乳腺叶状肿瘤新进展 ppt课件.ppt

* * Phyllodes tumor shows leaf-like growth pattern * Phyllodes tumor shows stromal overgrowth * The lesion displays fibroepithelial hyperplasia * There are numerous mitosis * The lesion exhibits stromal cell pleomorphism with high mitotic index * It demonstrates the stromal cells features as sarcomatous growth pattern * Mimic of phyllodes tumor Fibroadenoma,cystic with leaf-like pattern * Spindle cell carcinoma masquerading as a fibroepithelial lesion CK5/6 CK14 * 导管周间质肉瘤(periductal stromal sarcoma, PDSS) 罕见双相性肿瘤变型，绝经前后女性 高度增生的肉瘤样梭形细胞围绕一个或多个导管形成“套状”，浸润周围脂肪组织 导管或小叶外周由无明显变化的增生间质包绕，缺乏叶状结构 PDSS增生分布提示源于导管周间质 PDSS扩散至小叶时围绕小叶并保留其结构 * PDSS组织学标准： 肉瘤样细胞密度和非典型性不等的梭形间质增生为主，围绕单个小管、导管或小叶，形成套状结构类似管周型结构，缺乏叶状结构 一个常为多个结节融合或有脂肪组织分开，而不形成实体性结构 核分裂最多的范围内核分裂≥3/10HPFs 浸润周围乳腺组织 研究显示核分裂0-2/10有复发潜能，无转移；而核分裂更多者有复发和转移潜能 * 核分裂3-5/10HPFs 非典型性很小 40岁以下很少见，37-89（平均55.3）岁 肿块0.2-6.0（平均2.97）cm 免疫组化：局灶性CD34、CD117，SMA-，ER-、PR- 低度恶性 复发肿瘤可见局灶性PT结构，所有的PDSS随着时间推移可能都演化成PT。 * 导管周间质增生(periductal stromal hyperplasia,PDSH)： 结节性、温和的间质增生围绕正常或变形的导管形成间质套 间质细胞无至轻度非典型性 核分裂＜3或0-2/10HPFs. * Periductal stromal sarcoma resembling a radial scar, with stromal overgrowth Three recurrences over 10 years with progressive stromal overgrowth From Rosen’s Breast Pathology 3ed. * Copyright ? 2009 Wolters Kluwer. 2 Periductal Stromal Tumor: A Rare Lesion With Low-Grade Sarcomatous Behavior. Burga, Ana; Tavassoli, Fattaneh American Journal of Surgical Pathology. 27(3):343-348, March 2003. * Copyright ? 2009 Wolters Kluwer. 3 FIG. 1. Multiple nodules of atypical spindle cells forming cuffs around large ducts that retain their architectural structure, devoid of leaf-like pattern. Insert: High-power view showing relationships of stroma to the epithelial elements. * Copyright ? 2009 Wolters Kluwer. 3 FIG. 2. Three PDSS nodules infiltrate into the surrounding adipose tissue coalescing at their interface. * Copyright ? 2009 Wolters Kluwer. 3 FIG. 3. Multiple periductal sarcomatous proliferations partially coalescing and infiltrating