Borderline leaf-shaped tumor on histology. Features of radiation diagnostics of rare diseases of the mammary gland of a tumor nature. Fibroadenoma of the breast - video

Leaf tumor is a benign tumor. The size of the tumor can be both small and giant. On palpation, a leaf-shaped tumor is defined as a round or oval neoplasm with clear contours and a smooth surface.

Phylloid tumor has a lobular structure and consists of several nodes. Upon closer examination, the tumor tissue is gray-white in color, with a characteristic layered structure and noticeable slit-like and cystic cavities, with traces of hemorrhages and necrosis. The protruding layers of fibrous tissue look like the sheets of a closed book.

One of causes diseases are disharmonic disorders. Unlike a fibroadenoma, a leaf-shaped tumor continues to grow even after these disorders are corrected.

Treatment appointed on the basis of history, mammography and examination results. The method of surgical intervention is determined depending on histological studies, since the tumor in different departments may have different structure. Usually, a wide sectoral resection or quadrantectomy of the mammary gland is performed. Sometimes relapses are possible after sectoral resection, therefore, in some cases, when the size of the tumor is significant, amputation of the mammary gland is recommended.

Phylloid tumor, also known as leaf-shaped, or intracanalicular fibroadenoma with cellular stroma, is quite rare. The age of patients at the time of detection of the tumor is 40-50 years. The tumor is benign, connective tissue-epithelial, often unilateral.

Phyloid tumors are characterized by rapid, sudden growth and volume expansion. The sizes are variable - from a few centimeters to 20 cm. On palpation, a round or oval neoplasm with clear contours and a smooth surface is determined. The consistency is heterogeneous, includes densely elastic and softened areas.

According to the results of macroscopic examination, the tumor has a lobular structure and consists of several nodes. Upon closer examination, the tumor tissue is gray-white in color, with a characteristic layered structure and noticeable slit-like and cystic cavities, with traces of hemorrhages and necrosis. The protruding layers of fibrous tissue look like the sheets of a closed book.

The leaf-shaped tumor has the same morphological composition as the fibroadenoma. With fibroadenoma connective tissue turns into a fibrous, and in a leaf-shaped tumor it becomes multicellular, while the proliferating cells of the stroma become polymorphic, and can later turn into sarcomatous. One of the causes of the disease is dishormonal disorders. Unlike fibroadenoma, leaf-shaped tumor continues to grow even after these disorders are corrected.

The treatment of a phyllodes tumor is surgical, based on the history, mammography, and examination results. The method of surgical intervention is determined depending on histological studies, since the tumor in different departments may have a different structure. Usually, a wide sectoral resection or quadrantectomy of the mammary gland is performed. Sometimes, after sectoral resection, relapses are possible. Very rarely, foci of non-invasive or invasive ductal or lobular carcinoma can be found in phyllodes tumors.

High-quality diagnostics and treatment can only be provided by a specialist who, in accordance with your indications and based on your situation, will select an individual therapy regimen for you and give further recommendations.

Over the past 30 years of operation of the oncological center, only 168 patients with this tumor pathology have been observed, which is 1.2% of all neoplastic diseases mammary glands. We have not identified men with this tumor pathology. The presence of a palpable node in the mammary gland in 166 patients (98.8%) was the main reason for visiting a doctor.

At the same time, only two women (1.2%) complained of pain in the affected mammary gland. Discharge from the nipple of the breast was observed in 2 patients (1.2%). In 2 women, the tumor was detected at preventive examination. The age of patients with leaf-shaped tumor ranged from 11 to 74 years. Average age patients was 39.9 years. Women between the ages of 30 and 50 are most susceptible to this disease.

The average age of patients with a benign leaf-shaped tumor was significantly lower (p Leaf-shaped tumors of the mammary glands were localized in the right gland in 83 cases (49.4%), in the left mammary gland - in 80 (47.6%), in both mammary glands - in 5 (2.97%) In 16 patients (9.5%) with a leaf-shaped tumor, more than one node was detected, while in 5 cases (2.97%) the tumors were localized in both mammary glands and in 11 cases (6.5% ) - in one of the glands (5 - in the right, 6 - in the left).

Synchronous occurrence of a leaf-shaped tumor and fibroadenoma in the other mammary gland was detected in 5 patients (2.97%). The presence of more than one node in the mammary gland reliably indicates a benign variant of the leaf-shaped tumor (p
The study of the anamnesis of the disease made it possible to identify the following options for the growth rate of leaf-shaped tumors: tumors characterized by slow, rapid or two-phase growth (a period of long-term stable existence is replaced by a stage of rapid growth).

In 63 cases (37.5%), rapid growth was detected, in 52 cases (30.9%), a slow increase in the tumor from the moment of its increase was noted, and in 53 cases (31.5%), a two-phase course of the process, when a long-term formation suddenly began to rise sharply.
However, this criterion does not allow differentiating different variants of leaf-shaped tumor.

When examining women with leaf-shaped tumors, in most cases, the skin over the neoplasm was not changed - 118 cases (70.2%). Such skin symptoms as its fixation over the tumor, the "platform" symptom, are extremely rare and are not typical for leaf-shaped tumors - 5 patients (2.97%). More often in patients with a leaf-shaped tumor, skin symptoms such as cyanosis, thinning of the skin over the formation, and a pronounced venous pattern occur. They reflect the rapid, expansive growth of the tumor and the violation of the trophism of the skin of the mammary gland, but by no means invasion of it by the tumor. The result of increasing trophic changes in the skin is its ulceration.

