Traps in clinicopathologic diagnosis of malignant phyllodes tumor of the breast in adolescent female patients with intraductal carcinoma
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摘要:
目的 分析青少年女性恶性叶状肿瘤内癌的诊断陷阱并进行文献复习。 方法 对1例青少年女性恶性叶状肿瘤内癌的临床特点、HE染色和免疫组化特点并结合文献进行分析。 结果 患者女性，18岁，镜下肿瘤细胞异型性十分明显，肿瘤增长速度快，易出现肿瘤坏死，在空芯针穿刺、冷冻及常规病理时，需排除纤维腺瘤和其他类型肉瘤、化生性癌等诊断，全面广泛取材及免疫组化才能做出准确的病理诊断。 结论 青少年女性乳腺恶性叶状肿瘤十分少见，恶性叶状肿瘤内癌更是十分罕见，提高该病临床病理特点的认识，可尽量减少误诊。 Abstract:Objective To analyze traps in clinicopathologic diagnosis of malignant phyllodes tumors (MPTs) of the breast in adolescent females with intraductal carcinoma and review the literatures. Methods The clinical features, HE staining and immunohistochemical features of one 18-year-old female MPT case with intraductal carcinoma were analyzed combined with literatures. Results Histologic study showed marked cellular atypia in the tumor with rapid growth rate, and tumor necrosis was frequently associated. Before the performance of core needle biopsy (CNB), cryosurgery and routine pathological diagnosis, the diagnosis of fibroadenoma, other types of sarcoma and metaplastic carcinoma should be excluded, and a comprehensive and extensive collection of materials and immunohistochemistry is necessary in making an accurate pathological diagnosis. Conclusions MPTs of the breast in young females are rare, and MPTs in young females with intraductal carcinoma are even rarer. Therefore, improving the understanding of its clinicopathological features can reduce the risk of misdiagnosis. -
[1] Rosen PP . Rosen＇s breast pathology[M]. New York: Lippin-Cott-Ray, 1996: 155-72. [2] RO Weller.The International histological classification of tumors[C]//World Health Organization, 1981,34(99): 555-74. [3] Tavassoli F, Devilee P. Pathology&genetics,tumours of the breast and female genital organs[M]. lyon: Larc Press, 2003. [4] Rosai J. Problems in breast pathology revisited preface[J].Semin Diagn Pathol, 2010, 27(1): 2-4. doi: 10.1053/j.semdp.2009.11.001 [5] 丁华野, 张祥盛, 步 宏, 等. 乳腺病理诊断和鉴别诊断[M].北京: 人民卫生出版社, 2014: 264-6. [6] Abdul AM, Sullivan F, Kerin MJ, et al. Malignant phyllodes tumour with liposarcomatous differentiation,invasive tubular carcinoma and ductal and lobular carcinoma in situ:Case report and review of the literature[J]. Patholog Res Int, 2010,28(1): 501274-9. [7] Barrio AV, Clark BD, Goldberg JI, et al. Clinicopathologic features and long-term outcomes of 293 phyllodes tumors of the breast[J]. Ann Surg Oncol, 2007, 14(10): 2961-70. doi: 10.1245/s10434-007-9439-z [8] Karim RZ, Scolyer RA, Tse GM, et al. Pathogenic mechanisms in the initiation and progression of mammary phyllodes tumours[J]. Pathology, 2009, 41(2): 105-17. doi: 10.1080/00313020802579342 [9] Kwon JE, Jung WH, Koo JS. Molecules involved in epithelial-mesenchymal transition and epithelial-stromal interaction in phyllodes tumors: implications for histologic grade and prognosis[J]. Tumour Biol, 2012, 33(3): 787-98. doi: 10.1007/s13277-011-0296-9 [10] 金 华, 郭红红, 丁华野. 乳腺叶状肿瘤内的小叶瘤变及微小浸润癌临床病理观察[J]. 