实的乳腺叶状囊肉瘤术前钼靶X线及彩色多普勒超声影像学表现,并与手术病理标本进行对照分析,评价记录肿块部位、形态、大小、边缘、密度或内部回声、有无钙化、后方回声,内部血流和周围腺体结构、皮肤、乳头、腋窝淋巴结等影像学征象,分析影像学征象与病理组织学的相关性。结果:,钼靶组诊断符合率为75%,12 例乳腺叶状囊肉瘤患者钼靶组诊断乳腺叶状肿瘤8例,叶状囊肉瘤肿瘤1例,乳腺癌1例,乳腺良性肿块(纤维腺瘤)2 例。超声组诊断符合率为66.67%,诊断为叶状肿瘤7例,叶状囊肉瘤1例,乳腺癌2例,纤维腺瘤2例。结论:乳腺叶状囊肉瘤的钼靶X线和超声表现具有比较典型的影像特征,二者联合有利于早期发现本病,但叶状肿瘤的良恶性及叶状囊肉瘤的恶性程度与影像学表现无显著相关性,确诊主要依靠病理检查。     

96例乳腺叶状肿瘤复发转移及预后相关因素分析

目的分析乳腺叶状肿瘤患者的临床病理因素与局部复发、远处转移及预后的关系。方法回顾性分析2011年3月至2018年12月期间重庆医科大学附属第一医院收治的96例乳腺叶状肿瘤患者的临床病理及随访资料,采用χ~2检验及logistic多因素回归分析患者临床病理因素与局部复发和远处转移的关系;运用Kaplan-Meier法计算无病生存率(DFS),采用log-rank检验及Cox比例风险模型分析患者各临床病理因素与预后的关系。结果 96例乳腺叶状肿瘤患者中94例为单侧发病,2例为双侧发病;良性36例,交界性34例,恶性26例。有27例患者术后出现局部复发,4例患者发生远处转移,4例患者死亡,1、3、5年累积DFS分别为81.2%、64.9%、64.9%,5年累积总生存率为92.3%。多因素分析显示,年龄、肿瘤类型和手术方式与局部复发有关(P0.050),未发现各临床病理因素与远处转移有关(P0.050),发现肿瘤类型是影响预后的独立影响因素(P0.050)。结论乳腺叶状肿瘤复发率较高,年龄及肿瘤类型是影响术后局部复发的独立因素,外科手术为主要治疗方式,扩大切除术或乳房全切除术为可供选择的手术方式。     

乳腺分叶状肿瘤诊疗进展

乳腺分叶状肿瘤(phyllodes tumor,PT)是纤维上皮性肿瘤,在乳腺肿瘤性疾病中较为少见。该文对分叶状肿瘤的临床特点、病理特征、临床检查诊断、治疗现状及预后等作一综述,以提高临床医师对其认识和疾病诊疗规范。     

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??Diagnosis and treatment of breast phyllodes tumors XUAN Li-xue, BI Xiao-feng. Breast Disease Center, Cancer Hospital of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100021, China Abstract Phyllodes tumors ,which are defined as fibroepithelital of breast tumours?? are uncommon,and they are difficult to predict biologic behavior based on clinicopathologic features. The diagnosis and classification of phyllodes tumors of the breast rely mainly on histopathological examination, core needle aspiration biopsy is the best diagnostic method,The different surgical operation should be performed according to the different classification. Breat surgery with clear margin is the current treatment of choice for phyllodes tumours.The ues of adjuvant chemotherapy??radiation therapy and endocrine therapy appears to be increasing in recent years, but its efficacy is debatable.     

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??Diagnosis and treatment progress of phyllodes tumor of breast ZUO Wen-shu, ZHENG Gang. Breast Disease Center, Shandong Cancer Hospital, Shandong Academy of Medical sciences, Jinan 250117, China
Corresponding author: E-mail??cjcpt@public.jn.sd.cn
Abstract Phyllodes tumors??which are defined as fibroepithelital of breast tumours??are uncommon??and they are difficult to predict biologic behavior based on clinicopathologic features. The diagnosis and classification of phyllodes tumors of the breast rely mainly on histopathological examination. Core needle aspiration biopsy is the best diagnostic method. The different surgical operation should be performed according to the different classification. Breast surgery with clear margin is the current treatment of choice for phyllodes tumors. The rationality of the first operation resection range is the most important prognostic factor. The postoperative adjuvant chemotherapy, radiation therapy and endocrine therapy appear to be increasing in recent years??but their efficacy is debatable.     

Diagnostic challenges of benign breast phyllodes tumour: A rapid-growing tumour during pregnancy caused breast loss. A case report

IntroductionPhyllodes tumours are rare breast neoplasms. It is especially rare in pregnancy.Presentation of caseWe report a case of a 37-year-old woman with left breast benign phyllodes tumour, which started to grow very fast during pregnancy. The tumour was too big for breast-conserving surgery and it was necessary to remove the whole left breast. Patient underwent successful nipple-skin-sparing mastectomy with immediate silicone implant reconstruction.ConclusionBreast phyllodes are classified as benign, borderline, and malignant. Standard treatment of breast phyllodes is surgery. The choice of surgery type depends on the tumour factors and breast size.We highlight that, inadequate treatment of phyllodes tumour can result to recurrence, growth, or even metastatic spread, when tumour has malignant potential.     