A leaf-shaped tumor on palpation was a well-defined neoplasm delimited from the surrounding breast tissue.
Clear contours were detected in 140 cases (83.3%), indistinct contours - in 28 cases (16.6%). Tuberosity and smoothness of the contours of the neoplasm were noted in almost equal proportions (75 (44.6%) and 93 (55.4%) cases, respectively).

Symptoms such as the heterogeneous consistency of the tumor and the tuberosity of its contours, detected by palpation, are a reflection of the characteristic macroscopic picture. When examining the removed tumors in such cases, cavities were found filled with a mucoid mass and polypoid growths in them.

Changes in the nipple, so typical of breast cancer, are not characteristic of a leaf-shaped tumor. We encountered nipple retraction in 3 patients (1.8%), nipple edema was found in 14 cases (8.3%) of leaf-shaped tumor. Palpable lymph nodes of elastic consistency on the side of the lesion were found in 26 patients (15.5%), enlargement of the lymph nodes was always reactive and was more common in women with trophic skin changes.

The size of leaf-shaped breast tumors varied from 1 to 35 cm. The average size in general group leaf-shaped tumors was 7.46 cm. However, interesting data were obtained when determining the average size of leaf-shaped tumors of various histological variants. It turned out that the minimum size of the tumor was detected in the benign variant of leaf-shaped tumors - 6.87 cm, while in the malignant variant - 14.09 cm (with the intermediate - 11.56 cm).

On this basis, benign leaf-shaped tumors with a size of up to 5 cm significantly differ from the intermediate and malignant variants of tumors (p
In the analysis of clinical diagnoses established in the clinic of the Russian Cancer Research Center. N.N. Blokhin of the Russian Academy of Medical Sciences, out of 168 patients with leaf-shaped tumors, 13 cases (7.7%) were diagnosed with a leaf-shaped tumor without specifying the degree of malignancy, and in 28 cases (16.7%) - a diagnosis of sarcoma. Breast cancer was diagnosed in 59 cases (35.1%), fibroadenoma in 58 cases (34.5%), and cyst and nodular mastopathy in 6 (3.6%) and 4 (2.4%) cases, respectively.

At the same time, in all cases with tumors less than 5 cm, an incorrect diagnosis was made ("fibroadenoma", "cancer", "cyst", "nodular mastopathy"). With tumors of large and giant sizes, clinicians in most cases diagnosed breast sarcoma - 28 cases (16.7%).

Thus, when the tumor size is less than 5 cm, the clinical diagnosis of a leaf-shaped tumor is extremely difficult. In the vast majority of such observations, the leaf-shaped tumor was represented by a well-demarcated, solid formation of a dense consistency without any skin symptoms and changes in the nipple-areolar complex, which led to the establishment clinical diagnosis fibroadenomas in 58 cases (34.5%). The presence of a small seal of elastic consistency against the background of diffuse mastopathy without clear contours was the reason for the diagnosis of nodular mastopathy in 4 cases (2.4%).

Identification of skin symptoms (fixation of the skin over the tumor, "platform", etc.) in combination with a palpable tumor of a dense consistency with tuberous contours served as the basis for the diagnosis of breast cancer in 59 patients (35.1%). Cyst - in 6 cases (3.6%), diagnosed in those cases where clinically the formation had an elastic consistency, smooth, even contours (macroscopically it was represented by a single-chamber cavity with mucus-like contents and polypoid growths that did not fill its entire lumen). In 28 cases (16.7%), the basis for the diagnosis of breast sarcoma was a number of clinical and anamnestic data (rapid tumor growth with large sizes; characteristic changes in the skin over the tumor in the form of thinning, hyperemia, cyanosis, increased venous pattern; heterogeneous consistency of the neoplasm, tuberosity of the contours).

Thus, for the most part, the diagnosis of "leaf-like tumor" turns out to be a diagnosis established at the histological level. Thus, only 41% of preoperative diagnoses corresponded to the histological diagnosis.

Analyzing therapeutic approaches for benign and intermediate variants of leaf-shaped tumors, it can be stated that all variants were used. surgical interventions used in diseases of the mammary glands. The main option surgical treatment is sectoral resection breast (81.2% of cases). The use of various types of mastectomies and radical resections is due either to the large size of the tumor or to diagnostic errors.

The data in the table show that an increase in the volume of surgical intervention leads to a decrease in the likelihood of developing a local recurrence of the disease. So, in all cases of tumor enucleation, local recurrences occurred, with sectoral resections in 19.7% of cases, and after mastectomy - only in 1 case (4.8%). Relapses develop on average after 17 months (from 3 to 4 years). However, the time for the development of tumor recurrence after surgery is longer with a benign variant of a leaf-shaped tumor than with an intermediate one (45.5 and 26.3 months; p>0.05). Comparison of various options for performing mastectomy with the course of the disease did not reveal the presence of correlations between them.

The situation is similar with sectoral and radical resections of the mammary glands. There were no significant differences in the tendency to recurrence depending on age, neoplasm growth rate, morphological criteria. When comparing the histological variant of the tumor and the development of recurrence, it was revealed that intermediate leaf-shaped tumors recur more often than benign ones (23.8% and 17.4%, respectively, p > 0.05). Patients with relapses were re-operated: mastectomy was performed in 4 cases, sectoral resection was performed in the rest. It should be noted that the tendency to recurrence is a characteristic feature of leaf-shaped tumors, and sometimes it becomes persistent (15 relapses were noted in one patient)

Unjustified tightening medical measures(carrying out chemotherapy, radiation therapy) is due to errors in the diagnosis of the disease.

