乳腺叶状肿瘤很少见，其治疗仍有待讨论。根据间质的组织病理学特征，它们被分为良性、交界性或恶性。本研究展示了10年恶性叶状瘤的诊断和治疗经验。2003年至2013年在我们的肉瘤多学科小组会议上转介讨论的所有患者均被诊断为恶性叶状瘤。对患者人口统计、活检详细信息、切除范围、最终病理、重建、辅助治疗、复发和总生存期进行评估。在 10 年期间确定了 30 名患者。与初次活检相比，八名 (26.7%) 在完成切除后诊断升级为恶性叶状瘤。九人 (30%) 在转诊到我们的服务之前在其他地方接受了乳房手术作为最终治疗。其中四例 (44.4%) 需要更广泛的切除，三例发生转移 (33.3%) 并死亡。 21 名患者通过我们的服务接受了初次手术，其中 3 名患者 (14.3%) 死于疾病。总体而言，13 名患者接受了根治性乳房切除术，其中 92.3% 具有足够的切缘（组织学上 >1 cm）且无局部复发，9 名患者进行了简单乳房切除术，22.2% 具有足够的切缘，1 名局部复发，8 名患者进行了广泛的局部切除，37.5% 具有足够的切缘，1 名局部复发对于恶性叶状瘤患者，减少复发和提高生存率的最佳机会是充分切除，并应考虑根治性乳房切除术。对于交界性病变，应考虑转诊至专科中心，我们建议延迟重建，因为有可能组织学升级为恶性肿瘤。版权所有 © 2024 Elsevier Ltd、BASO ~ 癌症外科协会和欧洲外科学会肿瘤学。版权所有。

Phyllodes tumours of the breast are rare, and their treatment is still subject to discussion. They are classified as benign, borderline, or malignant based on histopathological characteristics of the stroma. This study demonstrates 10 years' experience in diagnosis and management of malignant phyllodes.All patients referred for discussion at our sarcoma multidisciplinary team meeting from 2003 to 2013 with a diagnosis of malignant phyllodes were identified. Patient demographics, biopsy details, excision extent, final pathology, reconstruction, adjuvant treatment, recurrence and overall survival were assessed.Thirty patients were identified over the 10 year period. Eight (26.7 %) had their diagnosis upgraded to malignant phyllodes on completion excision, compared to initial biopsy. Nine (30 %) had breast surgery elsewhere as definitive treatment before referral to our service. Four of these (44.4 %) required more extensive excision and three developed metastases (33.3 %) and died. Twenty-one patients had primary surgery through our service and three (14.3 %) died from disease. Overall, 13 patients had radical mastectomy, 92.3 % with adequate margins (>1 cm histologically) and no local recurrence, 9 simple mastectomy 22.2 % with adequate margins and 1 local recurrence and 8 wide local excision with 37.5 % adequate margins and 1 local recurrence.For malignant phyllodes patients, the best chance to reduce recurrence and improve survival is adequate excision and radical mastectomy should be considered. For borderline lesions, consideration should be given for referral to a specialist centre and we recommend delayed reconstruction, because of the chance of histological upgrade to malignancy.Copyright © 2024 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.