乳腺叶状肿瘤的临床病理分析

Clinicopathologic analysis of phyllodes tumours

目的分析乳腺叶状肿瘤(phyllodes tumours,PT)的临床病理特征、超声表现及治疗方法。方法收集2007年11月至2016年7月于北京市海淀区妇幼保健院就诊的纤维上皮性肿瘤1325例,对其中的37例PT患者的临床病理资料进行回顾性研究。结果 PT占纤维上皮性肿瘤的2.8%(37/1325)。37例PT患者中有26例为良性,7例交界性,4例恶性。PT患者的平均发病年龄为33.9岁,良性PT患者的平均年龄为31.8岁,交界性PT为36.3岁,恶性PT为43.8岁。1例恶性PT内可见导管原位癌,11例PT伴有纤维腺瘤,1例良性PT患者在3年前有导管原位癌手术史。20例随访病例中,有2例PT肿物切除后复发,其中1例为良性PT,1例为交界性PT,复发后组织病理学与之前相似,扩大切除后未复发。结论恶性PT的发病年龄较良性及交界性PT大;PT内出现癌提示为一种碰撞瘤;彩色多普勒超声对PT的诊断价值较低;PT以手术切除为主,选择合适的手术方案对于预防PT的复发具有重要意义。

Objective To analysis the clinical and histopathologic characteristics, ultrasound features and treatment of phyllodes tumours（PT）. Method 37 patients with PT, among 1325 with fibroepithellal tumours, from November 2007 to July 2016 from Haidian Maternal and Child Health Hospital were enrolled in this study. The clinicopathologic data of 37 cases was retrospectively analyzed. Result The 37 cases of PT accounted for 2.8% （37/1325） of all fibroepithelial tumours, including 26 cases of benign PT, 7 cases of borderline and 4 cases of malignant. The average age of the 37 cases was 33.9 years old, the average age of benign PT 31.8 years old, the average age of borderline PT 36.3 years old and the average age of malignant PT 43.8 years old. 1 case of malignant PT associated with ductal carcinoma in situ （DCIS） inside and 11 cases of PT associated with fibroadenoma were observed. 1 case of benign PT suffered DCIS 3 years ago. 2 cases of PT recurred during the 20 follow-up cases, 1 case of benign PT and the other of borderline. The histological type was the same as the former. Following extended resection, the 2 patients remained recurrence-free. Conclusion The average age of malignant PT is elder than borderline and benign PT.The coexisting of PT and carcinoma sugguests a collision tumour. Ultrasound plays little role in diagnosis of PT. Resection is the main treatment, which is important for prevention of recurrence.