There were no distant metastases and deaths associated with these histological forms. A completely different picture is observed when analyzing the course of malignant leaf-shaped tumors (23 patients), where, along with local recurrence, there is also distant metastasis (malignancy is due to the development of sarcoma against the background of a leaf-shaped tumor). As stated earlier, the average size malignant leaf-shaped tumors (11.6 cm) significantly prevails over those in other histological variants this disease. characteristic clinical picture represented by an increase in the affected mammary gland in volume. The skin of the gland is thinned, of a purple-bluish hue, with an expanded subcutaneous venous network. The tumor is mobile relative to the chest wall.

Malignant leaf-shaped tumor occurs significantly in more late age than benign (43.8 and 37.5 years, respectively; p
The data in the table indicate that recurrence is feature of this tumor process and develops both after sectoral resections and after radical mastectomy. At the same time, after sectoral resections, local recurrences occurred almost twice as often as after mastectomy (40% and 22.2%, respectively; p>0.05). Relapses in a malignant variant of a leaf-shaped tumor develop significantly earlier than in a benign variant (14.25 and 45.5 months; p 0.05). No other correlations (including the fact of adjuvant treatment) affecting the likelihood of relapse were found.

Relapses that occurred in 5 patients were promptly removed. Two of them relapsed (in one case - after radiation therapy), which, in turn, required additional surgical intervention (in one patient, a large pectoral muscle with resection of the anterior segments of the ribs - alive in the subsequent 8 years).

The presence of malignancy of the stromal component predetermined the features of the course of the disease. We did not reveal metastases of leaf-shaped tumors in regional lymph nodes. Hematogenous metastases were noted in 4 patients (lungs, liver, bones), which led to death.

In one case (liver metastases) occurred simultaneously with a recurrence in the area of operation (after mastectomies) after 4 years, in the other - for 2 years, also after mastectomies. Attempts to conduct chemotherapy in all cases were unsuccessful. A significant relationship was found between the development of metastases and the size of the primary tumor node: so, in the presence of metastases, the average size of the latter was 20 cm, while with favorable course diseases - 6.37 cm (p

Breast sarcomas:

During the same period of time, from 1965 to 1999, 54 patients with a histologically confirmed diagnosis of breast sarcoma were treated in the clinics of the Russian Cancer Research Center of the Russian Academy of Medical Sciences, which is 0.34% of all tumor diseases of the mammary glands. In this group of tumor pathology, 1 man was noted.

The average age of patients is 44.1 years (16-69 years) and practically does not differ from that in malignant leaf-shaped tumors of the mammary glands. The advantage of the side of the lesion was not revealed: the process in the left mammary gland was detected in 26 cases, in the right - 28. Multicentricity, synchrony of the lesion in this group of patients was not noted. The size of the tumor node varied from 7 to 35 cm, averaging 14.09 cm.

Describing their disease, most patients note the rapid, sometimes rapid growth of the tumor, which is the main reason for visiting a doctor.

The clinical picture of mammary sarcomas does not fundamentally differ from that of a malignant leaf-shaped tumor: the affected mammary gland, as a rule, is significantly enlarged in volume, with purple-cyanotic skin and a pronounced subcutaneous venous network. Diagnostic criteria more informative than with leaf-shaped tumors. More than half of patients (74%) have a short history of the disease (less than a year), which is due to the rapid, sometimes rapid growth of the tumor.

When assessing the growth rate of breast neoplasms, a history of rapid and two-phase growth rates was noted both in leaf-shaped tumors and in sarcomas. A slow growth rate was noted mainly by patients with leaf-shaped tumors. A slow growth rate is not characteristic of breast sarcomas (only 1.8%). Thus, the presence of a slow growth rate is more indicative of the presence of a leaf-shaped breast tumor than a sarcoma (p
With an increase in the size of the tumor node, the percentage of mammary sarcomas increases. Thus, when the size of the tumor node is more than 15 cm, sarcoma was detected in 71% of cases. At the same time, with a neoplasm size of up to 3 cm, not a single case of a malignant leaf-shaped tumor and sarcoma was detected.

According to the microscopic picture, the following types of soft tissue sarcomas were identified: osteogenic sarcoma - 1, angiosarcomas - 15, liposarcoma - 4, neurogenic - 5, leiomyosarcoma - 5, rhabdomyosarcoma - 0, malignant fibrous histiocytoma - 11. Review of histological preparations due to their absence in the pathoanatomical archive in 13 cases was not performed (it was treated as a polymorphic cell sarcoma without regard to histogenetic affiliation).

The large size of the tumor node, the rapid growth of the neoplasm and the threat of its ulceration in the vast majority of cases predetermined surgical stage treatment. Surgical intervention was an integral component of treatment in 92.6% of patients (50 patients). As an independent type of primary treatment in 33 patients (61.1%). In other cases, the operation was supplemented with radiation therapy - in 8 cases, chemotherapy - in 6 cases, and their combination - in 3 patients. 4 patients attempted chemotherapy due to the initial generalization of the process. In addition to surgery, radiation therapy (standard radiation therapy ROD 2 Gy, SOD 40-46 Gy, radiation therapy with large fractions ROD5Gy, SOD20Gy) and chemotherapy were used mainly for the malignant variant of leaf-shaped tumors and sarcomas.

