良性乳腺叶状肿瘤1例临床分析  

Benign phyllodes tumor of the breast in a case

作　　者：马周鹏 王夕富[2] 唐小波 席晨辉 MA Zhoupeng;WANG Xifu;TANG Xiaobo;XI Chenhui(Department of Radiology,Jiading Branch Hospital of Shanghai General Hospital,Shanghai 201803,China;Department of Radiology,Shanghai General Hospital,Shanghai 201620,China;Department of General Surgery,Jiading Branch Hospital of Shanghai General Hospital,Shanghai 201803,China)

机构地区：[1]上海市第一人民医院嘉定医院放射科,上海201803 [2]上海市第一人民医院放射科,上海201620 [3]上海市第一人民医院嘉定医院普外科,上海201803

出　　处：《中华实用诊断与治疗杂志》2024年第9期884-887,共4页Journal of Chinese Practical Diagnosis and Therapy

摘　　要：目的分析1例良性乳腺叶状肿瘤患者的临床资料,探讨其临床特征。方法2023年10月11日上海市第一人民医院嘉定医院1例女性患者以“右乳无痛性肿物11 d”为主诉就诊。患者右乳外侧9点位距离乳头约2 cm处可触及一肿物,质韧偏硬,界限较清,活动度可,腋窝及锁骨上未触及肿大淋巴结。乳腺超声检查示BI-RADS 5类;乳腺钼靶X线提示BI-RADS 4c类;MRI T2WI压脂及弥散加权成像序列均呈较高信号,增强扫描肿块呈明显持续强化,无明显囊变及坏死,提示为BI-RADS 4c类。入院第3天于全身麻醉下行手术治疗,术后常规行组织病理检查并随访。结果术中见肿块边界清晰,有完整包膜,无胸大肌筋膜及皮肤侵犯,距肿块周边20 mm处分离腺体,完整切除肿物及部分正常腺体。术后组织病理示肿块有完整包膜,切面灰白、质韧;光镜下见肿瘤由增生的间质和上皮细胞构成,见分叶状结构及上皮样裂隙;间质细胞增生呈梭形、异型性小,密度不一、无坏死,核分裂像少见,无病理性核分裂像。免疫组织化学示CK5/6(部分+)、P63(+)、雌激素受体(+)、孕激素受体(+)、CD34(部分+)、Ki-67(间质10%~15%+)。诊断为右乳良性叶状肿瘤。术后10 d切口Ⅰ期/甲级愈合,恢复良好,无相关并发症发生。术后6个月复查乳腺彩超未见异常。结论该例良性乳腺叶状肿瘤患者临床主要表现为无痛、分叶状肿块,MRI T_(2)WI压脂及弥散加权成像序列均为较高信号,增强扫描肿块呈明显持续强化,无明显囊变及坏死,行手术完整切除肿物安全、有效,近期未见复发。Objective To analyze the clinical data of a patient with benign phyllodes tumor of the breast and to explore its clinical characteristics.Methods A female patient visited Jiading Branch Hospital of Shanghai General Hospital with the chief complaints of“right breast painless mass for 11 d”on October 11,2023.At 9 o'clock outside the right breast,about 2 cm from the nipple,there was a tumor,tough and hard,with clear boundary and moderate motion,and no enlarged lymph nodes in the armpit and the supraclavicular area.Breast ultrasonography showed BI-RADS 5,and mammography indicated BI-RADS 4c.Both the lipid-pressure and diffusion-weighted imaging sequences of MRI T_(2)WI showed high signals,and the enhanced scan showed greatly continuous enhancement,without obvious cystic degeneration and necrosis,suggesting BI-RADS 4c.By day 3 after admission,the patient was performed surgery under general anesthesia,and was subjected to postsurgical routine histopathologic examination and follow-up afterwards.Results During surgery,the boundary of the mass was clear,with an intact capsule and no invasion of the pectoralis major muscle fascia or skin.The gland was separated 20 mm away from the periphery of the mass,and the mass and partial normal glands were completely removed.The postsurgical histopathology showed the mass had an intact capsule,with greyish-white and tough section.Light microscopy showed that the tumor was composed of proliferating mesenchymal and epithelial cells,with lobulated structures and epithelioid fissures visible.Mesenchymal cell proliferation was spindle shaped,with low atypia,varying density,no necrosis,rare nuclear division and no pathologic nuclear division,Immunohistochemistry showed CK5/6(partially+),P63(+),estrogen receptor(+),progesterone receptor(+),CD34(partially+),and Ki-67(mesenchymal 10%to 15%+).The patient was finally diagnosed with benign phyllodes tumor of the right breast.The patient got primary healinr 10 d after surgery,with a good recovery and no related complications.A follow-up of b

关 键 词：乳腺叶状肿瘤 良性 影像特征 组织病理特征 

分 类 号：R737.9[医药卫生—肿瘤]