乳腺叶状囊肉瘤 NCCN2015v3指南

Phyllodes Tumors of the Breast

乳腺叶状囊肉瘤

(also known as phyllodes tumors, cystosarcoma phyllodes)

（也称为叶状肿瘤、叶状囊肉瘤）

Phyllodes tumors of the breast are rare tumors comprised of both stromal and epithelial elements.山东省肿瘤医院呼吸肿瘤内科张品良

乳腺叶状肿瘤是罕见的肿瘤，由基质和上皮成分两部分组成。

Phyllodes tumors exist in benign, borderline, and malignant subtypes, although there is not uniform agreement on the criteria for assigning subtype or for predicting biological behavior.

叶状肿瘤存在良性、交界性和恶性亚型，尽管对于分配亚型或预测生物学行为没有统一的标准。

The subtype of phyllodes tumor appears less important for risk of recurrence than does the margin of tumor-free resection achieved by surgical treatment.

对于复发风险叶状肿瘤的亚型似乎不如手术治疗获得无瘤切缘重要。

Diagnosis of phyllodes tumors prior to excisional biopsy/lumpectomy is uncommon.

切除活检/切除术前叶状肿瘤的诊断是罕见的。

Phyllodes tumors occur in an older age distribution than fibroadenoma, a younger age distribution than the invasive ductal and lobular cancers, and with a mean age of 40.

叶状肿瘤比纤维腺瘤的年龄分布老龄，比浸润性导管癌和小叶癌的年龄分布年轻，平均年龄40岁。

Phyllodes tumors often enlarge rapidly and are usually painless.

叶状肿瘤常常增大迅速，通常是无痛的。

Phyllodes tumors often appear on ultrasound and mammography as fibroadenomas, and FNA cytology and even core needle biopsy are inadequate to reliably distinguish phyllodes tumors from fibroadenoma.

在超声和乳房摄影上叶状肿瘤常常似乎像纤维腺瘤，而FNA细胞学甚至针芯活检均不足以可靠地鉴别纤维腺瘤和叶状肿瘤。

Thus, in the setting of a large or rapidly enlarging clinical fibroadenoma, excisional biopsy should be considered to pathologically exclude a phyllodes tumor.

因此，在一个大的或迅速增大的临床纤维腺瘤的情况下，应考虑手术切除活检排除叶状肿瘤。

Patients with Li-Fraumeni syndrome (germline TP53 mutation, see NCCN Guidelines for Genetic/Familial High Risk Assessment) have an increased risk for phyllodes tumors.

Li-Fraumeni综合征患者（生殖细胞TP53突变，见遗传/家族性高危评估NCCN指南）叶状肿瘤的风险增加。

Local recurrences of phyllodes tumors are the most common site of recurrence.

局部复发是叶状肿瘤最常见的复发部位。

Most distant recurrences occur in the lung, and may be solid nodules or thin-walled cavities.

远处复发最常发生在肺，可能是实性结节或薄壁空洞。