Widya Ralph L, Rodrigues Myra F, Truong Pauline T, Watson Peter H, Weir Lorna M, Knowling Margaret A, Wai Elaine S
Radiology, Leiden University Medical Center.
Radiation Oncology, Erasmus Mc Cancer Institute.
Cureus. 2017 Nov 3;9(11):e1815. doi: 10.7759/cureus.1815.
Background Phyllodes tumor (PT) of the breast is an uncommon fibroepithelial neoplasm. Malignant epithelial transformation in PT is rare. This study reports clinicopathologic characteristics and outcomes of patients with malignant epithelial transformation in PT. Methods From an institutional database of 183 patients with newly diagnosed PT referred to a Canadian provincial cancer institution between 1999 and 2014, 11 cases of PT with concomitant in situ or invasive carcinoma were identified. Descriptive analysis was performed to document the characteristics, treatment and outcomes of this cohort. Results Prevalence of malignant epithelial transformation in PT was 6.0%. Median (range) age was 54 (35-75) years. Types of carcinoma were ductal carcinoma in situ (DCIS) (n = 6), lobular carcinoma in situ (n = 4), and invasive ductal carcinoma (IDC) (n = 1). Median PT size was 5 (1-15) cm. Three PTs were classified as benign (27%), five as borderline (45%), and three as malignant (27%). Mastectomy was performed in six (55%) and breast conserving surgery in five (45%) patients. Hormonal therapy was used in two cases: one with a 1 cm, grade 2 DCIS, and one with an 11 cm, grade 1 IDC, the latter also receiving radiotherapy. Mean follow-up duration was 54 (6-175) months. None of the cases showed any evidence of disease after treatment at the time of their last follow-up. Conclusion This case series showed a higher prevalence of malignant epithelial transformation in PT than reported in previous literature. Outcomes were favourable despite the presence of either in situ or invasive carcinoma within PT.
背景 乳腺叶状肿瘤（PT）是一种罕见的纤维上皮性肿瘤。PT 中恶性上皮化生很少见。本研究报告了 PT 中发生恶性上皮化生患者的临床病理特征及转归。方法 从 1999 年至 2014 年转诊至加拿大某省级癌症机构的 183 例新诊断 PT 患者的机构数据库中，识别出 11 例伴有原位或浸润性癌的 PT 病例。进行描述性分析以记录该队列的特征、治疗及转归。结果 PT 中恶性上皮化生的发生率为 6.0%。中位（范围）年龄为 54（35 - 75）岁。癌的类型为导管原位癌（DCIS）（n = 6）、小叶原位癌（n = 4）和浸润性导管癌（IDC）（n = 1）。PT 的中位大小为 5（1 - 15）cm。3 例 PT 被分类为良性（27%），5 例为交界性（45%），3 例为恶性（27%）。6 例（55%）患者行乳房切除术，5 例（45%）患者行保乳手术。2 例患者使用了激素治疗：1 例为 1 cm 的 2 级 DCIS，1 例为 11 cm 的 1 级 IDC，后者还接受了放疗。平均随访时间为 54（6 - 175）个月。末次随访时，所有病例治疗后均未显示疾病复发迹象。结论 该病例系列显示 PT 中恶性上皮化生的发生率高于既往文献报道。尽管 PT 内存在原位或浸润性癌，但其转归良好。
