Department of Surgery, Mito Medical Center, National Hospital Organization, Ibaraki, Ibaraki, Japan.
Breast Cancer. 2010 Jul;17(3):218-24. doi: 10.1007/s12282-009-0099-7. Epub 2009 Apr 7.
Here we present a case of malignant phyllodes tumor which was composed almost exclusively of a fibrosarcomatous component. A 52-year-old Japanese female noted a rapid increase of her right breast tumor. On admission, multiple lung metastases were detected by imaging. Right simple mastectomy was performed. The tumor, 10 x 10 cm in the largest dimension, had somewhat of a pushing margin, and showed a flesh-like appearance with marked necrosis. Microscopically, the tumor showed proliferation of atypical ovoid- or spindle-shaped cells in a myxoid matrix. Multiple sectioning revealed that the tumor had only focal occurrence of elongated tubular structures, and the occurrence of a small component of benign phyllodes tumor, leading to the aforementioned final diagnosis. Spindle cell carcinoma was excluded on the basis of the HE findings and the lack of immunoreactivity for cytokeratin when using a broad spectrum antibody mixture. Although the patient received adjuvant chemotherapy, no responsiveness was obtained. The patient died 4 months following surgery. We reviewed 15 malignant phyllodes tumors with metastases reported in Japan. The estimated 2.2-year survival rate following detection of metastasis was 11%, thus confirming the aggressiveness of the disease.
我们在此报告一例几乎完全由纤维肉瘤成分组成的恶性叶状肿瘤病例。一名 52 岁日本女性发现其右乳房肿瘤迅速增大。入院时，影像学检查发现多发性肺转移。行右侧单纯乳房切除术。肿瘤最大径为 10x10cm，呈推挤性边界，呈肉质外观，伴有明显坏死。显微镜下，肿瘤在黏液样基质中显示出增生的异型卵圆形或梭形细胞。多个切片显示肿瘤仅局灶性出现长形管状结构，以及良性叶状肿瘤的小成分，导致上述最终诊断。根据 HE 发现和广谱抗体混合物对细胞角蛋白无免疫反应性，排除了梭形细胞癌。尽管患者接受了辅助化疗，但未获得应答。术后 4 个月患者死亡。我们复习了日本报道的 15 例有转移的恶性叶状肿瘤。转移后估计 2.2 年的生存率为 11%，因此证实了该疾病的侵袭性。