诊断病理学杂志, 2013, 20(09): 560-3. doi: 10.3969/j.issn.1007-8096.2013.09.016 [11] Macher GS, Marme F, Goeppert B, et al. Invasive ductal breast cancer within a malignant phyllodes tumor:case report and assessment of clonality[J]. Hum Pathol, 2010, 41(2): 293-6. doi: 10.1016/j.humpath.2009.08.006 [12] Jones AM, Mitter R, Springall R, et al. A comprehensive genetic profile of phyllodes tumours of the breast detects important mutations, intra-tumoral genetic heterogeneity and new genetic changes on recurrence[J]. J Pathol, 2008, 214(5): 533-44. doi: 10.1002/path.v214:5 [13] Muller KE, Tafe LJ, de Abreu FB, et al. Benign phyllodes tumorof the breast recurring as a malignant phyllodes tumor and spindle cell metaplastic carcinoma[J]. Hum Pathol, 2015, 46(2): 327-33. doi: 10.1016/j.humpath.2014.10.014 [14] Hodges KB, Abdul KF, Wang M, et al. Evidence for nsformation of fibroadenoma of the breast to malignant phyllodes tumor[J]. Appl Immunohistoehem Mol Morphol, 2009, 17(4): 345-50. doi: 10.1097/PAI.0b013e318194d992 [15] Ang MK, Ooi AS, Thike AA, et al. Molecular classification of breast phyllodes tumors: validation of the histologic grading scheme and insights into malignant progression[J]. Breast Cancer Res Treat, 2011, 129(2): 319-29. doi: 10.1007/s10549-010-1204-5 [16] Hirano H, Matsushita K, Okimura A, et al. Nuclear survivin expression in stromal cells of phyllodes tumors and fibroadenomas of the breast[J]. Anticancer Res, 2014, 34(3, SI): 1251-3. [17] Burga AM, Tavassoli F. Periducttal stromal tumor:a rare lesion with low-grade sarcomatous behavior[J]. Am J Surg Pathol, 2003, 27(9): 343-8. [18] Liang MI, Ramaswamy B, Patterson CC, et al. Giant breast tumors: Surgical management of phyllodes tumors, potential for reconstructive surgery and a review of literature[J]. World J Surg Oncol, 2008, 6(9): 117-24. [19] Jang JH, Choi MY, Lee SK, et al. Clinicopathologic risk factors for the local recurrence of phyllodes tumors of the breast[J]. Ann Surg Oncol, 2012, 19(8): 2612-7. doi: 10.1245/s10434-012-2307-5 [20] Macdonald OK, Lee CM, Tward JD, et al. Malignant phyllodes tumor of the female breast:association of primary therapy causespecific survival from the Surveillance,Epidemiology,and End Results(SEER)program[J]. Cancer, 2006, 107(9): 2127-33. doi: 10.1002/(ISSN)1097-0142 [21] Barth RJ, Wells WA, Mitchell SE, et al. A prospective,multiinstitutional study of adjuvant radiotherapy after resection of malignant phyllodes tumors[J]. Ann Surg Oncol, 2009, 16(8): 2288-94. doi: 10.1245/s10434-009-0489-2 [22] Wei J, Tan YT, Cai YC, et al. Predictive factors for the local recurrence and distant metastasis of phyllodes tumors of the breast: a retrospective analysis of 192 cases at a single center[J]. Chin J Cancer, 2014, 33(10): 492-500. [23] Lenhard MS, Kahlert S, Himsl I, et al. Phyllodes tumour of the breast: Clinical follow-up of 33 cases of this rare disease[J]. Eur J Obstet Gynecol Reprod Biol, 2008, 138(2): 217-21. doi: 10.1016/j.ejogrb.2007.08.002 [24] Bousquet G, Marsiglia H. Phyllodes tumor of the breast[J]. Int J Radiat Oncol Biol Phys, 2008, 70(2): 492-500. doi: 10.1016/j.ijrobp.2007.06.059 [25] Spitaleri G, Toesca A, Botteri EA, et al. Breast phyllodes tumor: A review of literature and a single center retrospective series analysis[J]. Crit Rev Oncol Hematol, 2013, 88(2): 427-36. doi: 10.1016/j.critrevonc.2013.06.005 -
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