B5-6 美国ROCHESTER 大学医学中心

患者，女，50岁，2cm 病变。

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 学习了，图片也很清晰！

 同意二楼，纤维腺瘤伴良性叶状肿瘤（Fiber adenoma with benign leafy tumors）

读片会讨论意见

A：纤维腺瘤，部分为叶状肿瘤
B：良性叶状肿瘤
C：纤维上皮性肿瘤，可见分叶状结构及间质分布不均匀，细胞温和，
核分裂像<4/10HPF，考虑为良性分叶状肿瘤。
D：乳腺腺病伴ADH 及良性叶状肿瘤
E：腺病，导管乳头状瘤样增生。
F：Fibroadenoma with focal phyllodes feature
G：叶状肿瘤良性
H：良性分叶状肿瘤
I：分叶状肿瘤，良性
J：乳腺导管内纤维腺瘤

原单位意见：Fibroadenoma with area of benign phyllodes tumor transformation
讨论：Phyllodes Tumors：A group of circumscribed biphasic tumors, characterized by a double
layered epithelial component surrounded by an overgrowth and hypercellular stromal typically
organized in leaf-like structures (Enhanced intracanalicular pattern).It display morphologic
spectrum between FA and pure sarcoma.Biphasic with epithelial and stroma proliferation;Stroma
more cellular than a FA, higher in zones in close contact with epithelium;Bizarre stromal cells have
no significance;>90% are benign;Local recurrence not infrequent;Wide local excision are require
and curative (>10mm margins).
Phyllodes Tumors - Benign ： pushing border (very small tumor buds OK, may be the
source of recurrence) ;minimal atypia (can have occasional bizarre giant cells) ;<4/10 HPF mitosis
18% recurrence, no metastasis ;Can have areas with sparse cellularity, hyalinization, myxoid
changes, necrosis (in large tumors). Lipomatous, cartilaginous, and osseous metaplasia have been
reported.
Phyllodes Tumors - Malignant ：metastasis- most reliable;sarcomatous elements (fibromost
common, can be as lipo, rhabdo, osteo as well).others: infiltrative border, stromal over growth
(> 4 x or 10 x), moderate to marked cellular atypia, > 10/10 HPF mitosis,8%-27% met/death.
Phyllodes Tumors - Borderline: features in between (33% recurrence, 6% mets/death).
Phyllodes Tumors -Ki-67：Chan YL et al 2004, 63 case，Ki-67 expression >10%，85% of
Malignant PT.16% of Benign PT.Noronha YS, et al. 2009 USCAP,33 cases,Ki-67 expression
ranging:Benign: <1-10%,Borderline: 2-15%,Malignant: 4%-20%.

学习学习，谢谢！

二者并存的病例第一次见到，谢谢！