Cystosarcoma phyllodes of breast

Introduction to phyllodes cystosarcoma of the breast Cystosarcoma phylloide is a malignant transformation of fibrotic tissue in breast fibroma tissue. It is a malignant tumor with epithelial components and connective tissue. Pathological examination shows a mixture of benign epithelial tissue and malignant sarcoma. The disease was diagnosed by Muller in 1938. First reported in the year and considered to be a benign tumor. Later, some scholars found that the disease is not completely benign according to the degree of cell differentiation and clinical findings. Therefore, it is divided into benign and malignant types, and dozens of synonymous nouns appear. In 1982, according to the principle of histological classification, WHO renamed the tumor as breast. Tumors are classified into benign, critical lesions and malignant. basic knowledge The proportion of sickness: 0.01% Susceptible people: women Mode of infection: non-infectious Complications: breast lumps

Causes of phyllodes cystosarcoma of the breast

(1) Causes of the disease

The cause of the disease is unknown, and may be related to the imbalance of estrogen levels in the body. It is reported that the endocrine function is unstable during the menarche, and the endocrine changes occur in the early stage of sexual maturity and in different stages of the elderly, which is prone to inconsistency. Among them, the increase of estrogen secretion is the basis of the occurrence of phyllodes cystosarcoma, so endocrine factors have a great relationship in etiology.

(two) pathogenesis

The pathological features of phyllodes cystosarcoma of the breast are:

1. Gross morphology: The tumor volume is quite different. The small diameter is 2~3cm in nodular shape. The larger one can be 40~50cm. The malignant tumor is slightly larger than the benign tumor. The tumor edge is also clear. The true capsule, the cut surface is grayish white, yellow in the necrotic area or liposarcoma-like metamorphosis area, about 1/3 of the cases have cystic cavities, there are clear or bloody liquids in the capsule, more commonly a plurality of polyps The tumor is filled with the cyst, causing the fissure state of the tumor section. The tumor is soft as meat, and there are also hard parts, sometimes with bone and cartilage metaplasia.

2. Histomorphology: The tumor tissue consists of two components: epithelial cells and fibrous tissue, but the fibrous tissue components are more active and proliferating, forming the main components of the tumor. The cells are densely packed, and the nuclear hypertrophy is deep, like fibrosarcoma or low-grade malignant fibrosarcoma. The density and differentiation of different sections in the same tumor, or different regions of the same section, can be very different. In a few cases, adipose tissue with different degrees of differentiation, mucus tissue, and even cartilage can be found in the interstitial components. In addition to the above ingredients, the diagnosis of this disease must be found to have epithelial cell components, otherwise it is difficult to distinguish from breast sarcoma.

Breast phyllodes sarcoma prevention

Pay attention to rest, work and rest, and orderly life.

Complications of phyllodes cystosarcoma of the breast Complications breast lumps

Breast lumps, breast pain.

Symptoms of phyllodes cystosarcoma of the breast Common symptoms Lymph node enlargement and congestion

The most common clinical manifestations are local painless masses. Patients almost all seek medical treatment because of the discovery of a mass. There are also a few patients who have stinging or mild pain. In clinical examination, they can usually touch l~3cm mass. The largest case in the literature is reported. Up to 40 ~ 50cm, the texture can be hard or soft, most of them occur on one side, there are very few sides, the course of disease varies from 1 month to 10 years, the longest can reach more than 40 years, an average of 4.5 years, the tumor growth has been slow Most of them have been slow and recently increased rapidly, and the growth rate of tumors has little relationship with benign and malignant. Although the tumors can be large but have no adhesion to surrounding tissues and skin, individual cases can cause local skin due to huge tumors. Thinning, brightening, congestion, and even ulceration due to oppression, the nipple is moved, but retraction or discharge is rare, and a small number of patients may have axillary lymph nodes, but usually no metastasis.

Examination of phyllodes cystosarcoma of the breast

1. Puncture cytology examination:

The reliability of the auxiliary diagnosis of this disease is small, because the degree of stromal cell proliferation and abnormality in different parts of the tumor is different, so it is difficult to make an accurate diagnosis.

