Abdul Aziz Mardiana, Sullivan Frank, Kerin Michael J, Callagy Grace
Division of Anatomic Pathology, Galway University Hospitals, Galway, Ireland.
Patholog Res Int. 2010 Jul 5;2010:501274. doi: 10.4061/2010/501274.
A 43-year-old woman presented with a right breast lump that had enlarged over 5 months. She had chemoradiotherapy for non-Hodgkin's lymphoma in 1989. Histology revealed a malignant phyllodes tumour (PT) with liposarcomatous differentiation and ductal carcinoma in situ (DCIS) within the tumour with invasive tubular carcinoma, DCIS, and lobular carcinoma in situ in the surrounding breast. She had surgery and adjuvant radiotherapy. One year follow-up showed no recurrence or metastatic disease. Liposarcomatous differentiation is uncommon in PTs, and coexisting carcinoma is rare with 38 cases in 31 reports in the literature. Carcinoma is reported in malignant (n = 19), benign (n = 16) and in borderline PTs (n = 3) with invasive carcinoma (n = 18) and pure in situ carcinoma (n = 19) recorded in equal frequency. Carcinoma is more commonly found within the confines of benign PTs; whereas it is more often found surrounding the PT or in the contralateral breast in malignant PTs. Previous radiotherapy treatment is reported in only two cases. The aetiology of co-existing carcinoma is unclear but the rarity of previous radiotherapy treatment suggests that it is incidental. This case highlights the diverse pathology that can occur with PTs, which should be considered when evaluating pathology specimens as they may impact on patient management.
一名43岁女性因右乳肿块就诊，该肿块在5个月内增大。她曾于1989年接受过非霍奇金淋巴瘤的放化疗。组织学检查显示为恶性叶状肿瘤（PT），伴有脂肪肉瘤样分化，肿瘤内有导管原位癌（DCIS），周围乳腺组织中有浸润性小管癌、DCIS和小叶原位癌。她接受了手术及辅助放疗。1年的随访显示无复发或转移疾病。脂肪肉瘤样分化在PT中并不常见，并存癌罕见，文献报道的31篇报告中有38例。在恶性（n = 19）、良性（n = 16）和交界性PT（n = 3）中均有癌的报道，浸润性癌（n = 18）和单纯原位癌（n = 19）的发生频率相同。癌更常见于良性PT范围内；而在恶性PT中，癌更常出现在PT周围或对侧乳腺。仅两例报告有既往放疗史。并存癌的病因尚不清楚，但既往放疗史罕见表明其为偶然情况。该病例突出了PT可能出现的多种病理情况，在评估病理标本时应予以考虑，因为它们可能影响患者的管理。
