摘要
目的：探讨乳腺间质肉瘤（Stromal sarcoma of the breast，SSB）的临床病理特征、诊治方法及预后。方法：对天津医科大学附属肿瘤医院1954年5月～2007年9月收治的6例SSB患者的临床病理资料进行回顾性分析。结果：患者均为女性，1例绝经。发病年龄20～55岁，中位年龄38岁。患者均以乳腺肿物为首发症状，3例位于乳腺外上象限，肿物中位最大直径6cm（3～15cm），3例有肿块短时间内迅速增大的病史，1例伴间断性疼痛。按美国肿瘤联合会（AJCC）制定的临床及病理分期（第六版）标准：ⅡA期1例，ⅡB期2例，ⅢB期2例，1例无法评估。4例患者首次治疗采用乳腺肿物局部切除术，复发后采用全乳切除或改良根治术，侵犯胸大肌者则行根治术。最终2例行全乳切除术，2例行乳腺根治术，2例行乳腺改良根治术。术后病理证实均为乳腺间质肉瘤，其中1例伴灶性骨化，1例伴粘液变性。4例患者首次行腋窝淋巴结清扫，均未见淋巴结转移。术后3例患者行辅助化疗，所有患者均未行放疗。术后中位随访36．5个月（8～204个月）间，4例行肿物局部切除术的患者均复发，其中3例患者2次以上复发，首次复发中位时间为2．5个月（1～4个月）。1例患者于术后7个月出现双肺转移，未治疗，余5例患者均无瘤生存。结论：乳腺间质肉瘤术前诊断困难，肿物局部切除术后易复发，保证切缘阴性的局部扩大切除术或全乳切除术是治疗乳腺间质肉瘤的合适手段，腋淋巴结清扫是不必要的。术后辅助化疗、放疗的疗效尚不明确。
Objective： To investigate the clinical and pathological characteristics, diagnosis and treatment of stromal sarcoma of the breast （SSB）. Methods： The clinical and pathological data of 6 patients with SSB treated between 1954 and 2007 were retrospectively analyzed. Results： All patients were female and one was menopausal. The median age of the patients was 39 years （range, 20-55）. All cases had a history of a palpable mass. The tumor rapidly augmented in a short time period in 3 patients. One patient had discontinuous pain and 3 patients had masses located in the upper outer quadrant of the breast. The median tumor radius was 6.0 cm （range, 3-15 cm）. According to the AJCC breast cancer staging standard （6th edition）, 1 case was of stage Ⅱ A, 2 cases were of stage Ⅱ B, 2 cases were of stage ⅡB and one case couldn＇t be staged. Four patients were initially treated by excising the tumor and then underwent mastectomy or modified radical mas- tectomy after recurrence. Radical mastectomy was suitable for those with pectoralis major muscle involvement. Two patients received simple mastectomy, 2 patients underwent radical mastectomy and another 2 patients received modified radical mastectomy. After surgery, all patients were identified as SSB through pathology, with focal ossification in one case and mucinous degeneration in another one case. Four patients who un- derwent axillary lymph node dissection did not have lymph node metastases. Three patients received chemotherapy after surgery. After a median follow-up time of 36.5 months （8-204 months）, 4 patients had recurrence after local excision and 3 patients had recurrence more than 2 times with a median time to recurrence of 2.5 months （1 to 4 months） after surgery. One patient had lung metastases at 7 months after the initial surgery and the other 5 patients were alive without disease at the end of the follow-up period. Conclusion： SSB is difficult to diagnose preoperatively and is characterized by its tendency to recur locally. To obtain negative margins, wide local excision or mastectomy must be performed. Axillary lymph node dissection is not mandatory. The role of adjuvant chemotherapy and radiotherapy is still controversial.
出处
《中国肿瘤临床》
CAS
CSCD
北大核心
2009年第3期131-134,共4页
Chinese Journal of Clinical Oncology
关键词
乳腺肿瘤
间质肉瘤
复发
治疗
Breast neoplasm
Stromal sarcoma
Recurrence
Therapy