2. Frozen slices during surgery:

After excising the specimen, 2 to 3 pieces of tumor tissue can be cut in 2 to 3 different parts, and then serial section examination is performed, which is generally not easy to miss diagnosis.

3. X-ray molybdenum target:

Small tumors can be seen with clear spherical or elliptical uniform dense shadows on the edges, smooth edges and no burrs; large tumors are wavy or polycystic, occasionally calcified, and different from cancer is subcutaneous The fat layer is still intact.

4. Ultrasound examination:

The tumor is large, with low lobes and clear echoes. Because the edge of the lesion is smooth, the ultrasound often has signs of attenuation of the lateral edge of the sound beam. Sometimes it is difficult to distinguish it from the surrounding adipose tissue. The echo after the tumor is weakened, enhanced or not. The cystic zone is filled with liquid and appears as an anechoic, fissure-like cavity.

5. Liquid crystal heat map check:

The skin temperature of the tumor area is higher, and the skin temperature of the surrounding normal tissue can differ by more than 3 °C.

6. Angiography:

Feasible arterial and subcutaneous venous angiography showed significant blood supply and subcutaneous vein dilation.

Diagnosis and diagnosis of phyllodes cystosarcoma of the breast

diagnosis

In clinical practice, patients with large tumors in the breast should first consider the possibility of this disease. When the body is examined, the tumor is very large. Many patients even occupy the whole milk. The mass is round or lobulated, the surface is uneven, and the texture is tough. Sometimes, it may have a sense of elasticity or sac, with clear boundaries and good mobility. A small number of lumps have tenderness. The affected sputum lymph nodes are accessible due to proliferative reactions, but rare metastases. X-ray examination of the mammography shows a clear spherical or elliptical shape. Shadow, large tumors can also be wavy or multi-capsule; B-ultrasound has a spherical or cystic mixed sound image; arterial and breast subcutaneous venography, the tumor has obvious blood supply and subcutaneous vein expansion, etc., according to the above performance Diagnosis should be free of difficulties.

Differential diagnosis

Clinically, phyllodes cystosarcoma should be distinguished from breast cancer, breast fibrosis and malignant sarcoma.

1. Breast cancer:

(1) The lobular sarcoma has a long course of disease and slow growth, while the course of breast cancer is short.

(2) Most of the squamous cystic sarcoma are large in size, uneven, and have nodular lobular shape. Some of the parenchyma are elastic like rubber and some are cystic, while breast cancer is small in size, no lobulation, and hard in texture. No cystic, no elasticity.

(3) The lobular sarcoma has a clear perimeter, and only a few infiltrate into the peripheral interstitial pectoral muscle, while the border of the breast cancer is unclear and can infiltrate into the surrounding tissue.

(4) The squamous cystic sarcoma is invasive growth and non-adhesive to the skin. Due to the large influence of the tumor on the venous return, most of the surface has varicose veins. As the tumor grows, the skin tension is large and thin, smooth and watery, sometimes Causes oppressive necrosis, while breast cancer is invasive growth can adhere to the skin, there is an "orange peel" change, surface varices are rare.

(5) lobular sarcoma nipple is normal, but there may be push displacement, nipple discharge is rare, and breast cancer is located under the areola, most of which adhere to the nipple, nipple elevation or invagination.

(6) Axillary lymph node metastasis of lobulated cystic sarcoma is less common, while axillary lymph node metastasis of breast cancer is more common.

2. Breast fibroma:

(1) Breast fibroma grows faster at the beginning, and gradually grows slowly afterwards, while phyllodes cystosarcoma begins to be slower, and then suddenly grows up. Some cases grow more rapidly and grow greatly in a few months.

(2) The size of breast fibroma is small, no more than 5cm, the surface is smooth, the boundary is clear, the texture is uniform, no lobulation, and the volume of lobular sarcoma is mostly 10-20cm, the surface is uneven, there are lobes, the texture is not Evenly.

(3) Breast fibroma can be multiple or single, while lobular sarcoma is mostly single.

(4) Breast fibroma occurs mostly in young women. It is rare in children over 50 years old, and phyllodes cystosarcoma is not only seen in young and middle-aged women, but also in older women.

3. Malignant sarcoma:

It is mainly based on pathological examination for identification.

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