As a postoperative treatment, radiation therapy was used in 12 cases, in the treatment of relapses and (or) metastases - in 11 cases. various schemes therapy reflects the stages of development of chemotherapeutic approaches in oncology: from Thio-Tef monotherapy to schemes using drugs from the group of anthracycline antibiotics and platinum drugs. As an adjuvant treatment, chemotherapy was performed in 9 cases, in 18 - as a therapy for the metastatic process. The most frequently used regimens included vincristine, adriamycin and cyclophosphamide (14 cases). Hormone therapy in the complex treatment of leaf-shaped tumors and breast sarcomas was carried out in two cases of steady progression of the metastatic process. The volume of surgical intervention varied from sectoral resection to radical Halsted mastectomy (radical resection was not performed).

There was no correlation between different types of mastectomies and the course of the disease, so all types of mastectomies are combined into one group. The table data eloquently show that the volume of surgical intervention in the form of sectoral resection is clearly insufficient - in 71% local recurrence of the disease, while with mastectomy - 22% (p
At the same time, additional therapeutic measures (radiotherapy, chemotherapy, or their combination) do not significantly affect the nature of the course of the disease. At the same time, if we do not detail adjuvant treatment by type, but divide patients with developed relapses according to the presence or absence of adjuvant therapy, then adjuvant treatment was accompanied by the development of relapse in 5 patients, and in the absence of treatment, relapse occurred in 12 patients (in 3 out of 8 after radiotherapy; in 1 out of 6 after chemotherapy and 1 out of 3 after chemoradiotherapy). And, although there is no significant difference in these groups (probably due to the small number of observations), these data should be taken into account.

Interesting results were obtained by comparing the course of the disease with the histological form of sarcoma. It turned out that in 12 (66.7%) of 18 patients with local recurrence of the disease, breast angiosarcoma was detected, which is characterized by persistent recurrence and extremely poor prognosis. No recurrence was found in lipo- and neurogenic breast sarcoma. Thus, the course of the disease appears to be more dependent on histological form diseases than on the amount of therapeutic measures.

Concerning the choice of the volume of surgical intervention, in our opinion, one should dwell on mastectomy. Lymphadenectomy has no grounds for its performance: lymphogenous metastasis is not typical for sarcomas. According to our data, histological examination of sarcoma metastases in regional lymph nodes were not detected. Metastasis was noted mainly in the lungs. The fact of development of local recurrence is unfavorable factor prognosis for the development of distant metastases (in 11 of 18 patients with local recurrence, distant metastases; R
Patient survival is low. During the 1st year, 9 patients (16.6%) died, 5-year survival was 37.8%, 10 years survived 28.0%.

Treatment of distant metastases (lungs, bones, liver) is ineffective. Regardless of the type of chemotherapy, the effect was either absent or short-lived. Only 2 cases of success were noted: excision of a solitary metastasis in the lung (liposarcoma), the patient is alive for 22 years later, and 1 case of effective chemotherapy in lung metastases (malignant fibrous histiocytoma, 9 courses of chemotherapy with vincristine, carminomycin and interferon), death of this of the patient occurred 5 years after the end of chemotherapy from generalization of another malignant disease- cancer of the gallbladder.

- fibro-epithelial formation of the mammary gland, belonging to the group of potentially malignant tumors. The presence of a leaf-shaped tumor is manifested by a seal in the tissues of the mammary gland, sometimes of gigantic size; in some cases - pain and discharge from the nipple. Diagnostic tactics include ultrasound, mammography, puncture biopsy and cytological examination of the material. Treatment of a leaf-shaped tumor of the breast is only surgical and may include performing a sectoral resection, radical resection, or mastectomy.

General information

Carrying out a radical resection of the mammary gland, subcutaneous or radical mastectomy is justified in the case of a large size of the tumor or its malignant nature. Lymphadenectomy is usually not performed. After radical interventions, reconstructive mammoplasty is performed with own tissues or endoprostheses. Radiation and hormone therapy for leaf-shaped breast tumors are not indicated.

Prognosis for leaf-shaped tumor of the breast

A feature of leaf-shaped breast tumors is their frequent addiction to a recurrent course: according to observations, benign phyllodes fibroadenomas recur in 8.1% of cases, borderline - in 25%, malignant - in 20%.

Relapses often occur within a period of several months to 2-4 years; it is possible to transfer benign form to intermediate or sarcomatous. Expansion of the scope of intervention (mastectomy) leads to a decrease in the risk of developing local recurrences of a leaf-shaped breast tumor.

Many women perceive any neoplasm in the breast as malignant. However, the diagnosis in 80% of cases reveals benign changes- fibroadenomas. They may have a different shape. Phylloid fibroadenoma (leaf-shaped) is often detected. In most cases, it is treatable and does not turn into cancer.

Types of benign neoplasms

Fibrous adenoma of the breast is a collection of glandular and fibrous tissues. When probing the chest, it is possible to detect tissue compaction in the form of a round or oval nodule. It can cause discomfort to a woman when pain occurs. However, such a neoplasm does not pose a serious danger, since it belongs to the class of non-cancerous ones.

There are several types of fibroadenomas. They differ in localization, shape and structure:

Increased attention needs to be paid last look fibrous adenomas. To determine the nature of changes in the mammary gland, it is necessary to know what properties a leaf-shaped fibroadenoma has.

Characteristics of the phyllodes neoplasm

Despite the fact that the tumor is benign in nature, it is created increased risk its transition to sarcoma. Therefore, it is important to know what properties distinguish it from other forms of formations.

Leaf-shaped tumor is most often diagnosed in women experiencing a period of hormonal surge. This is usually the time of puberty (11-20 years) or the onset of menopause (45-55 years).

The occurrence of this type of fibroadenoma is influenced by many factors, among which are noted:

excess body weight;
fibroadenoma in the uterus;
diabetes; Reception hormonal drugs Pregnancy
a large number of abortions in history;
neoplasms in the ovaries;
liver disease and disorders in the endocrine system;
pregnancy and lactation;
taking hormonal drugs, including contraceptives.

