Morioka Emi, Noguchi Masakuni, Noguchi Miki, Inokuchi Masafumi, Shimada Ken-Ichi, Shioya Akihiro, Aikawa Akane, Minato Hiroshi, Earashi Mitsuharu
Department of Breast and Endocrine Surgery/Breast Center, Kanazawa Medical University Hospital, 1-1, Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa, 920-0293, Japan.
Department of Plastic Surgery, Kanazawa Medical University Hospital, 1-1, Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa, 920-0293, Japan.
Surg Case Rep. 2020 Nov 25;6(1):297. doi: 10.1186/s40792-020-01022-5.
Although the primary treatment for malignant phyllodes tumor (PT) is complete surgical excision with either breast-conserving surgery or total mastectomy, recent technical advances have led to the adoption of nipple-sparing mastectomy (NSM) with immediate breast reconstruction (IBR).
A 28-year-old woman noticed a mass in her left breast that was rapidly increasing in size. She underwent tumor excision and a histological diagnosis of marked degenerative and necrotic induration suggested benign PT. One year later, however, she was found to have recurrent masses in the left breast on follow-up mammography and sonography. Needle biopsy was performed and the tumor was diagnosed as borderline or malignant PT. She underwent NSM and sentinel lymph-node biopsy with IBR using a tissue expander. Histological examination of the mastectomy specimen showed multiple fibroepithelial tumors with marked stromal overgrowth, focal necrosis, and hemorrhage. Stromal cells showed pleomorphism and a maximal mitotic rate of approximately 25 per 10 high-power fields. The tumor was diagnosed as malignant PT. She did not receive adjuvant chemotherapy or radiation treatment. At 3-year follow-up, the patient remains free of disease and highly satisfied with the cosmetic results.
NSM with IBR is not a contraindication for malignant PT. It is both curative and can offer an appealing cosmetic option for localized malignant PT.
尽管恶性叶状肿瘤（PT）的主要治疗方法是采用保乳手术或全乳切除术进行完整的手术切除，但最近的技术进步已促使采用保留乳头的乳房切除术（NSM）并立即进行乳房重建（IBR）。
一名28岁女性注意到左乳房有一个肿块，其大小迅速增大。她接受了肿瘤切除，组织学诊断为明显的退行性和坏死性硬结，提示为良性PT。然而，一年后，在随访乳房X线摄影和超声检查中发现她左乳房有复发性肿块。进行了针吸活检，肿瘤被诊断为交界性或恶性PT。她接受了NSM和前哨淋巴结活检，并使用组织扩张器进行IBR。乳房切除标本的组织学检查显示多个纤维上皮肿瘤，伴有明显的间质过度生长、局灶性坏死和出血。间质细胞表现出多形性，最大有丝分裂率约为每10个高倍视野25个。肿瘤被诊断为恶性PT。她未接受辅助化疗或放疗。在3年的随访中，患者无疾病复发，对美容效果非常满意。
NSM联合IBR并非恶性PT的禁忌证。它既具有治愈性，又能为局限性恶性PT提供有吸引力的美容选择。
