96例乳腺叶状瘤的临床病理分析

CLINICOPATHOLOGICAL ANALYSIS OF 96 CASES OF PHYLLOIDES TUMORS OF THE BREAST

目的 探讨乳腺叶状瘤肿瘤组织学、手术方式对病人预后的影响。方法 光镜复习病理诊断为纤维瘤和叶状肉瘤的病理切片 ,按Azzopardi和Salvadori的良恶性诊断标准对肿瘤重新进行分析。结果 96例中良性肿瘤 54例 ( 56.2 5% ) ,交界性肿瘤 2 0例 ( 2 0 .83% ) ,恶性肿瘤 2 2例( 2 2 .92 % )。三组病人的平均年龄分别为 36.5岁、4 8.4岁及 53岁 ;肿瘤平均大小分别为 4 .4cm、6.9cm和 7.8cm。 54例良性肿瘤中 ,4 0例行局部扩大切除术 ,14例行单纯肿块摘除 ,其中 4例( 7.4 % )于单纯肿块摘除术后 1年内局部复发 ,复发后行肿块局部扩大切除术 ,5年存活率 10 0 %。2 0例交界性肿瘤均行局部扩大切除术 ,其中 1例术后 9个月局部复发 ,并行单侧乳房切除 ,5年存活率为 10 0 %。 2 2例恶性叶状瘤中 ,10例行单纯乳腺切除 ,10例行乳腺根治切除术 ,2例因肿瘤较小行局部扩大切除术。 2 2例恶性肿瘤中除 1例于乳腺根治术后死于肺转移外 ,其余均无复发和转移 ,5年存活率 91.67%。 10例根治切除标本均无腋窝淋巴结转移。结论

Objective To explore the influence of histology and operation patterns on the prognosis of cases with phylloides tumor of the breast.Methods Pathological sections were reviewed among the cases pathologically diagnosed as fibroadenoma and cystosarcoma phylloides and reclassification was made according to the criteria proposed by Azzopardi and Salvadori.Results Among the 96 cases,54 were benign,20 were borderline,and 22 were malignant.The average age of the three groups were 36.5,48.4 and 53 respectively.The average size of tumors in the three groups was 4.4cm,6.9cm,and 7.8cm respectively.Among the 54 cases of benign tumors,40 underwent wide local excision and others received simple local removal.Only 4 cases had recurrences after the simple local removal in 1 year and then received wide local excision.The 5year survival rate was 100%.All the borderline cases underwent wide local excision.Only one of them had local recurrence 9 months later and then received simple mastectomy.The 5year survival rate was 100%.Among the 22 cases of malignant tumors,10 cases underwent simple mastectomy,10 radical mastectomy,2 cases wide local excision because of the small size of tumors.Only 1 case died of metastatic tumor of lungs.The others experienced no recurrence or metastasis.No metostatic tumor of axillary lymph nodes occurred in the 10 cases having received radical mastectomy.Conclusion There exists close relationship between the clinical prognosis of phylloides tumor of the breast and the histology of tumor and operation patterns.