| Jia Li. A pulmonary metastatic breast phyllodes tumor and clinicopathology analysis. Oncol Transl Med, 2018, 4: 31-34. |
| 肺转移性乳腺叶状肿瘤一例临床及病理分析 |
| A pulmonary metastatic breast phyllodes tumor and clinicopathology analysis |
| Received:February 05, 2018 Revised:March 28, 2018 |
| DOI：10.1007/s10330-018-0255-5 |
| 中文关键词: 乳腺叶状肿瘤；肺转移 |
| 英文关键词: breast phyllodes tumor; pulmonary metastasis |
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| 中文摘要: |
| 摘要
目的 乳腺叶状肿瘤是一种少见的纤维上皮性肿瘤，该肿瘤最典型的特征是形成叶状结构，由间质和上皮两种成分组成，生物学行为难以预测，转移可见，由于与软组织肿瘤难以鉴别，经常被误诊，本文讨论乳腺叶状肿瘤病理特征，并回顾相关文献，总结其诊断及鉴别诊断要点，避免该肿瘤的漏诊及误诊。
方法 本文介绍一例肺转移性叶状肿瘤的病例，并结合手术切除标本组织的镜下形态（HE染色）及免疫组化（SP法）结果，进行分析。
结果 镜检示肿瘤细胞呈长梭形，排列成束状、漩涡状以及编织状，细胞丰富，异型明显，核分裂象易见，局部区域可见残留的导管上皮，肿瘤周边组织呈推挤状浸润性生长。免疫组织化学结果：肿瘤细胞：S-100-，CD34-,actin+，Ki-67+约40%，ER-,PR+,CD10灶+,SMA+,Bcl-2+,CKP-。追问病史，患者于6年前曾行右乳肿块切除术，术后病理为右侧乳腺恶性叶状肿瘤。结合临床病史及原病理诊断，本例诊断为肺转移性乳腺恶性叶状肿瘤结节。
结论 发生于肺的梭形细胞肿瘤，首先要考虑是转移性，因为大多数软组织肉瘤多行血行转移，肺部转移较常见。鉴于乳腺的恶性PT发生肺转移比较少见，在诊断时，一定要询问原手术史，以免造成漏诊或误诊。 |
| 英文摘要: |
| Objective Breast phyllodes tumors (PTs) are rare fibroepithelial tumors that are characterized by
formation of foliation patterns. Behaviorally, only relatively poor prediction of PTs is possible based on their
histological appearance. PTs are frequently misdiagnosed because they are difficult to differentiate from
soft tissue tumors. In this report, we describe the pathological features of a rare case of PT and review the
relevant literature, summarizing the essentials of the diagnosis and differential diagnosis, while attempting
to avoid misdiagnosis or missed diagnosis of the tumor to the best of our abilities.
Methods We present a case of pulmonary metastatic lobular tumor, analyzing the morphological
[hematoxylin-eosin (HE) staining] and immunohistochemical (streptavidin perosidase method, SP) features
of the tissue.
Results Long spindle-shaped tumor cells were observed using microscopy. The cells were arranged in
bundles, with a whirlpool pattern, and braided. The proliferation of the spindle cells was markedly atypical
and karyokinesis was elevated. Residual ductal epithelium was detected in some areas, and the margins
of the tumor tissues showed invasive growth. Immunohistochemical studies of the spindle-shaped tumor
cells were positive for actin, PR, CD10, SMA, Bcl-2, and negative for CKP, S-100, CD34, ER. The Ki-67
index was 40%.
Conclusion The spindle cell tumor identified in the lung should first be considered as a metastatic
neosplasm, because most soft-tissue sarcomas commonly metastasize through the bloodstream to the
lungs. Although malignant breast PTs are rare, a detailed medical history that includes prior surgical history
is required to avoid wrongful or missed diagnosis. |
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