When a leaf-shaped fibroadenoma occurs, a seal is observed in the mammary gland, which has a limited localization. It is characterized by a lobed structure. When probing, you can detect the connection of several nodes into a single whole.

During growth, the neoplasm changes appearance chest. The skin above it is stretched, has a cyanotic, sometimes purple color. Through it, the vascular and venous mesh.

If there is a rapid growth of the neoplasm within 3-4 months, then doctors are inclined to make a diagnosis of "phylloid type fibroma". However, it can be confirmed only with the help of various instrumental studies.

Diagnostic methods

If you suspect a phyllodes fibroadenoma, you must definitely visit a mammologist. She will appoint necessary examinations to confirm or refute the diagnosis. Before the appointment, the doctor will conduct a complete examination of the breast, palpation, and also collect anamnesis data. In the future, the patient will need to undergo research using laboratory and instrumental diagnostics.

The first step is to donate blood biochemical analysis. Based on its results, a conclusion will be made about the presence of hormonal disorders in the woman's body.
Next, the patient will be assigned a mammography - X-ray of the mammary glands.
The study can also be carried out using an ultrasound machine, which will allow you to assess the nature of changes in the breast. During this method, fibroadenoma is differentiated from a cyst.
During a biopsy, a piece of tissue is taken, which will be sent to cytological examination. According to the results of the analysis, the nature of the damage to the breast tissues, as well as the presence or absence of cancer cells, is noted. Biopsy Mammography

Only after the diagnosis, the doctor can prescribe treatment for the neoplasm.

Method of treatment of phyllodes fibroadenoma

If there is a formation in the breast less than 1 cm in size, doctors prescribe dynamic monitoring. In this case, a woman must visit a mammologist, repeat ultrasound and mammography after a while to identify the condition of phyllodes fibroadenoma.

If the neoplasm is large, then surgery is prescribed. It is shown when:

rapid growth of neoplasm;
the presence of a visible breast defect;
an extensive neoplasm, the size of which exceeds 5 cm;
planned pregnancy.

The operation is carried out in two
persons:

enucleation method;
sectoral resection.

During enucleation, the neoplasm is husked through a small incision made in the chest. In this case, there are practically no scars, they are insignificant.

Sectoral resection is distinguished by the removal of the neoplasm. The elimination of the tumor itself can be shown directly. In more severe cases it is necessary to remove the tissue that surrounds it (3 cm from the edge of the nodes). The disadvantage of the method is possible relapse fibroadenomas. In this case, amputation of the breast will be indicated.

Sometimes doctors resort to prescribing conservative treatment. It is indicated for small tumors, the size of which does not exceed 8 mm. Therapy is aimed at resorption of education. However, it does not always lead to a positive result.

After any medical manipulations, a woman needs to undergo a control ultrasound. Indeed, with complications and the absence of positive dynamics, the neoplasm can turn into a malignant one for no apparent reason. Therefore, with changes in the mammary gland, a woman should definitely consult a doctor.

Fibroadenoma of the breast - video

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Leaf tumor of the breast

Leaf-shaped tumor of the mammary gland is a fibro-epithelial formation of the mammary gland, belonging to a group of potentially malignant tumors. The presence of a leaf-shaped tumor is manifested by a seal in the tissues of the mammary gland, sometimes of gigantic size; in some cases - pain and discharge from the nipple. Diagnostic tactics include ultrasound, mammography, puncture biopsy and cytological examination of the material. Treatment of a leaf-shaped tumor of the breast is only surgical and may include performing a sectoral resection, radical resection, or mastectomy.

A leaf-shaped breast tumor in mammology is also found under the names of leaf-shaped fibroadenoma, intracanalicular fibroadenoma, giant myxomatous fibroadenoma, phyllodes fibroadenoma, etc. Like other two-component breast formations (fibroadenomas), leaf-shaped tumor is characterized by proliferation of epithelial and connective tissue components with a predominance of the latter. Among fibro-epithelial formations of the mammary gland, the incidence of leaf-shaped tumor is about 1.2-2%.

The leaf-shaped tumor of the mammary gland is a difficult-to-diagnose formation with a tendency to intensive growth, recurrence, and malignant degeneration into sarcoma. Malignancy of the leaf-shaped tumor of the mammary gland is observed in 3-5% of cases.

Characteristics of leaf-shaped tumors of the breast

The international histological classification refers the leaf-shaped tumor to fibro-epithelial formations and distinguishes three possible forms- benign, borderline (intermediate) and malignant.

The macroscopic picture of a leaf-shaped breast tumor depends on the size of the formation. Tumors up to 5 cm in diameter are delimited from surrounding tissues solid education grayish-white or pinkish in color with a coarse-grained or lobed structure. The section shows slit-like cavities and small cysts containing a viscous mucus-like mass. The macrostructure of leaf-shaped tumors of the mammary gland larger than 5 cm is always represented by cystic cavities and crevices filled with a gelatin-like secret, polypoid growths in cystic cavities.

Microscopically, the stromal (connective tissue) component predominates in the structure of a leaf-shaped breast tumor. The difference from breast fibroma is a more pronounced stroma with significant phenomena of nuclear polymorphism and proliferation of stromal cells.

A leaf-shaped tumor can be represented by a single or multiple nodes located in one or both mammary glands. Phyloid tumors are characterized by sudden, rapid growth; the size of leaf-shaped fibroadenoma is variable - from small nodules to 20 or more cm in diameter.

