乳腺巨大恶性叶状肿瘤1例

患者女, 40岁。2019年10月, 患者自己发现左乳有一大小约2 cm×2 cm肿物, 质硬, 活动度差, 无其他伴随症状。3个月后, 自觉该肿物较前明显增大, 遂至外院就诊。2020年1月21日超声检查显示, 左乳探及范围约4.5 cm×2.4 cm低回声, 边界清, 内有丰富血流信号, 乳腺影像报告和数据系统(breast imaging reporting and data system, BI-RADS)4a类。医师建议手术治疗, 患者拒绝, 后自行至非正规医疗机构行中药及针灸治疗, 治疗期间左乳肿物仍持续增大。7月, 因行火针治疗导致肿块表面皮肤破溃。12月, 皮肤破溃处开始出现菜花样赘生物, 患者遂再次至外院就诊。乳腺超声检查显示, 左乳非均质占位, 乳头周围可探及不规则囊实性回声, 较厚处约11 cm, 内有丰富血流信号, BI-RADS 5类。2021年1月12日, 患者于外院行左乳肿物粗针穿刺术, 病理诊断为间叶组织来源肿瘤。免疫组化结果:广谱CK(-)、CK5/6(-)、P63(-)、ER(-)、PR(-)、c-erbB-2(0)、E-cad(-)、Ki-67(3...     

乳腺分叶状肿瘤八例报告

回顾分析8例乳腺分叶状肿瘤患者的临床病理资料,良性2例,交界性2例,恶性4例,患者年龄29～50岁,平均年龄41岁。肿块最大径平均6．6cm（3～38cm）。4例有肿块短时间内迅速增大的病史,4例曾接受2～3次肿瘤局部切除术,1例行局部扩大切除术,2例行乳腺单纯切除术,3例行乳腺改良根治术,1例胸壁复发的巨大肿瘤行皮肤与肋骨的全层切除、背阔肌-侧胸-腹直肌跨区皮瓣转移修复,1例在20个月内做过5次手术。随访3～72个月,8例患者均生存,其中2例分别于首次手术后8和21个月出现肺转移。回顾分析提示,乳腺分叶状肿瘤术前诊断困难,易局部复发,保证切缘阴性的局部扩大切除术是治疗乳腺分叶状肿瘤的合适的手段。     

年轻女性乳腺恶性叶状肿瘤3例及文献复习

目的：探讨年轻女性乳腺恶性叶状肿瘤的临床病理学特点及诊断要点。方法对3例年轻女性乳腺恶性叶状肿瘤的临床资料、病理形态学及免疫组化结果进行分析,并结合相关文献进行讨论。结果3例女性患者,年龄14～20岁;镜下肿瘤细胞异型明显,核分裂＞10／10HPF。结论年轻女性乳腺恶性叶状肿瘤少见,提高对该病临床病理特点的认识,对避免误诊是至关重要的。     

巨大良性乳腺叶状肿瘤1例报道及文献复习

目的:提高对乳腺叶状肿瘤临床特点和诊疗现状的认识。方法:回顾我科收治的1例巨大良性乳腺叶状肿瘤的临床资料及诊治过程,并结合文献进行复习。结果:患者右乳肿块7年,B超示:右侧乳腺可探及大小约20cm×20cm混合回声包块,内可见液性暗区。全麻下行右侧乳腺单纯切除术,术中冰冻考虑恶性病变,组织来源不能确定,遂加行右侧腋窝淋巴结清扫术。结论:乳腺叶状肿瘤临床上发病罕见,仅以乳腺肿块为首发症状,术前诊断困难,易误诊,明确诊断主要依靠术后病理学检查,故易导致过度治疗或治疗不当。     

巨大良性乳腺叶状肿瘤1例报道及文献复习

目的：提高对乳腺叶状肿瘤临床特点和诊疗现状的认识。方法：回顾我科收治的1例巨大良性乳腺叶状肿瘤的临床资料及诊治过程,并结合文献进行复习。结果：患者右乳肿块7年,B超示：右侧乳腺可探及大小约20cm×20cm混合回声包块,内可见液性暗区。全麻下行右侧乳腺单纯切除术,术中冰冻考虑恶性病变,组织来源不能确定,遂加行右侧腋窝淋巴结清扫术。结论：乳腺叶状肿瘤临床上发病罕见,仅以乳腺肿块为首发症状,术前诊断困难,易误诊,明确诊断主要依靠术后病理学检查,故易导致过度治疗或治疗不当。     

