Fibroepithelial lesions; The WHO spectrum
Fibroepithelial lesions; The WHO spectrum
复制标题
DOI：
10.1053/j.semdp.2017.05.006
复制
发表时间：
2017-09-01
影响因子：
2.3
通讯作者：
Chen, Yunn-Yi
中科院分区：
文献类型：
--
作者：
Krings, Gregor;Bean, Gregory R.;Chen, Yunn-Yi
乳腺纤维上皮病变包括一组形态学和生物学异质性的双相肿瘤，具有上皮和间质成分，表现出广泛的临床行为。纤维腺瘤是一种常见的良性肿瘤，有许多组织学变异，其中大多数不构成诊断挑战。细胞和青少年纤维腺瘤可以有重叠的特点与叶状肿瘤，应该承认。叶状肿瘤构成了一系列具有不同临床行为的病变，并根据世界卫生组织（WHO）的建议，基于一组组织学特征将其分为良性、边缘性或恶性。最近的发展显着扩大了我们的纤维上皮病变的发病机制的理解，突出纤维腺瘤作为真正的肿瘤，并强调了一个共同的叶状肿瘤的形式复发MED12外显子2突变。此外，测序研究已经阐明了与叶状肿瘤进展相关的途径。叶状肿瘤的准确诊断和分级对患者的治疗和预后很重要，因为分级与局部复发风险增加广泛相关，并且基本上只有恶性肿瘤转移。然而，在许多情况下，纤维上皮病变的分类仍然具有挑战性的核心活检和切除标本。在良性肿瘤中，一个常见的问题是如何区分良性叶状肿瘤和细胞性纤维腺瘤，这在很大程度上是由于诊断中使用的组织学特征的主观性和病变之间的组织学重叠。由于需要整合多个主观和不明确的参数，评分变得更加复杂。在组织学谱的另一端，恶性叶状肿瘤必须与更常见的化生性癌和原发性或转移性肉瘤区分开来，这在芯活检中可能特别困难。免疫组化可用于鉴别诊断，但应注意解释的警告。本文综述了纤维上皮病变谱的概况和最新进展，特别强调了诊断中的常见问题和实际问题。(C)2017爱思唯尔公司All rights reserved.
Fibroepithelial lesions of the breast comprise a morphologically and biologically heterogeneous group of biphasic tumors with epithelial and stromal components that demonstrate widely variable clinical behavior. Fibroadenomas are common benign tumors with a number of histologic variants, most of which pose no diagnostic challenge. Cellular and juvenile fibroadenomas can have overlapping features with phyllodes tumors and should be recognized. Phyllodes tumors constitute a spectrum of lesions with varying clinical behavior and are graded as benign, borderline or malignant based on a set of histologic features according to recommendations by the World Health Organization (WHO). Recent developments have significantly expanded our understanding of the pathogenesis of fibroepithelial lesions, highlighting fibroadenomas as true neoplasms and underscoring a commonality with phyllodes tumors in the form of recurrent MED12 exon 2 mutations. In addition, sequencing studies have elucidated pathways associated with phyllodes tumor progression. Accurate diagnosis and grading of phyllodes tumors are important for patient management and prognosis, as grade broadlycorrelates with increasing local recurrence risk, and essentially only malignant tumors metastasize. However, classification of fibroepithelial lesions in many cases remains challenging on both core biopsy and excision specimens. A commonly encountered problem at the benign end of the spectrum is the distinction of benign phyllodes tumor from cellular fibroadenoma, which is largely due to the subjective nature of histologic features used in diagnosis and histologic overlap between lesions. Grading is further complicated by the requirement to integrate multiple subjective and ill-defined parameters. On the opposite end of the histologic spectrum, malignant phyllodes tumors must be distinguished from more common metaplastic carcinomas and from primary or metastatic sarcomas, which can be especially difficult in core biopsies. Immunohistochemistry can be useful in the differential diagnosis but should be interpreted with attention to caveats. This review provides an overview and update on the spectrum of fibroepithelial lesions, with special emphasis on common problems and practical issues in diagnosis. (C) 2017 Elsevier Inc. All rights reserved.