■叶状肿瘤(PT),占乳腺肿瘤的不到1%,由上皮和基质成分组成。如果遇到恶性异源成分,PT被认为是恶性的。恶性叶状肿瘤(MPT)仅占PT的8%至20%。我们报告一例MPT伴骨肉瘤和软骨肉瘤分化的病例,并复习文献讨论其鉴别诊断和治疗。
一名59岁的中国妇女来到我们医院,因为她的左乳房有一个明显的肿块,持续了1个月。于2023年1月11日对左乳腺肿块进行术前粗针活检(CNB)。病理诊断为恶性肿瘤,具体类型不清楚。对左乳进行乳房切除术和前哨淋巴结活检。通过碳纳米颗粒和亚甲蓝双重染色鉴定,在3个前哨淋巴结中未发现转移。观察到叶状肿瘤的异源骨肉瘤和软骨肉瘤分化。免疫组织化学:梭形肿瘤细胞ER(-),PR(-),HER-2(-),CK-pan(-),CK7(-),CK8(-),SOX10(-),S100(-),和MDM2(-),CK5/6(-),P63(-),P40(-)均为阴性。CD34:(+),SATB2(+),P53(90%强),CD68(+),Ki-67(LI:约60%)。乳腺内未发现导管原位癌。荧光原位杂交(FISH)表明USP6在福尔马林固定的上呈阴性表达,石蜡包埋(FFPE)组织切片。
■MPT很少见,MPT中的异源分化非常罕见。它可以通过病理诊断为化生性癌,原发性骨肉瘤,或骨化性肌炎被排除。该病例可以帮助临床医生改善该病的预后和治疗。
UNASSIGNED: Phyllodes tumors (PTs), which account for less than 1% of mammary gland tumors, composed of both epithelial and stromal components. If a malignant heterologous component is encountered, PT is considered malignant. Malignant phyllodes tumors (MPTs) only account for 8% to 20% of PTs. We report a case of MPT with osteosarcoma and chondrosarcoma differentiation and review the literature to discuss the differential diagnosis and therapy.
UNASSIGNED: A 59-year-old Chinese woman come to our hospital because of a palpable mass she had had for 1 months in the left breast. Preoperative core needle biopsy (CNB) was performed on the left breast mass on January 11, 2023. Pathological diagnosis was malignant tumor, the specific type was not clear. Mastectomy and sentinel lymph node biopsy of the left breast was performed. No metastasis was found in 3 sentinel lymph nodes identified by carbon nanoparticles and methylene blue double staining. Heterologous osteosarcoma and chondrosarcomatous differentiation of phyllodes tumor were observed. Immunohistochemistry: spindle tumor cells ER(-), PR(-), HER-2(-), CK-pan(-), CK7(-), CK8(-), SOX10(-), S100(-), and MDM2(-), CK5/6(-), P63(-), P40(-) were all negative. CD34:(+), SATB2(+), P53(90% strong), CD68 (+), Ki-67(LI: about 60%). No ductal carcinoma in situ was found in the breast. Fluorescence in situ hybridization (FISH) indicated USP6 was negatively expressed on formalin-fixed, paraffin-embedded (FFPE) tissue sections.
UNASSIGNED: MPTs are rare, and heterologous differentiation in MPTs is exceedingly rare. It could be diagnosed by pathology when metaplastic carcinoma, primary osteosarcoma, or myositis ossificans were excluded. This case could help clinicians to improve the prognosis and treatment of this disease.