4.5 Article

Comprehensive Clinical-Pathologic Assessment of Malignant Phyllodes Tumors

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AMERICAN JOURNAL OF SURGICAL PATHOLOGY
卷 47, 期 11, 页码 1195-1206

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LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/PAS.0000000000002109

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Malignant phyllodes tumor; distant metastasis; World Health Organization; diagnostic criteria

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The latest World Health Organization classification of breast tumors recommends diagnosing malignant phyllodes tumors (MPTs) when all 5 morphologic features are present. However, a retrospective study found that the current recommendation may miss a significant number of MPTs with distant metastases, suggesting the need for refined diagnostic criteria.
The latest World Health Organization classification of breast tumors recommends diagnosing malignant phyllodes tumors (MPTs) when all 5 morphologic features are present: permeative borders, marked stromal cellularity, marked stromal cytologic atypia, >= 10 mitoses per 10 high-power fields (HPF), and stromal overgrowth. We assessed the performance of this recommendation to capture MPTs and features predictive of distant metastasis in a multi-institutional retrospective study. Of 65 MPTs, most cases had at least focally permeative borders (58, 89%), with marked stromal cellularity in 40 (61.5%), marked atypia in 38 (58.5%), >= 10 mitoses per 10 HPF in 50 (77%), and stromal overgrowth in 56 (86%). Distant metastases were observed in 20 (31%) patients (median follow-up 24.5 mo, 1 to 204). Only 13 of 65 (20%) cases had all 5 morphologic features, while only 7 of 20 (35%) cases with distant metastases had all 5 features. In univariate analysis, only marked stromal atypia (P=0.004) and cellularity (P=0.017) were associated with decreased distant metastasis-free survival. In multivariate Cox regression, the combination of stromal overgrowth, marked stromal cellularity, and atypia (C-index 0.721, 95% CI: 0.578, 0.863) was associated with decreased distant metastasis-free survival. The current World Health Organization recommendation will miss a significant number of MPTs with distant metastases. We propose refined diagnostic criteria for MPTs: (1) stromal overgrowth combined with >= 1 feature(s) (marked cellularity, marked atypia, or >= 10 mitoses per 10 HPF), or (2) in the absence of stromal overgrowth, marked cellularity combined with >= 1 feature(s) (permeative borders, marked atypia, or >= 10 mitoses per 10 HPF).

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