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。     

乳腺叶状囊肉瘤

乳腺叶状囊肉瘤 (ｃｙｓｔｏｓａｒｃｏｍａｐｈｙｌｌｏｄｅｓ ,ＣＰ)是 1种少见的乳腺肿瘤 ,因其生物学特性和临床表现多样 ,对其组织学分类、治疗方法的选择、预后的认识都存在不同的意见 ,我们结合最近国内外文献对其作一综述。1　命名乳腺叶状囊肉瘤 (ＣＰ)首先由Ｍ櫣ｌｌ     

乳腺叶状囊肉瘤4例诊治分析

乳腺叶状囊肉瘤临床少见 ,术前诊断困难 ,手术切除范围不一。我院近十年收治 4例 ,现报告如下。例 1:女 ,45岁。右乳腺肿块半月。体检 :右乳外下方可触及 3× 3× 2ｃｍ3大小肿块 ,中等硬 ,表面光滑 ,活动。术前诊断 :乳腺癌 ?切除右乳肿块 ,术中发现肿块质较脆 ,无包膜 ,与周围组织界限不清。冰冻切片报告 :低度恶性肿瘤。行全乳切除术。病理诊断 :右乳叶状囊肉瘤。例 2 :女 ,2 5岁。左乳肿块一个月 ,生长较快 ,3天前出现局部疼痛。体检 :左乳外上椭园形肿块 ,约 5× 4ｃｍ2 质硬 ,边界清 ,表面欠光滑 ,活动。Ｂ超提示乳腺癌。在局麻下切除…     

乳腺叶状囊肉瘤３３例临床病理分析

目的：探讨乳腺叶状囊肉瘤的病理行征与临床诊断以及治疗和预后的关系。方法：对３３例经病理证实的乳腺叶状囊肉瘤，根据间质细胞异形程度和核分裂数、是否浸润，是否含有特殊间质成分进行分级。结果：Ⅰ级８例，Ⅱ级１６例，Ⅲ级９例，Ⅰ级复发３例误诊６例，Ⅱ级复发２例误诊９例，Ⅲ级复发５例误诊７例，７例含特殊间质成分。结论：乳腺叶状囊肉瘤易误诊和复发，应与巨纤维腺瘤和乳腺癌鉴别。     

乳腺叶状囊肉瘤22例临床病理分析

叶状囊肉瘤为乳腺的少见肿瘤 ,约占女性乳腺肿瘤的０．３ %～０．９ % ,其组织结构与乳腺纤维瘤相似 ,含有上皮间质两种肿瘤成份 ,并可见肿瘤细胞不同程度异型 ,本组对２２例乳腺叶状囊肉瘤进行回顾性分析 ,旨在探讨其病理及临床意义。材料和方法收集我院１９７６年１月至１９９８年１２月经手术切除的标本２２例 ,复习全部原始记录 ,患者均为女性 ,年龄从１３岁～５０岁 ,病程５个月至８年不等 ,平均年龄３０岁。均因发现乳腺无痛性肿块就诊 ,肿块位于左侧者１６例（７２．７３%） ,右侧者６例（２７．２７%） ,位于外上象限１０例（４５．…     

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。     

乳腺叶状囊肉瘤1例报告并文献复习

乳腺叶状囊肉瘤又称叶状肿瘤,属罕见病,占所有乳腺肿瘤１％,组织学上可分恶性和低度恶性［１］。我科于１９９９年４月手术切除１例（占所有乳房肿瘤手术病例的０．５％）,该病例术后行局部放疗,一般情况良好,现报告如下。１　临床资料患者,女性,２５岁,１ａ前因左乳腺包块在当地医院行包块切除;术后６个月肿块复发,再次手术,两次手术均未做病理确诊。３个月后肿块再次复发并迅速增大,到我院就诊,门诊以左乳腺巨纤作者单位：云南省肿瘤医院　６５０１０６　昆明市人民西路１７４号维腺瘤收治入院。病人一般情况好。查体：体温…     

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     

乳腺叶状囊肉瘤1例

1　病例介绍患者 ,女 ,35岁。发现左乳腺肿块半年 ,近 2月来生长迅速 ,于 1995年 11月10日入院。查体 :左乳外下象限可触及一 4cm× 3cm× 2 cm大小肿物 ,质硬、活动 ,边界清 ,行左乳腺肿块切除术。病理检查 :肿物大小 3.5 cm× 3cm× 2 cm,表面光滑 ,有部分包膜 ,切面灰白色 ,分叶状 ,有散在大小不等裂隙 ,质细、韧。镜检 :肿瘤由乳腺导管上皮和间质两种成分构成。导管上皮呈裂隙样、腺管状 ,上皮分化良好 ,局部可见增生成多层 ,但无异型 ,基底膜完整 ;间质成分由密集的短梭形细胞组成 ,轻至中度异型 ,核分裂相 (2～ 3)个 /10 HPF。瘤细…     

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.     

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。     

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.     

乳腺叶状肿瘤局部复发的临床风险因素分析

目的分析乳腺叶状肿瘤局部复发的临床风险因素。方法使用SPSSCox比例风险模型分析2002年12月至2008年12月中国医科大学附属第一医院66例乳腺叶状肿瘤患者各种临床风险因素与局部复发的关系。单因素分析采用X2检验。结果本组患者的发病年龄为17—83岁（中位年龄41岁）,良性40例,交界性24例,恶性2例。局部复发15例,其中12例复发发生于区段切除术。在不同手术方式、不同组织学等级的叶状肿瘤患者之间,复发率的差异均有统计学意义（P〈0．05）。手术方式为保护因素（RR=0．151）,扩大切除术和乳房切除术者的复发风险较区段切除术者下降至66／1000和53／1000;组织学等级为危险因素（RR=5．803）,恶性和交界性叶状肿瘤患者的局部复发风险分别为良性肿瘤者的12．26倍和4．37倍。结论恶性程度高和手术方式选择不当影响预后。叶状肿瘤以手术治疗为首选,应选择切除范围扩大的手术方式,尤其是对恶性程度高的患者。     

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。     

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.     

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.