| 图片： | |
|---|---|
| 名称： | |
| 描述： | |
- 2012年第47期——左乳肿块(已点评）
-
liangjinjun 离线
- 帖子：2328
- 粉蓝豆：2
- 经验：2457
- 注册时间：2007-08-07
- 加关注 | 发消息
-
本帖最后由 冰洋 于 2012-12-25 09:19:50 编辑
翻译如下：
我同意原单位的诊断：良性脂肪叶状肿瘤
这是一个明显的带有脂肪组织成份的纤维上皮性肿瘤，下面这些特征支持这个诊断：
1 年龄30岁，肿瘤直径12cm；
2 没有包膜，但界限清楚；
3 肿瘤周围上皮和间质的分布不均匀，图片4为叶状结构，虽然这张图片没有完全显示这种结构。部分出现间质细胞导管周聚集，肿瘤间质不全是细胞增多；
4 没有间质的非典型性及未见分裂相。图片可见上皮细胞分裂相。
作为纤维上皮性肿瘤，本例相对一致的特征是富于脂肪组织，叶状肿瘤脂肪化生中可见。
本例主要的鉴别诊断有导管周间质肉瘤，为浸润性，不象本例界限清楚。导管周间质肉瘤中脂肪组织不是肿瘤成份，但脂肪组织被肿瘤浸润，而脂肪叶状肿瘤中，脂肪组织是肿瘤的一部分，而且导管周间质肉瘤没有叶状结构。最重要的是，本例没有肉瘤样特征（间质细胞的非典型性及分裂相）
我认为“Chiang”为本例的获奖者，虽然他的评论很简单，但其后面的点评切中要害。
祝圣诞新年快乐！
I would agree with the original hospital’s diagnosis: benign lipophyllodes tumor.
This is apparently a fibroepithelial tumor, but with adipose tissue component. The following features of this case support the above diagnosis: 1. Age 30 and tumor size 12 cm. 2. Not encapsulated, but it is demarcated. 3. The distribution of the stroma and epithelium is not symmetrical all around the tumor. It is disturbed in photo #4, with possible leave-like structures, even though the photo did not show the full view of it. Periductal concentration of the stroma cells is somewhat present, while the tumor stroma is not really that much hypercellular. 4. There is no stroma atypia, and no stroma mitosis identified. Those mitoses shown in the photo seem from epithelial cells.
The relatively unique feature for this case is the abundant adipose tissue as part of the fibroepithelial tumor, which is well documented in phyllodes tumor as lipomatous metaplasia.
The main differential diagnosis for this case is the periductal stromal sarcoma, which should be infiltrative, not as demarcated as in this case. The adipose tissue in periductal stromal sarcoma is not part of the tumor, but the adipose tissue being infiltrated by tumor, while in lipophyllodes tumor, the adipose tissue IS part of the tumor. Further, there should be no leave like structures in periductal stromal sarcoma. Most importantly, there are no sarcomatous features in this tumor (stromal cell atypia, mitosis).
I think “Chiang” could be the winner for this case. Even though his original comment was too simple, the comment he made latter on has hit the points.
Merry Christmas and Happy New Year!