The etiology of leaf-shaped breast tumor is unclear. Its development is associated with hormonal balance, primarily with hyperestrogenism and a lack of progesterone. In this regard, the peaks in the detection of phyllodes fibroadenomas fall on the hormonally active transitional periods of women's lives: 11-20 years and, most often, 40-50 years. In isolated cases, leaf-shaped tumors of the mammary glands occur in men.

Provoking factors in the formation of leaf-shaped tumors of the mammary gland can be pregnancy, abortion, lactation, fibrocystic mastopathy, as well as extragenital endocrinopathies and metabolic disorders - diabetes mellitus, tumors of the adrenal glands and pituitary gland, nodes thyroid gland obesity, liver disease, etc.

Symptoms of a leaf-shaped tumor of the breast

For a leaf-shaped tumor of the mammary gland, a two-phase course is typical. Usually, after a long period of slow development, which sometimes lasts for decades, there comes a phase of sudden rapid growth. The average size of phyllodes fibroadenomas is 5–9 cm, although cases have been described when the tumor reached a diameter of 45 cm and weighed 6.8 kg. At the same time, the size of the leaf-shaped breast tumor does not have prognostic value - a small formation can be malignant and, on the contrary, a giant fibroadenoma can be benign.

Usually, a leaf-shaped breast tumor is detected by the patient herself or by a mammologist during palpation in the form of a dense node. With a large size of a leaf-shaped tumor, the skin over the mammary gland becomes thinner, acquires a purple-cyanotic hue with translucent dilated saphenous veins. There may be pain in the mammary gland, discharge from the nipple of the affected gland, skin ulceration.

A leaf-shaped tumor is more often localized in the upper and central quadrants of the mammary gland, and with large sizes it occupies most or the whole chest. A malignant leaf-shaped tumor of the breast usually metastasizes to the lungs, liver, bones; lymph node metastases are uncommon.

Diagnosis of a leaf-shaped tumor of the breast

On palpation, a leaf-shaped tumor of the mammary gland is determined as a seal delimited from the surrounding tissues with a lobed structure, consisting of several nodes merging with each other.

With the help of ultrasound of the mammary glands, a hypoechoic formation is revealed, on the cut it resembles a “head of cabbage”, which has a heterogeneous structure, multiple anechoic (liquid) cavities and crevices. At doppler ultrasound inside the nodular formation of the mammary gland, an abundant network of various veins and arteries is determined. Mammography reveals a tumor conglomerate of oval or irregular round shape, lobed structure with clear outlines; the tumor shadow is homogeneous and quite intense.

The importance of preoperative differentiation of benign leaf-shaped breast tumor and sarcoma dictates the need for a cytological assessment of the formation. For this purpose, a needle biopsy tumors from its various sites and subsequent cytological examination of the biopsy.

In view of the rapid progression, variability of the course and the potential for malignancy in relation to the leaf-shaped tumor of the breast, it is indicated exclusively surgical tactics. For benign and intermediate leaf-shaped tumors, a sectoral resection of the mammary gland or a quadrantectomy is performed.

Prognosis for leaf-shaped tumor of the breast

A feature of leaf-shaped tumors of the breast is their frequent tendency to recurrence: according to observations, benign phyllodes fibroadenomas recur in 8.1% of cases, borderline - in 25%, malignant - in 20%.

Relapses often occur within a period of several months to 2-4 years; at the same time, the transition of a benign form to an intermediate or sarcomatous one is possible. Expansion of the scope of intervention (mastectomy) leads to a decrease in the risk of developing local recurrences of a leaf-shaped breast tumor.

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Leaf-shaped fibroadenoma - do not miss the threat!

Fibroadenoma foliaceus is a rare breast tumor that usually develops in women in their 40s. These tumors are also called phyllodes, from the Greek word phyllodes, which means leaf-like. It can be said that more correct name- “leaf-like tumors”, as this is a group of neoplasms, whose representatives can have very different behavior.

This name is due to the fact that tumor cells have a leaf-shaped growth pattern. Fibroadenoma foliaceus tends to grow rapidly but rarely spreads beyond the breast.

Types of leaf-shaped fibroadenoma

Phylloid fibroadenoma is observed in approximately 0.5% of all breast tumors, it is formed from a combination of stromal and epithelial cellular elements. A neoplasm can develop both in the right and in the left breast.

There are three main types of phyllodes tumors:

Benign (non-cancerous) - make up approximately 50-60% of phyllodes tumors.
Borderline tumors are not yet malignant, but they can turn into them.
Malignant - make up approximately 20-25% of all leaf-shaped tumors.

In their least aggressive form, phyllodes tumors are similar to benign fibroadenomas, which is how they got their name, leaf-shaped fibroadenoma of the breast. On the other hand, malignant leaf-shaped neoplasms can metastasize with the bloodstream to distant organs, sometimes turning into sarcomatous lesions.

How do phyllodes tumors develop in the breast?

Unlike breast cancer called carcinoma, which develops inside the ducts or lobules of the breast (intracanalicular tumor), leaf-shaped tumors start growing outside of them (like pericanalicular fibroadenoma). Phylloid tumors develop in the connective tissue (stroma) of the breast, which includes adipose tissue and ligaments surrounding ducts, lobules, blood vessels and lymphatic vessels in the chest. In addition to stromal cells, they may also contain cells from the ducts and lobules of the mammary gland.

Symptoms and signs of leaf-shaped fibroadenoma

The most common symptom of phyllodes tumors is a nodule in the breast, which the patient or physician may find on self-examination or breast examination. These neoplasms can grow rapidly over several weeks or months to a size of 2-3 cm, and sometimes more. Such rapid cell proliferation does not mean that a phyllodes tumor is malignant, because benign neoplasms can also grow quickly.

