Cystosarcoma phyllodes in adolescent girls and young women: a study of 45 patients.
Cystosarcoma phyllodes in adolescent girls and young women: a study of 45 patients.
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青春期女孩和年轻女性的叶状囊肉瘤：一项针对 45 名患者的研究。
DOI：
10.1097/00000478-199801000-00008
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发表时间：
1998
影响因子：
5.6
通讯作者：
P. Rosen
中科院分区：
文献类型：
--
作者：
P. Rajan;M. Cranor;P. Rosen
叶状囊肉瘤是一种少见的肿瘤，多发于少女和年轻女性。本研究试图在这种不寻常的临床环境中定义CP的临床和病理特征。研究了45例青春期前、青春期少女和年轻女性的CPs（34例为良性，11例为恶性）。肿瘤的分类基于以下形态学特征：间质细胞、核异型性、有丝分裂活性、坏死和肿瘤边界的性质。手术治疗为局部切除或乳房切除术。患者年龄10 ~ 24岁，平均17.7岁。肿瘤最宽处为1.4 cm ~ 10.2 cm（平均4.6 cm）。两个乳房受到的影响相同。32例患者行局部切除加或不加再切除，4例患者行乳房切除术。36例患者随访时间平均为58.4个月。36例中有6例（16%）局部复发（4例良性，2例恶性）。6例复发患者，镜下肿瘤边界浸润，手术边缘阳性。有一例高级别恶性肿瘤伴横纹肌肉瘤间质分化及高有丝分裂率发生全身转移。最后随访时，34例患者存活，无疾病证据，1例患者存活，肺转移，1例患者死于无关原因。我们的结论是，青春期女孩和年轻女性的CP并不比老年患者更具攻击性。浸润性肿瘤边界和阳性手术切缘是局部复发的最佳组织学预测指标。有丝分裂活性是评估转移潜力的最重要标准。在这个年龄组的CP应治疗，以最大限度地保护乳房。对于由于肿瘤体积相对于乳房体积较大而不能通过切除来治疗的CPs，可能需要进行乳房切除术以获得清晰的边缘。
Cystosarcoma phyllodes (CP) is an uncommon tumor in adolescent girls and young women. This study seeks to define the clinical and pathologic features of CP in this unusual clinical setting. Forty-five CPs (34 benign and 11 malignant) in prepubertal and adolescent girls and young women were studied. Classification of the tumors was based on the following morphologic features: stromal cellularity, nuclear atypia, mitotic activity, necrosis, and the nature of tumor borders. Surgical therapy was local excision or mastectomy. The age of the patients ranged from 10 to 24 years (mean 17.7). The tumors measured 1.4 cm to 10.2 cm at their widest point (mean 4.6). Both breasts were affected equally. Thirty-two patients were treated by local excision with or without reexcision and four patients by mastectomy. Follow-up was available for 36 patients for a mean of 58.4 months. Local recurrence was reported in six of the 36 cases (16%) (four benign and two malignant). The six patients with recurrent disease had infiltrative tumor borders and positive surgical margins microscopically. There was a single instance of systemic metastases from a high-grade malignant tumor with rhabdomyosarcomatous stromal differentiation and a high mitotic rate. At last follow-up, 34 patients were alive with no evidence of disease, one patient was alive with pulmonary metastases, and one patient died of an unrelated cause. We concluded that CP in adolescent girls and young women is not more aggressive than in older patients. Infiltrative tumor borders and positive surgical margins are the best histologic predictors for local recurrence. Mitotic activity is the most important criterion for assessing the metastatic potential. CP in this age group should be treated to maximize breast conservation. Mastectomy may be required to obtain clear margins for CPs that cannot be managed by excision because of large tumor size relative to breast volume.