Buchberger W, Strasser K, Heim K, Müller E, Schröcksnadel H
Department of Radiology, University of Innsbruck, Austria.
AJR Am J Roentgenol. 1991 Oct;157(4):715-9. doi: 10.2214/ajr.157.4.1654022.
Phylloides tumor is a rare fibroepithelial breast tumor that occasionally has unpredictable clinical behavior. In nine cases of histologically benign tumors and one case of malignant phylloides tumor, the findings on physical examination, mammography, sonography, and aspiration biopsy were correlated retrospectively with the histologic diagnosis of resected specimens. Mammograms showed a round or lobulated benign-appearing opacity in nine cases; one small tumor was missed mammographically. Sonography depicted all tumors as mostly solid masses. Sonographic features included low-level internal echoes, either uniform or scattered; smooth contours; and no significant posterior shadowing. Intramural cysts were shown in six cases. Neither mammography nor sonography allowed reliable differentiation between benign and malignant phylloides tumors. Aspiration biopsy permitted accurate diagnosis of seven benign tumors. The malignant phylloides tumor was classified as a malignant tumor, but the definite differentiation from a carcinoma could not be made. Two histologically benign phylloides tumors were misdiagnosed as carcinomas. Although uncommon, phylloides tumor should be considered in the differential diagnosis of mammographically benign-appearing breast masses, especially if sonography shows intramural cysts within a well-defined solid lesion. Aspiration cytology is unreliable because of the inhomogeneity of the tumor; both intraoperative frozen section and permanent sections are needed for correct histologic diagnosis.
叶状肿瘤是一种罕见的乳腺纤维上皮性肿瘤，其临床行为偶尔难以预测。对9例组织学诊断为良性的肿瘤及1例恶性叶状肿瘤患者，回顾性分析其体格检查、乳腺X线摄影、超声检查及穿刺活检结果，并与切除标本的组织学诊断进行对比。乳腺X线摄影显示9例为圆形或分叶状、表现为良性的不透光区；1例小肿瘤在乳腺X线摄影中漏诊。超声检查显示所有肿瘤大多为实性肿块。超声特征包括内部低回声，可均匀或散在分布；边界光滑；无明显后方声影。6例显示有壁内囊肿。乳腺X线摄影和超声检查均无法可靠地区分良性和恶性叶状肿瘤。穿刺活检准确诊断出7例良性肿瘤。恶性叶状肿瘤被归类为恶性肿瘤，但无法与癌进行明确鉴别。2例组织学诊断为良性的叶状肿瘤被误诊为癌。尽管叶状肿瘤不常见，但在乳腺X线摄影表现为良性的乳腺肿块鉴别诊断中应考虑到，尤其是超声显示边界清晰的实性病灶内有壁内囊肿时。由于肿瘤的不均匀性，穿刺细胞学检查不可靠；正确的组织学诊断需要术中冰冻切片和永久切片。
