Esposito Nicole Nicosia, Mohan Deepak, Brufsky Adam, Lin Yan, Kapali Malathy, Dabbs David J
Department of Pathology, University of Pittsburgh, Pittsburgh, Pa 15213, USA.
Arch Pathol Lab Med. 2006 Oct;130(10):1516-21. doi: 10.5858/2006-130-1516-PTACAI.
Phyllodes tumors (PTs) of the breast are biphasic neoplasms composed of epithelium and a spindle-cell stroma. Currently, PTs are classified as benign, borderline, or malignant based on histopathologic features. However, histologic classification does not always predict outcome. Objective.-To determine the prognostic value of a variety of clinicopathologic features and immunoreactivities in PTs.
Sixteen benign, 8 borderline, and 6 malignant PTs with follow-up were examined for reactivity across a panel of immunohistochemical stains, including c-Kit, endothelin 1, p16, p21, p53, and Ki-67. Clinicopathologic features, including stromal cellularity, mitotic rate, and margin status, were also assessed. Tumor variables were compared among tumor subgroups and between tumors that did and did not recur.
Of the 30 PTs, 4 recurred (1 benign, 2 borderline, 1 malignant). One patient with a malignant tumor died of metastatic disease 34 months after initial diagnosis. The overall positive rate of c-Kit immunoreactivity was 13% in benign, 63% in borderline, and 67% in malignant PTs. Endothelin 1 epithelial cytoplasmic staining was seen in 100% of benign, 50% of borderline, and 17% of malignant PTs. Additionally, p16, p21, p53, and Ki-67 were differentially expressed among benign, borderline, and malignant tumors. Positive surgical resection margins was the only variable that significantly predicted recurrent disease (P = .02).
Stromal c-Kit positivity and epithelial endothelin 1 negativity are more often associated with malignant PTs; however, only positive margin status is significantly associated with tumor behavior.
乳腺叶状肿瘤（PTs）是由上皮和梭形细胞间质组成的双相性肿瘤。目前，PTs根据组织病理学特征分为良性、交界性或恶性。然而，组织学分类并不总能预测预后。目的：确定多种临床病理特征和免疫反应性在PTs中的预后价值。
对16例良性、8例交界性和6例恶性且有随访资料的PTs进行一组免疫组织化学染色反应检测，包括c-Kit、内皮素1、p16、p21、p53和Ki-67。还评估了临床病理特征，包括间质细胞密度、有丝分裂率和切缘状态。比较肿瘤亚组之间以及复发和未复发肿瘤之间的肿瘤变量。
30例PTs中，4例复发（1例良性、2例交界性、1例恶性）。1例恶性肿瘤患者在初次诊断后34个月死于转移性疾病。c-Kit免疫反应性的总体阳性率在良性PTs中为13%，交界性PTs中为63%，恶性PTs中为67%。内皮素1上皮细胞质染色在100%的良性PTs、50%的交界性PTs和17%的恶性PTs中可见。此外，p16、p21、p53和Ki-67在良性、交界性和恶性肿瘤中表达存在差异。手术切缘阳性是唯一能显著预测复发性疾病的变量（P = 0.02）。
间质c-Kit阳性和上皮内皮素1阴性更常与恶性PTs相关；然而，只有切缘阳性状态与肿瘤行为显著相关。
