Vos D I, Mastboom W J, de Vos R A
Medisch Spectrum Twente, afd. Heelkunde, Enschede.
Ned Tijdschr Geneeskd. 1998 Mar 28;142(13):716-21.
In three women aged 51, 37 and 58 years, with a palpable tumour in the breast, excision and pathological examination led to the diagnosis of 'phyllodes tumour'. During 3-5 years after radical excision, in one patient followed by radiotherapy, no recurrences were seen. This rare breast tumour with a variable clinical course usually affects women between the ages of 30 and 50. There is often a large tumour and (or) rapid growth. Mammography and ultrasound are unhelpful diagnostically. Cytology is unreliable as the tumour is heterogeneous. Histologically the tumour can be benign, borderline malignant or malignant. Surgical excision with a margin of > or = 1 cm is the therapy of choice. The risk of recurrence after insufficient excision is considerable and histological deterioration can occur. Multiple samples, examination of resection margins and investigation into atypia, mitotic activity and stromal overgrowth are essential for making a prognosis and a treatment plan. In case of doubt regarding radicality, surgeon and pathologist should compare views; non-radicality necessitates re-excision.
在三名年龄分别为51岁、37岁和58岁的女性中，她们乳房可触及肿块，经切除及病理检查诊断为“叶状肿瘤”。在根治性切除后的3至5年里，其中一名接受放疗的患者未见复发。这种临床病程多变的罕见乳腺肿瘤通常影响30至50岁的女性。肿瘤往往较大且（或）生长迅速。乳腺钼靶摄影和超声检查对诊断无帮助。由于肿瘤异质性，细胞学检查不可靠。从组织学上看，肿瘤可以是良性、交界性恶性或恶性。手术切除边缘≥1 cm是首选治疗方法。切除不充分后复发风险很大，且可能发生组织学恶化。多个样本、切缘检查以及对异型性、有丝分裂活性和间质过度生长的研究对于制定预后和治疗计划至关重要。如果对根治性存在疑问，外科医生和病理学家应交换意见；根治不彻底则需要再次切除。
