Jagdewsing Dhierin R, Murtaza Ghulam, Jagdewsing Sima A, Jagdewsing Shruti A, Fahmy Noor Safra C, Silva Fhns Anthony, Koendjbiharie Tanul, Djojomoenawi Sherilyn, Kwakye Omane V, Mahmud Nm Motachim
Department of Colorectal Cancer Surgery, Dalian Medical University, Dalian, CHN.
Department of Surgery, Services Hospital Lahore, Lahore, PAK.
Cureus. 2024 Dec 22;16(12):e76221. doi: 10.7759/cureus.76221. eCollection 2024 Dec.
Phyllodes tumor (PT) is a variant of fibroepithelial proliferations of the breast, histologically demonstrating a leaf-like pattern. The WHO has categorized PTs as benign, borderline, or malignant based on their histological characteristics. The objective of this paper is to assess the clinicopathological factors with malignancy in PT of the breast.
Medical records of 101 diagnosed PT patients in the Second Affiliated Hospital of Dalian Medical University between 2008 and 2023 were reviewed. Information on clinical presentation and histopathological findings of the lesions were retrieved from patient files and/or histological reports, respectively.
Of the 101 patients, all were female and had a mean age of 44.35 ± 14.14 years and mean tumor size of 8.3 ± 5.8 cm The distribution for the histological type was benign (n = 54, 53.4%), borderline (n = 36, 35.6%) and malignant (n = 11, 10.8%). Most benign PTs were observed in younger patients, while borderline and malignant PTs involved elderly patients, with a mean age of 47.56 ± 11.86 years for borderline PT and a mean age of 46.55 ± 11.62 years for malignant PT. Benign PTs had a mean size of 5.58 ± 2.29 cm, while those of borderline and malignant were larger, with a mean size of 10.58 ± 6.79 cm and 14.90 ± 6.44 cm, respectively. Malignant PTs had higher lactate dehydrogenase (LDH) levels of 232 ± 91.5 U/L compared to borderline PTs, 177.9 ± 19.9 U/L, and benign PTs, 177.6 ± 39.9U/L. The course of the disease of the malignant PT group was slightly longer (436.9 ± 391.3 weeks) than that of the benign (44.17 ± 71.54 weeks) and borderline (54.33 ± 94.33 weeks). In histopathology, necrosis was observed only in malignant PTs (81.8%), and severe stromal atypia was seen in 72.7% of malignant cases. The mitotic count was highest in malignant PTs at 13.18 ± 4.43 HPF as compared to benign 3.52 ± 2.97 HPF and borderline PTs at 7.28 ± 2.21 HPF.
Benign PTs were more common in this study than malignant or borderline PTs. There was a highly significant correlation between patient age, tumor size, LDH, and disease progression in all subtypes of PT. This analysis showed that malignant PTs were larger and observed in older patients with higher LDH and with a longer duration of the disease. Other factors, in addition to histological properties, are useful in determining PT behavior and management. More studies at an advanced level of evidence in the form of randomized trials are required when developing a risk classification for PT based on patient age, tumor size, and LDH.
叶状肿瘤（PT）是乳腺纤维上皮增生的一种变体，组织学上呈叶状模式。世界卫生组织根据其组织学特征将PT分为良性、交界性或恶性。本文的目的是评估乳腺PT中与恶性相关的临床病理因素。
回顾了大连医科大学附属第二医院2008年至2023年间101例确诊为PT患者的病历。分别从患者病历和/或组织学报告中获取病变的临床表现和组织病理学检查结果信息。
101例患者均为女性，平均年龄44.35±14.14岁，平均肿瘤大小8.3±5.8 cm。组织学类型分布为良性（n = 54，53.4%）、交界性（n = 36，35.6%）和恶性（n = 11，10.8%）。大多数良性PT见于年轻患者，而交界性和恶性PT多见于老年患者，交界性PT的平均年龄为47.56±11.86岁，恶性PT的平均年龄为46.55±11.62岁。良性PT的平均大小为5.58±2.29 cm，而交界性和恶性PT的平均大小更大，分别为10.58±6.79 cm和14.90±6.44 cm。与交界性PT（177.9±19.9 U/L）和良性PT（177.6±39.9 U/L）相比，恶性PT的乳酸脱氢酶（LDH）水平更高，为232±91.5 U/L。恶性PT组的病程（436.9±391.3周）比良性组（44.17±71.54周）和交界性组（54.33±94.33周）略长。在组织病理学上，仅在恶性PT中观察到坏死（81.8%），72.7%的恶性病例出现严重的间质异型性。恶性PT的有丝分裂计数最高，为13.18±4.43个高倍视野（HPF），而良性为3.52±2.97 HPF，交界性PT为7.28±2.21 HPF。
在本研究中，良性PT比恶性或交界性PT更常见。在PT的所有亚型中，患者年龄、肿瘤大小、LDH与疾病进展之间存在高度显著的相关性。该分析表明，恶性PT更大，见于年龄较大、LDH较高且病程较长的患者。除组织学特征外，其他因素有助于确定PT的行为和治疗。在基于患者年龄、肿瘤大小和LDH制定PT风险分类时，需要更多高级别证据形式的随机试验研究。
