Nishimura R, Hasebe T, Imoto S, Mukai K
Pathology Division, National Cancer Centre Research Institute East, Chiba, Japan.
Virchows Arch. 1998 Jan;432(1):89-93. doi: 10.1007/s004280050139.
A malignant phyllodes tumour with a noninvasive ductal carcinoma component is reported. The patient was an 80-year-old Japanese woman with a breast tumour detected by routine physical examination. A simple mastectomy was performed. The excised tumour was 10.5 x 9.4 x 5.4 cm in size and bulged into the skin with ulceration. The macroscopic appearance was that of a phyllodes tumour. Histologically the tumour consisted mainly of stromal components with a leaf-like structure lined by atypical ductal epithelium. The epithelial component showed gradual evolution to intraductal papillary carcinoma in a few areas. The stromal component was composed mainly of fibrosarcoma with areas of osteosarcoma and rhabdomyosarcoma. Neither stromal invasion of intraductal carcinoma nor transition between the stromal and epithelial elements was seen. Three months after the operation, death occurred, with multiple pulmonary and subcutaneous metastases. This case probably represents malignant change in both the stromal and the epithelial components of a phyllodes tumour. Since the two elements were independent, the possibility that a phyllodes tumour may be one of the origins of true carcinosarcoma is raised.
报告了1例伴有非浸润性导管癌成分的恶性叶状肿瘤。患者为1名80岁日本女性，通过常规体格检查发现乳腺肿瘤。行单纯乳房切除术。切除的肿瘤大小为10.5×9.4×5.4cm，向皮肤表面隆起并伴有溃疡形成。大体外观呈叶状肿瘤表现。组织学上，肿瘤主要由间质成分构成，具有由非典型导管上皮衬覆的叶状结构。上皮成分在少数区域逐渐演变为导管内乳头状癌。间质成分主要由纤维肉瘤构成，并伴有骨肉瘤和横纹肌肉瘤区域。未见导管内癌的间质浸润以及间质与上皮成分之间的转化。术后3个月，患者死亡，伴有多发肺和皮下转移。该病例可能代表叶状肿瘤的间质和上皮成分均发生了恶变。由于这两种成分相互独立，因此提出叶状肿瘤可能是真性癌肉瘤起源之一的可能性。