乳腺恶性分叶状肿瘤的临床病理学观察

目的：探讨乳腺恶性分叶状肿瘤的临床病理特征、免疫组织化学特征、诊断及鉴别诊断、预后。方法：对6例乳腺恶性分叶状肿瘤进行病理组织学观察和免疫组织化学标记,并随访10—84个月。结果：乳腺恶性分叶状肿瘤病史上均有较长时问或数年前相对静止的无痛性肿块。大体结构呈分叶状膨胀性生长、包膜不完整或无包膜;镜下肿瘤组织由间叶细胞构成,细胞异型性大,主要呈纤维肉瘤、恶性纤维组织细胞瘤形态,部分肿瘤组织向脂肪肉瘤、平滑肌肉瘤、及横纹肌肉瘤方向分化。肿瘤组织可以经淋巴道转移。肿瘤细胞免疫组织化学表达情况：Vim：6／6、AE1／AE3：0／6、EMA：0／6、CD117：3／6、CD34：1／6、S-100：2／6、SMA：2／6、CD99：4／6、bcl-2：3／6、p53：5／6、Ki67：〉10％、ER：0／6、PR：2／6、MyoD1：1／6。结论：乳腺恶性分叶状肿瘤病理诊断主要依据组织学观察,免疫组织化学检测有一定的辅助作用。预后主要由肿瘤组织分化程度决定。     

乳腺恶性分叶状肿瘤的临床病理学观察

目的:探讨乳腺恶性分叶状肿瘤的临床病理特征、免疫组织化学特征、诊断及鉴别诊断、预后.方法: 对6例乳腺恶性分叶状肿瘤进行病理组织学观察和免疫组织化学标记,并随访10-84个月.结果:乳腺恶性分叶状肿瘤病史上均有较长时间或数年前相对静止的无痛性肿块.大体结构呈分叶状膨胀性生长、包膜不完整或无包膜;镜下肿瘤组织由间叶细胞构成,细胞异型性大,主要呈纤维肉瘤、恶性纤维组织细胞瘤形态,部分肿瘤组织向脂肪肉瘤、平滑肌肉瘤、及横纹肌肉瘤方向分化.肿瘤组织可以经淋巴道转移.肿瘤细胞免疫组织化学表达情况:Vim:6/6、AE1/AE3:0/6、EMA:0/6、CD117:3/6、CD34:1/6、S-100:2/6、SMA:2/6、CD99:4/6、bcl-2:3/6、p53:5/6、Ki67:>10%、ER:0/6、PR:2/6、MyoD1:1/6.结论: 乳腺恶性分叶状肿瘤病理诊断主要依据组织学观察,免疫组织化学检测有一定的辅助作用.预后主要由肿瘤组织分化程度决定.     

巨型乳腺叶状囊肉瘤合并多种慢性疾病1例并文献复习

乳腺叶状囊肉瘤是一类由乳腺纤维结缔组织和上皮成分组成的一种少见的纤维上皮性肿瘤。其发病率在女性所有乳腺肿瘤中占不到1%,且主要好发于40-50岁女性。多呈现出3-5cm大小,而手术为其主要治疗方式。本文报道1例重达11kg的乳腺叶状囊肉瘤合并其他多种慢性疾病。其最大直径和周径分别达45cm和94cm。现就乳腺叶状囊肉瘤的症状、诊断与治疗做一回顾。     

46例乳腺分叶状肿瘤临床病理特点及误诊分析

目的探讨乳腺分叶状肿瘤的临床病理特点及误诊原因。方法对46例经病理复诊明确诊断的乳腺分叶状肿瘤病例进行回顾性分析,并用免疫组化法检测AE1／AE3、VIM、平滑肌肌动蛋白（Act）和Ki-67表达。结果46例乳腺分叶状肿瘤术前临床诊断相符者24例,其余术前诊断分别为：乳腺纤维腺瘤15例,乳腺增生或混合性囊肿4例,乳腺癌或疑似乳腺癌3例。术前临床诊断误诊率为47．83％（22／46）。术中冰冻病理诊断为乳腺分叶状肿瘤40例,漏诊率为13．04％（6／46）。术后石蜡切片病理诊断：46例乳腺分叶状肿瘤中良性35例,交界性7例,恶性4例。免疫组化表达结果：VIM表达均为阳性,表达在肿瘤问质细胞;Act在部分病例（36．96％,17／46）表达于间质细胞;AEl／AE3均无间质细胞表达（用于排除梭形细胞癌）;Ki-67平均阳性细胞指数在良性、交界性和恶性中分别为13％、28％和69％,Ki-67表达在三者之间差异有统计学意义（P〈0．05）。结论乳腺分叶状肿瘤存在较高的临床误诊率和冰冻病理漏诊率,而其治疗方式的选择与病理分型密切相关;免疫组化对判断其良、恶性有重要意义;肿瘤的及时确诊和手术方式选择是决定治疗成功的关键。     