Bilateral and multifocal phyllodes tumours of the breast: A case report

Phyllodes tumours are rare breast neoplasms that present as painless breast masses. They are classified as benign, malignant and borderline. More rare presentations of these tumours include bilateral asynchronous disease and unilateral multifocal disease. Surgical excision with clear margins remains the treatment of choice for these tumours. The present case report is the first to be discussed in the literature. It describes a patient presenting with synchronous bilateral, multifocal breast phyllodes tumours who underwent immediate reconstruction with tissue expanders at the time of her mastectomies.     

The malignant degeneration of a phyllode tumour in man: A case report

IntroductionMalignant phyllodes tumours of the breast represent less than 1% of all breast cancers.Few cases of phyllodes tumours have been reported in men.Case presentationWe present the case of a 60-year-old man who was operated on one year ago for a breast tumour that had undergone a lumpectomy with an anatomopathological study in favour of a grade 2 phylloid tumour. He was admitted to hospital with a palpable mass in his right breast. The lumpectomy enlarged to the right pectoralis major muscle was then performed with clear surgical margins.Microscopic examination revealed high-grade malignant phyllodes.Postoperatively, after 3 months, the patient was given a breast MRI and a PET/CT scan which returned without abnormalities.The patient is followed for eight months and has shown no signs of recurrence.DiscussionMalignant phyllodes tumours of the breast show clinical and mammographic signs comparable to those of benign lesions.The diagnosis is confirmed by histology, treatment is based on surgery, which may be a large lumpectomy or mastectomy, and the prognosis depends on several factors, the most important of which is the margin for surgical resection.ConclusionThe best treatment is a wide local excision with a safety margin of 1 cm, unless it is metastatic.Early diagnosis and surgery improves the prognosis.     

Cystosarcoma phyllodes of the breast

Cystosarcoma phyllodes is a rare breast lesion representing between 0.5 and 2.5 percent of all breast tumors. Its microscopic and clinical features are impressive. When first described by J. Mueller in 1838, the lesion was thought to be a benign neoplasm without metastatic potential. Nevertheless, more recent reports have shown either recurrent or metastatic cystosarcoma phyllodes. Some Authors have attempted to predict biologic behavior from histological appearance so that the extent of surgical management could be determined. However, only a small percentage of histologically malignant tumors have recurred or metastasized. The above observations stimulated the present analysis of the histology, clinical behavior, appropriate therapy and prognosis in ten patients with cystosarcoma phyllodes seen at our unit, from 1965 to 1979.     

The largest and neglected giant phyllodes tumor of the breast—A case report and literature review

IntroductionPhyllodes tumours are rare fibro-epithelial lesions. The role of the pathologist in the preoperative diagnosis of phyllodes tumours of the breast is critical to appropriate surgical planning. Wide local excision or mastectomy with adequate margin remains the treatment of choice. Local recurrence occurs in approximately 10- 16.1% of patients (Wei et al., 2014) [1] and distant metastases occurs in 6.3–31% of patients with malignant phyllodes tumours (Wei et al. (2014), Chaney et al., 1998) [1,2] but only in 4% of all phyllodes tumours (Salvador et al., 1989) [3]. Emphasis should be given in early diagnosis and intervention to decrease morbidity and mortality.     

Sarcoma of the breast

Reports of 4 personal cases of breast sarcomas (3 cases of cystosarcoma phyllodes and 1 angiosarcoma), the authors review the literature concerning these rare tumors which account for less than 1% of malignant tumors of the breast. Whilst the usual clinical picture is that of a large tumor deforming the breast with pseudo-inflammatory signs, sarcomas 1 to 3 cm in diameter were discovered and treated with good chances of recovery. The natural history of breast sarcomas is marked above all by the risk of hematogenic metastatic spread (30% of cases) whilst very few (5%) local recurrences are seen following surgical treatment by mastectomy. Emphasis is placed upon problems of histological diagnosis of the variety of sarcoma and the demonstration of histoprognostic factors which can be used to predict the outcome (mitotic activity, grading) showing evidence of good correlation in the series analyzed. The various characteristics of cystosarcoma phyllodes are described emphasizing the conditions surrounding its development, relations with benign phyllodes tumors. The particular severity of this sarcomatous form in the very young woman is mentioned. Prevention lies in the sufficiently extensive excision of the phyllodes tumor. Mesenchymatous sarcomas of the breast are also accompanied by a fairly favorable prognosis (5 year actuarial survival of 50 to 80% according to series). By contrast, two special and rare histological varieties, angiosarcoma and lymphosarcoma, are characterized by a much more gloomy prognosis and require different treatment including radiotherapy and chemotherapy.     

Difficulties in the pre-operative diagnosis of phyllodes tumours of the breast: a study of 84 cases

Eighty-four phyllodes tumours (71 benign, eight borderline and five malignant) diagnosed over a 16-year period were studied retrospectively, to assess the diagnostic value of the pre-operative modalities used. Mammography and ultrasound appearances were non-specific. The possibility of phyllodes tumour was raised in only 23% on fine needle aspiration cytology, and in 65% on core biopsy. Accuracy was better in smaller tumours, suggesting that larger tumours need more samples. For phyllodes tumours whose growth was measured, almost all had growth rates greater than for growing fibroadenomas. The pre-operative diagnosis of phyllodes tumours is difficult, and rapid growth and/or large size of apparent fibroadenomas may be the only imaging findings to suggest phyllodes tumour. It is important to review most fibroadenomas with ultrasound, to assess the rate of growth if any. Whole breast ultrasound showed that nearly one third of women with phyllodes tumours had concurrent fibroadenomas.