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Clinical Follow-up, Immunohistochemistry And Electroscope Study Of Breast Phyllodes Tumors

Posted on:2005-05-03Degree:MasterType:Thesis
Country:ChinaCandidate:Y ZhouFull Text:PDF
GTID:2144360125465416Subject:Surgery
Abstract/Summary:PDF Full Text Request
Objective Breast phyllodes tumor is comprised of benign epithelium and malignant stroma. The histological classification of Phyllodes tumor is not concordance with the clinical processes. Recurrence and metastasis could happen in benign PTs. The main prognostic facters were summarized, some of the biological characters of PTs were explored, and the histological origin of PT was surveyed with the methods of clinical follow-up, immunohistochemistry and electroscope observation.Methods The clinical material and pathological findings of 32 cases of patients with phyllodes tumors were reviewed and analyzed. And 22 cases were followed-up for 3 monthes to 24 years. The differential expression of Ki-67,nm23,bFGF were detected by IHC in 30 cases of phyllodes tumors, 30 cases of breast fibroadenoma and 30 cases of breast cancer. The expression of vimentin,CK,desmin and SMA were immuohistochemically detected in 30 cases of phyllodes tumors. And the ultrastructure of PT was studied by electroscope in 2 cases of phyllodes tumors. Results1. One patient died with metastasis, the other patients survived during the follow-up. Recurrence was found in 6 cases and metastasis was found in 1 case. The 5 years total survival rate is 92.9%, the recurrent rate is 27.3%, and the mortality is 4.5%.2. With the histological classification standard of WHO, 16 cases were classified as benign, 9 cases as borderline, and 5 cases as malignant. The mean score of pathologic features assessed of the three groups is 3,9,13, respectively, according to the pathologic feathures of the mitoses, necrosis, hemorrhage, margin, cellularity and atypia.3. The expressions of Ki-67 protein were enhanced significantly with the increase of the malignancy degree of PT, and the expressions of Ki-67 protein were significantly different among fibroadenoma, benign PT and borderline PT(p<0.01), but no different between borderline PT and malignant PT(p=0.202). The expression of nm23 and bFGF protein was decreased with the increasing degree of malignancy, and the expression of nm23 and bFGF are significantly different among the 5 groups(p<0.01)4. No expression of CK and desmin were found in all of the 30 cases of PT, and positive expressions of vimentin were found in all of the 30 cases of PT. The positive expressions of SMA were different in the 30 cases of PT (6 cases strong positive, 5 cases positive, 10 cases weak positive, and 9 cases negative).5. The features of ultrastructure of PT include long fusiform cell, plentiful collagen fibril in intercellular space, karyomegaly, and lack of organelles. Conclusion: 1. Tumor recurrence is mainly caused by inadequate excision border, and the degree of malignancy of recurrent tumor is higher than the primary tumor. The operation should be choosed according to the size and malignancy of the tumore. Chemotherapy and radiotherapy are effective to some phyllodes tumors. 2. The layer beneath the epithelium contains the proliferative pool of cells resulting in stromal hypercellularuity characterstic of PT. And the epithelium might play an important role in the tumor's progression. 3. Deletion of nm23 may be one of the reasons of metastasis.4. Immunohistological markers such as Ki-67, nm23 and bFGF might be used for the histopathological grading of PTs. 5. Neoplastic cells of PT are probably derived from periductal fibroblast according to the ultrastructure characters.
Keywords/Search Tags:breast phyllodes tumor, Immunohistochemistry, Ultrastructure
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