Giant phyllodes tumor in both breasts:one case report and literature review

Breast phyllodes tumor (BPT),which is composed of epithelial cells and fibrous connective tissue,is a special type of tumor and yet not unified in biological behavior and histological classification,with high risk of recurrence and potential metastasis.BPT in one side has high incidence in clinic while BPT in both sides is rarely found.We treated one patient with giant BPT in both sides and reported as follows. 1 Case report The patient,female,aged 49,was admitted due to a rapidly increased lump in the right breast in June 2010,and she complained that the lump had increased from the size of "an egg" to the size of "a basketball" in August and had then been treated as suspected inflammation with anti-inflammatory treatment before admission but failed.Physical examination on admission showed an about 35 cm× 32 cm ×33 cm huge lump in the right breast,firm and poorly-movable,with reddish purple and mildly warm epidermis,swollen but not ulcerated (Fig.1).     

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。     

Surgical treatment of phyllodes tumors of the breast: retrospective review of 172 cases

BACKGROUND AND OBJECTIVES: Phyllodes tumors (PTs) are uncommon biphasic breast tumors that usually occur in adult females. They are composed of a benign epithelial component and a cellular, spindle cell stroma forming a leaf-like structure. No one morphologic finding is reliable in predicting the clinical behavior of the tumor. The purpose of this study was to explore the clinicopathologic factors associated with outcome and metastasis. METHODS: We retrospectively reviewed the records of 172 patients seen at Mackay Memorial Hospital from January 1985 to December 2003. Clinical data analyzed included age, presenting symptoms and signs, tumor size, location, type of surgery, time to recurrence, and metastasis. The clinicopathologic factors associated with outcome and metastasis were analyzed statistically using the chi-square test with Yate correction. RESULTS: The mean follow-up was 71 months (range 7-237). The mean age was 37 years (range 11-73). The majority of tumors were found in the upper outer quadrant (46.0%), with an equal propensity to occur in either breast (48.8% vs. 50.0%). The pathologic diagnoses included 131 benign, 12 borderline, and 29 malignant lesions. Nineteen patients (11%) had a recurrence and three (1.7%) had metastases. The initial diagnosis of all 19 recurrent tumors were benign. Age, surgical approach, mitotic activity, and surgical margin were significantly correlated with recurrence (P = 0.029, 0.020, 0.048, and 0.00018, respectively). Stromal cellularity, stromal overgrowth, stromal atypia, mitotic activity, tumor margin, and heterologous stromal elements were significantly correlated with metastases (P = 0.032, 0.00008, 0.000002, 0.004, 0.005, and 0.046, respectively). Mammography and breast echo were not reliable for differentiating PTs from fibroadenomas (6.9% vs. 37.9% and 3.3% vs. 45%, respectively). Frozen section was of limited value (41.6%). The role of adjuvant radiotherapy and chemotherapy remains to be defined. Local excision, wide excision, or mastectomy with negative surgical margins yielded high local control rates (88.7%, 88.2%, and 100%, respectively), but local excision was associated with a relatively high percentage of positive surgical margins (18.3%). A total of 42 modified radical mastectomies were performed. The reasons for these procedures included a diagnosis of malignancy on frozen section or because the tumors were so large, they were assumed to be carcinomas. No axillary lymph node metastases were found. Fifteen patients in our series had tumors with infiltrating tumor margin, severe stromal overgrowth, atypia, and cellularity. All three patients with metastases (3/15) were in this group. Presence of metastases was significantly correlated with this group (P = 0.0000038). CONCLUSIONS: Wide excision with a clear margin may be the preferable initial therapy, even for malignant PTs. Routine axillary lymph node dissection is not recommended. Patients have tumors with infiltrating tumor margin, severe stromal overgrowth, atypia, and cellularity are at high risk for metastases.     

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。     

Desmoid tumor associated with cystosarcoma phyllodes of the breast.

A case of desmoid tumor of 17 years' duration associated with cystosarcoma phyllodes of 17 months' duration is presented. Good initial response to radiation therapy of the desmoid tumor was shown. Poor response of cytosarcoma phyllodes to radiation therapy was noted. A comparison between the similarities and differences of the two tumors is presented.     

