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摘要: 本文分析并总结了北京协和医院乳腺外科诊治的2例乳腺恶性孤立性纤维性肿瘤(solitary fibrous tumor, SFT)的临床及病理特点。2例患者均以乳腺巨大肿物为主要表现, 行乳腺肿物局部扩大切除术治疗, 未清扫患侧腋窝淋巴结; 术后病理提示CD34(+)、S-100(-), 符合SFT免疫组化特点; 因肿瘤细胞存在多形性及高核分裂相, 故诊断为恶性SFT。2例术后均未行辅助治疗, 1例患者于术后6个月出现局部复发, 目前均无远处转移表现。乳腺原发恶性SFT需病理明确诊断, 乳腺肿物局部扩大切除或患侧乳腺单纯切除是主要治疗手段, 目前无明确证据表明腋窝淋巴结清扫及辅助放化疗可延长患者生存期。
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关键词:
- 乳腺肿物 /
- 恶性, 孤立性纤维性肿瘤
Abstract: Clinicopathological characteristics of two cases with malignant breast solitary fibrous tumor (SFT) in Peking Union Medical College Hospital were retrospectively analyzed with a review of relevant literature. Both cases presented with giant breast lumps. Surgical treatment was performed with wide local excision of breast tumor without axillary surgery. Immunohistochemical analysis revealed typical SFT histological features with CD34 (+) and S-100(-). The presence of hypercellularity and nuclear atypia supported the diagnosis of malignant SFT. Neither patient received adjuvant systemic treatment. One patient developed local recurrence six months after surgery. Until now, there has been no evidence of distant metastases for both patients. Tumor biopsy is crucial for the diagnosis of malignant breast SFT. Wide local excision and mastectomy remain the mainstay of surgical treatment. Up to now, there is no solid evidence that axillary lymph node dissection and adjuvant chemotherapy/radiotherapy could benefit patients for survival.-
Key words:
- breast neoplasms /
- malignant, solitary fibrous tumor
第一、二作者对本文同等贡献（王常珺收集临床病例资料、文献复习，姚儒患者随访、文章撰写） -
[1] Gold JS, Antonescu CR, Hajdu C, et al. Clinicopathologic correlates of solitary fibrous tumors[J]. Cancer, 2002, 94:1057-1068. doi: 10.1002/cncr.10328 [2] Yang LH, Dai SD, Li QC, et al. Malignant solitary fibrous tumor of breast: a rare case report[J]. Int J Clin Exp Pathol, 2014, 7:4461-4466. [3] 游珊珊, 姜玉新, 刘赫, 等.乳腺叶状肿瘤的超声诊断[J].协和医学杂志, 2010, 01: 66-71. doi: 10.3969/j.issn.1674-9081.2010.01.018 [4] Magro G, Bisceglia M, Michal M, et al. Spindle cell lipoma-like tumor, solitary fibrous tumor and myofibroblastoma of the breast: a clinico-pathological analysis of 13 cases in favor of a unifying histogenetic concept.[J]. Virchows Archiv, 2002, 440:249-260. doi: 10.1007/s00428-001-0572-y [5] https: //www.uptodate.com/contents/zh-Hans/solitary-fibrous-tumor?search=solitary%20fibrous%20tumor&source=search_result&selectedTitle=1~24&usage_type=default&display_rank=1. [6] Cardillo G, Lococo F, Carleo F, et al. Solitary fibrous tumors of the pleura[J]. Curr Opin Pulm Med, 2012, 18:339-346. doi: 10.1097/MCP.0b013e328352f696 -
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