[Clinicopathologic features and prognostic factors of malignant phyllodes tumors].
OBJECTIVE
To study the clinicopathologic features of malignant phyllodes tumors (PT) by histopathologic analyses, immunohistochemical profiling and DNA content assay, and evaluation of the clinical outcome.


METHODS
Ten patients with malignant PT from 1999 to 2013 who were treated by surgery were enrolled in this study. The morphologic characteristics were studied under light microscope, standard two-step EnVision method of immunohistochemical staining was used to assess the expression of CK5/6, CKpan, 34β E12, desmin, p63, ER-α, PR, Ki-67, CD34, SMA, p53, p16, bcl-2 and CD117 in the tumors. The corresponding paraffin blocks were also used for flow cytometric DNA content assay. These data were correlated with the follow-up results.


RESULTS
The median age of onset was 46.5 years old. The mean tumor size was 7.4 cm (2.0-25.0 cm). At the end of the follow-up period (22 to 125 months), there were tumor recurrences in 3/8 patients and the median time of recurrence was 24 months. Metastasis occurred in 3/8 patients who all died of the tumors. PT had heterogeneous histology, with stromal overgrowth with leaf-like projections, periductal stromal overgrowth, and most commonly, diffuse stromal overgrowth with sarcomatous differentiation. The mean positive index of Ki-67 was 11.4%. The stromal tumor cells were positive for CD34, SMA, p53, p16, and bcl-2 in 3/10, 9/10, 6/10, 8/10, and 4/10 cases, respectively. CD117,ER-α and PR were negative. Interpretable DNA histograms were obtained in nine cases with triploidy in two cases.


CONCLUSIONS
The diagnosis of malignant PT should be considered based on the diversity of growth patterns and heterogeneous histology.Ki-67 and CD34 are valuable diagnostic and prognostic factors in patients with malignant PT. Tumors with diffuse stromal overgrowth, heterologous elements, Ki-67 ≥ 20% or aneuploidy are more likely to metastasize.
Department of Pathology, Peking University Health Science Center, Third Hospital of Peking University, Beijing 100191, China.
Cui
C
Jia
Department of Pathology, Peking University Health Science Center, Third Hospital of Peking University, Beijing 100191, China.
Fang
F
Mei
Department of Pathology, Peking University Health Science Center, Third Hospital of Peking University, Beijing 100191, China.
Jie
J
Zheng
Department of Pathology, Peking University Health Science Center, Third Hospital of Peking University, Beijing 100191, China.
Jiang-feng
JF
You
Department of Pathology, Peking University Health Science Center, Third Hospital of Peking University, Beijing 100191, China. E-mail: liujianying@bjmu.edu.cn.
Jian-ying
JY
Liu
D000328:Adult; D000368:Aged; D018952:Antigens, CD34 / Q000378:metabolism; D001859:Bone Neoplasms / Q000556:secondary; D001943:Breast Neoplasms / Q000235:genetics / Q000378:metabolism / Q000473:pathology* / Q000601:surgery / Q000628:therapy; D059186:Chemoradiotherapy, Adjuvant; D004171:Diploidy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000378:metabolism; D008175:Lung Neoplasms / Q000556:secondary; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D003557:Phyllodes Tumor / Q000235:genetics / Q000378:metabolism / Q000473:pathology* / Q000556:secondary / Q000601:surgery / Q000628:therapy; D057885:Triploidy
D018952:Antigens, CD34; D019394:Ki-67 Antigen