46例乳腺分叶状肿瘤临床病理特点及误诊分析

Clinicopathologic Features and Misdiagnostic Analysis of 46 Cases of Phyllodes Tumor of the Breast

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,表达在肿瘤间质细胞;Act在部分病例(36.96%,17/46)表达于间质细胞;AE1/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。

Objective To investigate the clinicopathologic features and cause of misdiagnosis of phyllodes tumor of the breast. Methods Forty-six cases of phyllodes tumor of the breast were analyzed retrospectively,and the ex- pressions of AE1/AE3, VIM,smooth muscle actin （Act）and Ki-67 were analyzed by using immunohistochemical method. Results Of the 46 cases of phyllodes tumor of the breast, the preoperative clinical diagnosis of 24 cases were consistent with the results, the preoperative diagnosis of the others were： 15 cases of breast fibroadenoma,4 ca- ses of breast hyperplasia or mixed cyst,3 cases of breast cancer or suspected breast cancer. The preoperative clinical diagnosis misdiagnosis rate was 47.83% （22/46）. The intraoperative pathological diagnosis for 40 cases of phyl- lodes tumor of the breast, the missed diagnosis rate was 13.04% （6/46）. Postoperative paraffin pathology diagno- sis ： of 46 cases o[ phyllodes tumor of the breast,35 cases of benign,7 cases of borderline,4 cases of malignant, lm- munohistochemical method results： VIM expression were positive in the interstitial cells; Act was positive in the in- terstitial cells of some cases （36.96% , 17/46 ） ; no AE1/AE3 expression in the interstitial cells （for the exclusion of spindle cell cancer） ; the average Ki-67 positive cell index in the benign, the borderline and the malignant were respectively 13% ,28% and 69% （P 〈 0.05）. Conclusion Phyllodes tumor of the breast has the higher clinical misdiagnosis rate and frozen pathological misdiagnosis rate, and the choices of treatment is related with the pathologi- cal typing, immunohistochemical method is important for the identification of benign and malignant. Tumor diagnosedpromptly and operation mode selection are the key to successful treatment.