The nodule is usually painless. If left untreated, the nodule can create visible to the eye convex. In more advanced cases leaf-shaped tumor can lead to the formation of an ulcer or an open sore on the skin of the breast.

Diagnostics

Like other, rare, types of breast tumors, leaf-shaped fibroadenoma is difficult to diagnose, since doctors almost never encounter it. Phylloid tumors may also look similar to the more common benign fibroadenomas.

The two key differences between fibroadenomas and leaf-shaped tumors are that the latter grow more rapidly and develop about 10 years later in age (after 40 as opposed to 30). These differences can help doctors distinguish between these growths.

Establishing a diagnosis is usually carried out in several steps:

Physical examination of the mammary glands;
Mammography;
Ultrasound procedure;
Magnetic resonance imaging.

Biopsy and histology the only way accurately diagnose a leaf-shaped tumor. In addition, it is possible to determine the type of neoplasm (benign, borderline or malignant) and the degree of cell proliferation.

The term "benign tumor" often leads people to think that the disease is not dangerous and does not require treatment. But benign phyllodes tumors, like malignant tumors, can grow to large sizes, create visible nodules on the breast, and even break through the skin, causing pain and discomfort. Therefore, any type of these neoplasms requires treatment.

Treatment

Whether a leaf tumor is benign, malignant, or borderline, the treatment is the same - surgery to remove the tumor along with at least 1 cm of surrounding healthy breast tissue. Some doctors believe that even more healthy tissue needs to be removed.

Wide excision is important because, when it is not performed, phyllodes tend to recur in the same area of the breast. This applies to both malignant and benign neoplasms.

Possible surgeries:

Lumpectomy - The surgeon removes the tumor and at least 1 cm of normal tissue around it.
If the mass is very large or the breast is small, it can be very difficult to make a wide excision and save enough healthy tissue to ensure a natural looking breast. In this case, the doctor may recommend carrying out:
- Partial or segmental mastectomy - the surgeon removes the part of the breast that contains the tumor.
- Total or simple mastectomy - the surgeon removes the entire breast, but nothing else.

Phylloidal tumors rarely spread to the axillary lymph nodes, so in most cases they do not need to be removed.

Malignant leaf-shaped tumors are rare. If they have not spread beyond the breast, radiation therapy may be used to stop cell proliferation. If they have metastasized to other parts of the body, treatment should include chemotherapy.

Care after treatment

The doctor should observe the patient after treatment. Phylloidal tumors can sometimes recur. Relapse usually develops within a year or two after surgery. Malignant leaf-shaped tumors may reappear faster than benign ones.

Physician and patient should cooperate by scheduling visits and examinations, which may include:

Physical examination of the breast by a doctor within 4-6 months;
Mammography and ultrasound procedure 6 months after treatment;
Magnetic resonance or CT scan- as directed by a doctor if he suspects a risk of distant metastases.

If malignant leaf-shaped tumors reappear in the breast, treatment includes wide excision or mastectomy. Some doctors also recommend radiation therapy.

Less than 5% of phyllodes tumors recur in other areas of the body (distant metastases). Possible treatment includes surgical removal, radiation therapy and chemotherapy.

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Phylloid tumor | Pharmacy in the House

A phyllodes tumor is a type of fibroadenoma benign tumor mammary gland. With a small size, a phyllodes tumor is difficult to distinguish from a fibroadenoma.

Phylloidal or as it is also called a leaf tumor, maybe various sizes ranging from the smallest to the gigantic. A phyllodes tumor can be detected by palpation of the breast. It is round or oval in shape with clear contours and a smooth surface. Such a tumor has a lobular structure. It consists of several nodes.

Considering the phylloidal tumor in more detail, we can say that it is a gray-white tissue with a layered structure and slit-like cystic cavities. You can also see traces of hemorrhage and necrosis. Phylloid layers resemble sheets of a closed book, hence the second name - sheet.

A phylloidal tumor that has a cellular stroma is a rare disease. It usually occurs in women in their 40s and 50s. Usually this tumor is benign affecting the connective epithelial part of the skin. Most often it is unilateral.

The morphological composition of the tumor is the same as that of fibroadenoma. Their difference lies in the fact that with a fibrous tumor, the connective tissue becomes fibrous, and with a leafy tumor, it becomes multicellular, and stroma cells are profiling. In the future, these cells become polymorphic and, if not treated, they can transform into sarcomatous.

Leaf sarcoma refers to "boundary" tumors. They border on malignant and benign tumors. If we consider a biopsy of a phyllodes tumor, atypical cells can be detected. They differ from healthy ones, but they cannot be called malignant either.

Symptoms

Phylloid tumor occurs quickly and suddenly. Its growth and increase in size is also fast. It can range in size from a few centimeters to 20 cm. When feeling the chest, you can find balls that have a smooth shape. Its consistency is heterogeneous and may include dense elastic areas and softened ones.

Causes of phyllodes tumor

The main cause of the tumor is dishormonal disorder. If the fibroadenoma stops growing after the elimination of the hormonal disorder, then the phyllodes tumor does not stop growing, even if all the disorders are eliminated. In addition, phyllodes fibroadenoma can degenerate into sarcoma.

Phylloid tumor treatment

Before prescribing treatment, the doctor conducts some research. Among them are mammography and examination of the patient. Also appointed and histological studies because the tumor may be different structure depending on its location. Mammologist doctor in order to put accurate diagnosis doing some research. This is a puncture biopsy, and blood tests for hormones.

