Bässler R, Zahner J
Pathologisches Institut der Städtischen Kliniken Fulda.
Geburtshilfe Frauenheilkd. 1989 Jan;49(1):1-10. doi: 10.1055/s-2008-1035726.
134 Cystosarcoma phyllodes were been observed in the course of 12 years among the diagnostic and consultative (n = 121) material. 133 tumors occurred in the female, one in the male breast. In 21 cases local recurrences and in 4 cases metastases developed. 6 recurrences following local excision were observed more than once: in one case 10 subsequent recurrent tumors, the last of these in the chest wall after mastectomy. Histopathologically, the recurrences were identified as benign (1 case), as borderline tumors (2 cases) and as malignant cystosarcoma (8 cases). In 10 further cases (48% of the recurrences) a stromal sarcoma was predominant. In accordance with the literature, we found in most cases a more aggressive growth and an enhanced malignancy. It is emphasized, that angioinvasive growth in the recurrent tumors can indicate distant metastases. The frequency of the recurrent cystosarcoma in our series was 16%, multiple subsequent tumors occurred in 29% of them. Recurrences are caused by proliferative remnants of the primary tumor following local excision, or they are tumors-de-novo induced by a extratumoral stromal hypercellularity of the surroundings like a new benign cystosarcoma. Therefore an initial wide excision is recommended for the benign and a mastectomy for the malignant cystosarcoma. The site of distant metastases of the 4 cases were the lung and the skeleton (rib and femur). In one case an axillary lymph node was involved by a recurrent giant cell stromal sarcoma. The interval between primary and metastases was 7 months to 5 years, between recurrent tumor and metastases 6 to 24 months or both tumors were observed simultaneously. Following the recent literature, distant metastases occur at an average rate of 19% of the malignant cystosarcomas. In single cases it is impossible to make a sure prognosis of cystosarcoma phyllodes, because recurrences and metastases are observed in all subtypes, but predominantly in the malignant cystosarcomas.
在12年的诊断和会诊（n = 121）病例中观察到134例叶状囊肉瘤。133例肿瘤发生于女性乳房，1例发生于男性乳房。21例出现局部复发，4例发生转移。局部切除后观察到6例复发不止一次：1例有10个后续复发性肿瘤，最后一个在乳房切除术后位于胸壁。组织病理学上，复发肿瘤被鉴定为良性（1例）、交界性肿瘤（2例）和恶性叶状囊肉瘤（8例）。另外10例（占复发病例的48%）以间质肉瘤为主。与文献一致，我们发现大多数病例生长更具侵袭性且恶性程度增加。需要强调的是，复发性肿瘤中的血管侵袭性生长可能提示远处转移。我们系列中复发性叶状囊肉瘤的发生率为16%，其中29%出现多个后续肿瘤。复发是由于局部切除后原发肿瘤的增殖性残余，或者是由周围肿瘤外间质细胞增多诱导产生的新发肿瘤，如新发良性叶状囊肉瘤。因此，对于良性叶状囊肉瘤建议初始广泛切除，对于恶性叶状囊肉瘤建议乳房切除术。4例远处转移的部位是肺和骨骼（肋骨和股骨）。1例复发性巨细胞间质肉瘤累及腋窝淋巴结。原发肿瘤与转移之间的间隔为7个月至5年，复发肿瘤与转移之间的间隔为6至24个月，或者两个肿瘤同时被观察到。根据最新文献，恶性叶状囊肉瘤远处转移的平均发生率为19%。在个别病例中，无法对叶状囊肉瘤做出确切预后判断，因为所有亚型均观察到复发和转移，但主要发生在恶性叶状囊肉瘤中。
