Jacobs Timothy W, Chen Yunn-Yi, Guinee Donald G, Holden Joseph A, Cha Imok, Bauermeister Donald E, Hashimoto Beverly, Wolverton Dulcy, Hartzog Grady
Department of Pathology, Virginia Mason Medical Center, Seattle, WA 98101, USA.
Am J Clin Pathol. 2005 Sep;124(3):342-54. doi: 10.1309/5N2C-4N5X-CB8X-W8JL.
Fibroepithelial lesions with cellular stroma (FELCS) in breast core needle biopsy (CNB) specimens may result in either fibroadenoma or phyllodes tumor at excision. We evaluated histologic features, proliferation indices (by Ki-67 and topoisomerase II a immunostaining) and p53 expression in 29 cases of FELCS in CNB specimens and correlated these with excision findings in a blinded manner. On excision, 16 patients had fibroadenomas and 12 had phyllodes tumors. All CNB specimens with mildly increased stromal cellularity were fibroadenomas on excision (n=4), and all with markedly cellular stroma were phyllodes tumors (n=4). Among CNB specimens with moderate cellularity (12 fibroadenomas and 8 phyllodes tumors), only stromal mitoses were discriminatory histologically. Stromal proliferation indices were significantly higher in CNB that were phyllodes tumors vs fibroadenomas. Assessment of stromal cellularity, mitoses, and proliferation indices might help determine the probability of phyllodes tumor occurring and guide management of these cases.
乳腺粗针穿刺活检（CNB）标本中的伴有细胞性间质的纤维上皮性病变（FELCS）在切除时可能导致纤维腺瘤或叶状肿瘤。我们评估了29例CNB标本中FELCS的组织学特征、增殖指数（通过Ki-67和拓扑异构酶IIα免疫染色）和p53表达，并以盲法将这些与切除结果相关联。切除时，16例患者患有纤维腺瘤，12例患有叶状肿瘤。所有间质细胞轻度增多的CNB标本在切除时均为纤维腺瘤（n = 4），所有间质细胞明显增多的均为叶状肿瘤（n = 4）。在间质细胞中度增多的CNB标本中（12例纤维腺瘤和8例叶状肿瘤），仅间质有丝分裂在组织学上具有鉴别意义。与纤维腺瘤相比，叶状肿瘤的CNB标本中的间质增殖指数显著更高。评估间质细胞性、有丝分裂和增殖指数可能有助于确定叶状肿瘤发生的可能性并指导这些病例的处理。