Radiotherapy to pulmonary metastases of a malignant phyllodes tumor of the breast

A bulky right breast tumor (15 × 15 cm) was discovered in a 54-year-old woman, and a simple mastectomy was performed, followed by 50 Gy of postoperative radiotherapy. Histologically, the tumor was malignant phyllodes tumor of the breast. Nine months after the mastectomy, multiple pulmonary metastases were detected and three lesions were treated with radiotherapy of 60 Gy/30 fractions for 43–54 days. Two lesions (16 × 12 mm and 18 × 16 mm) showed a partial response and no progression 2–4 months after the radiotherapy. The other lesion (22 × 18 mm) showed a partial response but progressed again 3 months later. She died of respiratory failure 18 months after the mastectomy. She also had muscle metastasis, but there were no locoregional recurrences. The malignant phyllodes tumor in this patient, showed a partial response to radiotherapy. Radiotherapy is considered useful for local control or symptomatic treatment of malignant phyllodes tumor.     

乳腺叶状囊肉瘤1例报告并文献复习

目的：报道乳腺叶状囊肉瘤1例,并探讨其临床病理特征、诊断及治疗方法。方法：回顾性分析1例乳腺叶状囊肉瘤患者的临床资料,结合相关文献进行病理、病因、诊断及治疗等方面的讨论。结果：本例患者曾因“乳腺纤维瘤”先后6次手术,第6次手术诊断为恶性分叶状肿瘤,术后半年出现胸壁、牙龈转移,胸壁、牙龈肿物切除术后,发现颧面部、上颌窦、胸椎多发转移,行2周期化疗,临床症状获得缓解,后因经济原因放弃治疗,随访3个月患者死亡。结论：乳腺叶状囊肉瘤由良性上皮成分和富于细胞的恶性问质成分组成,细针穿刺细胞学检查诊断价值有限,常需要手术获取完整标本,并结合免疫组化进行诊断。一旦出现复发或远处转移,应行全面检查明确病灶范围,进行综合治疗。其临床表现具有异质性,复发及远处转移者预后较差。     

乳腺叶状囊肉瘤合并骨转移1例并文献复习

1 病例资料 患者女,55岁,2012年6月因"发现右乳腺肿块8年余,明显增大半年"到我院乳腺外科就诊,自诉初起时为一蚕豆大小肿物,质地较硬,近半年明显增大,查体可扪及右乳巨大肿块,大小约11 cm×11 cm×9 cm,肿瘤边界欠清,不伴局部皮肤发红、水肿、增厚、粗糙、溃烂,质地偏硬,CT提示乳腺叶状囊肉瘤(cytosarcoma phyllodes,CP)可能(图1),遂行右乳单纯切除术,术后病理示:①(右乳)叶状囊肉瘤,肉瘤成分主要为纤维肉瘤;②右乳低切缘、乳头、皮肤及肿物周围均未见瘤组织浸润(图2).     

乳腺叶状囊肉瘤的21例临床分析

目的 探讨乳腺叶状囊肉瘤的诊断和治疗方法。方法 对1987年9月至2004年12月收治的21例乳腺叶状囊肉瘤病人的临床资料进行回顾性分析。结果 21例中行局部切除术5例,局部扩大切除术9例,单纯乳房切除术4例,改良根治术2例,皮下腺体切除术加乳房再造术1例。随访至2004年12月,5年生存率95．2％,局部复发率9．5％。结论 乳腺叶状囊肉瘤是一种特殊类型的乳腺肿瘤,其预后与肿瘤的组织学分级、肿瘤大小以及手术切除是否彻底有关。     

乳腺叶状囊肉瘤320例诊治分析

目的探讨乳腺叶状囊肉瘤临床诊断和治疗方法。方法回顾分析经手术病理确诊为乳腺叶状囊肉瘤的320例患者的诊断和治疗情况。结果行乳腺X片检查121例,B超检查25例,近红外检查21例,针吸细胞学检查42例;15例(12.4%)乳腺X片检查及3例(14.3%)近红外检查诊断为乳腺叶状囊肉瘤。临床诊断正确率为17.5%(56/320),误诊率为82.5%(264/320)。随访253例患者,其中局部复发45例(17.8%),远处转移死亡13例(5.1%)。结论乳腺叶状囊肉瘤诊断需常规病理检查,治疗宜行局部广泛切除或全乳切除。