The most common treatment for a phyllodes tumor is surgery in the form of a sectoral resection, and a quadrantectomy of the mammary gland can also be performed. However, it is worth remembering that sectoral resection can cause relapses, and as a result, one has to resort to amputation of the mammary gland.

Depending on the size (up to 5-8 mm) of the phyllodes tumor, conservative treatment can also be used. Such treatment aims at resorption of the tumor, but this does not always happen, despite the most selected course of treatment. It is worth remembering that proper treatment, as well as an accurate diagnosis can only be made by a mammologist, on the basis of the studies.

It also happens that phyllodes tumors can also have inclusions of non-invasive or invasive ductal carcinoma, as well as cancer of the lobular, but this happens extremely rarely.

But in order for the treatment to be most effective and short-term, it is necessary to consult a doctor in time for help. Early treatment will greatly facilitate treatment, which can last from 4 to 6 months.

After the treatment, it is necessary to re-examine and do a control ultrasound. If, after conservative treatment, the control ultrasound shows no dynamics, then it is urgently necessary to proceed to preparing the patient for surgery, since there is a risk of sarcoma.

In addition, on the basis of scientific research, medicine has concluded that a phylloid tumor can become malignant without visible reasons and almost no mammologist can give an accurate forecast at what time a benign tumor will develop into a malignant one.

Prevention of phyllodes tumor

I would like to say that, despite the fact that the tumor has been removed, it can occur again and again in different parts of the breast. It has nothing to do with surgery. But to prevent this from happening, it should be remembered that prevention is better than cure.

As prophylactic you need to know, and avoid, those moments that can damage the mammary gland. These moments are:

injections and inflammation of the female genital organs. All this leads to a violation of the hormonal background and has a bad effect on the mammary gland;

abortions, which, like inflammatory processes in the genital organs, lead to hormonal imbalance;

late birth of the first child;

long-term use oral contraceptives(more than 4 years);

radiation, a lot sunlight, dramatic weight loss uncontrolled by doctors and nutritionists;

And finally, I would like to say that the most dangerous in the treatment of this disease is self-medication. This is what can lead to the occurrence of breast cancer much faster than the wrong treatment or its absence at all.

The danger of a leaf-shaped tumor

The danger of this disease lies in the fact that at the first stage we are talking about a small tumor. that may be hiding. There are no vivid symptoms, education is capable of not making itself felt at all. At the same time, scientists have not yet identified factors that would provoke a further increase in education. The tumor can remain in a frozen state for years, sometimes even a solid part of life. And then periodically there is a rather sharp jump, which leads to the appearance of a very large formation.

Unpredictable behavior is characteristic of many oncological diseases or those capable of becoming malignant. Therefore, the leaf-shaped tumor is removed through surgery, which is the only in an efficient way treatment.

Sometimes the entire mammary gland is subject to removal, since the localization site is inside the ducts, which leaves little chance of saving the breast in healthy condition. At surgical intervention on the early dates malignant stage, as well as when detecting a still benign (and intermediate) prognosis is favorable. Despite its sometimes frightening appearance, the disease is quite well curable.

It should be noted that the malignancy of the formation is not related in any way to its size. Cancer may turn out to be completely small tumor, which could long time take for a fairly simple fibroadenoma. A large formation, on the other hand, may well be benign, despite its intimidating appearance. Therefore, only a mammologist can make a final diagnosis. Often this is done even by a whole group of specialists.

Causes of the appearance of a leaf-shaped tumor

Since most women prefer prevention to such diseases, many, quite understandably, are extremely interested in the causes of the appearance of a leaf-shaped tumor. However, scientists have not yet identified the exact and unambiguous reasons. They can only name risk factors:

Endocrine certain disorders that manifest themselves for a long time. Especially when it comes to in large numbers estrogen with low progesterone;
Very abrupt climate change, unfavorable climatic conditions. At the same time, doctors note that if a woman lives in her usual environment, to which her body has genetically adapted, then such problems do not arise. Therefore, only overloads for certain representatives of races are implied;
Past chest trauma. The relationship between different forms and foliar tumor. Scientists promise to publish information in as soon as possible after the end of the collection of material;
late birth. They become a real test for the body, capable of causing a sharp hormonal changes. The latter can provide negative impact on the body;
Chronic diseases of the pelvic organs. Violation of the normal functioning of the ovaries leads to an increased or reduced amount of sex hormones in the blood. Which often directly affects the condition of the mammary glands;
Rejection breastfeeding. Strong enough to affect if lactation has already begun;
Abortion, especially multiple abortions in this way. Causes a sharp hormonal forced restructuring, which sometimes has extremely unpleasant consequences;
Some psychosomatic illnesses in severe forms. In addition to endocrine disruption, they are also associated with a marked decrease in immune status. Which has its consequences;
Overweight. It leads to the accumulation of estrogen, in addition, excess fat can cause pressure on the mammary glands, their injury.

Diagnosis and treatment of the disease

Quite often, the tumor can be seen with ultrasound examination organism. MRI and mammography are also indicated. Histological data are very important in order to distinguish between fibroadenoma, which can sometimes be individual features confuse leaf-shaped tumor specialists, and the specified education.

Also, these data help to finally determine whether the disease is oncological or not. As mentioned above, the treatment of this tumor can be exclusively operational.

Moreover, the intervention should be carried out urgently, no postponements and transfers of operations should be allowed. Education behaves completely unpredictably, in medical practice there are cases when an intervention was prescribed for a benign tumor, and subsequently, according to the analyzes, analyzes came already about the beginning of rebirth.