乳腺叶状肿瘤的临床病理学研究

Clinicopathological study on phyllodes tumor of the breast

目的 探讨乳腺叶状肿瘤的病理形态学特点、分类和诊断标准、与复发转移的关系及其临床意义。方法 采用回顾性分析的方法对 2 0 3例有随访 (6～ 372个月 )资料的叶状肿瘤作了详细形态学特征的分析和分类研究 ,统计学聚类判别分析 (SPSS软件 10 0版 )。结果 良性 133例 (复发 2 8例 ) ,交界性 4 2例 (复发 19例 ,死亡 2例 ) ,恶性 2 8例 (复发 18例 ,死亡 15例 )。统计学分析结果显示 ,肿瘤生长方式、瘤细胞异型性、核分裂象计数和肿瘤性坏死所组成的变量子集分类错判率为零。以此 4项为主 ,完善了病理组织学诊断标准。良性、交界性和恶性组间复发率、转移和死亡率差异均有显著性意义。肿瘤复发随术式的扩大而减少 ,2次以上复发占 5 3 85 % (35 / 6 5 )。结论 此瘤可分为良性、低度恶性 (交界性 )及恶性三种类别。肿瘤生长方式、瘤细胞异型性、核分裂象和肿瘤性坏死是诊断此瘤并对其进行分级 (分类 )的重要依据。提示首次术式的选择的重要性 ,良性叶状肿瘤应选择肿物扩大切除术 。

Objective To study the relationship between pathological features and classification criteria of the breast Phyllodes tumor Methods 203 cases of breast phyllodes tumor diagnosed in 22 hospitals since 1956 were analyzed and reappraised by a retrospective study Results 133 cases were benign, 42 cases were borderline and 28 were malignant The follow up (6 to 372 months) showed that 28/133 benign, 19/42 borderline and 18/28 malignant cases recurred, and 17 patients (2 borderline and 15 malignant ) died The statistic cluster analysis demonstrated that stromal cellar atypia, margin involvement, mitotic activity and tumor necrosis were retained in the variable group, and no error distinguish were showed Conclusions The breast phyllodes tumor can be classified as the following three types: benign, borderline and malignant It is important to diagnose and classify the breast phyllodes tumor according to the involvement of tumor margin, stromal cellar atypia, mitotic activity, stromal overgrowth and tumor necrosis There are significant differences of 5 years survival rates, recurrent rates and death rates between the benign, borderline and malignant breast phyllodes tumor With wide excision the recurrence of the tumor decreased suggesting that broad excision is preferred for the benign phyllodes tumor and mastectomy is indicated for recurred borderline and malignant tumors