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- B1770Breast fibroepithelial lesions (cqz 15)
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I notoced there are some cases of fibroepithelial lesions (biphasic tumor)in our website. I send this case to open the discussion.
Fibroepithelial tumors including fibroadenoma (FA) and phyllodes tumors (PT). The definition and classification of PT are not very agreeable among pathologists. However, they are most common classified as bengin, borderline, or malignant suggested by WHO. Some pathologists use terms of benign, low grade maligant and high grade malignant. These two systems are very similar, borderlin equal to low grade malignant.
Hope you can give your diagnosis and mention why. I assume people may have different oppinions. It is ok. We just discuss the case.
标签：乳腺纤维腺瘤 叶状肿瘤
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About case 2: Patient had history of phyllodes tumor several years ago (outside hospital). So this is local recurrence of benign phyllodes. It is difficult to predict the prognosis for phyllodes. The major concern is local recurrence. Distant metastases are rare.Complete excision with wide free margin is the main treatment. One large review study indicated the chance of local recurrence was 21%, 46%, and 65% for the patients with benign, borderline, and malignant phyllodes.
For case #1 (09-3-7)
Phyllodes tumor, histologically benign.
Comment: small encapsulated lesion, low stromal cellularity , No mitosis (less than 0-4 mitotic figures/10 HPF) seen on the pictures althought scattered stromal cells showed mild muclear atypia.
Dr. Qianxun,
Thank you very much for your comment. For phyllodes tumors we count mitosis very carefully. Personally I never use ki67 stain for diagnosis of phyllodes. Could you describe the proliferative index more details for distinguishing benign from borderlin phyllodes? Thanks, cz
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| 以下是引用cqzhao在2009-4-16 2:24:00的发言：
Thank 笃行者 . I forget how to call the word 笃 even though you told me before. Please teacher me again. I will remember this time. cz |
呵呵，其实这个字以前我也不会读，查字典才知道“笃”读作"du",与“赌、堵”同音，“忠实，一心一意”的意思。
很高兴在网上认识赵老师，并且很荣幸在网上一睹赵老师的容颜。
- 博学之，审问之，慎思之，明辨之，笃行之。
Dr. Yang,
You are right. I cannot make the dx of phyllodes if it were the primary lesion for the second case. The dx of recurrent phyllodes was based on the pt's phyllodes history, the same location, and irregular border. The criteria are made by people, they often cannot be used for all cases. Individual case should be considered or treated individually in practical pathologic diagnosis.
