Lee Jane S, Chang Jodie, Hagemann Ian S, Bennett Debbie L
Washington University School of Medicine, Department of Pathology and Immunology, St. Louis, MO, USA.
Washington University School of Medicine, Mallinckrodt Institute of Radiology, St. Louis, MO, USA.
J Breast Imaging. 2021 Nov 16;3(6):703-711. doi: 10.1093/jbi/wbab065.
Phyllodes tumors (PT) are rare fibroepithelial lesions of the breast that commonly present as rapidly enlarging, palpable masses. Phyllodes tumors may be classified as benign, borderline, or malignant on the basis of histopathologic analysis. Although malignant PT cannot be distinguished from benign PT on the basis of imaging findings alone, studies suggest that malignant PT tend to be larger and irregular in shape, and they are less likely to have circumscribed margins. If biopsy results are indeterminate, excisional biopsy should be performed. Malignant PT can be difficult to distinguish histologically from sarcomas and spindle cell metaplastic breast carcinoma; the distinction is important for prognosis and treatment. Malignant PT are treated surgically with wide local excision, without a clear role for adjuvant radiation or chemotherapy in most cases. Nearly one-third of malignant PT recur locally, usually within a few years after initial diagnosis. Distant metastatic disease is rare, and the five-year overall survival rate of malignant PT is close to 80%. The purpose of this article is to review the clinical presentation, imaging appearance, histopathology, and management of malignant PT.
叶状肿瘤（PT）是一种罕见的乳腺纤维上皮性病变，通常表现为迅速增大、可触及的肿块。根据组织病理学分析，叶状肿瘤可分为良性、交界性或恶性。虽然仅根据影像学表现无法将恶性PT与良性PT区分开来，但研究表明，恶性PT往往更大且形状不规则，其边界较难清晰界定。如果活检结果不明确，应进行切除活检。恶性PT在组织学上可能难以与肉瘤和梭形细胞化生型乳腺癌区分；这种区分对预后和治疗很重要。恶性PT采用局部广泛切除手术治疗，在大多数情况下，辅助放疗或化疗并无明确作用。近三分之一的恶性PT会局部复发，通常在初次诊断后的几年内。远处转移很少见，恶性PT的五年总生存率接近80%。本文旨在综述恶性PT的临床表现、影像学表现、组织病理学及治疗方法。
