Clinical and Histopathological Correlations of Phyllodes Tumors of the Breast

BACKGROUND: Phyllodes tumors are relatively rare fibroepithelial tumors of the breast. There are no strict criteria for the classification of benign and malignant phyllodes tumor. The recurrence rate is relatively high, and no single criterion for predicting recurrence has yet been established. In an attempt to define the clinical features and their histopathological correlations, we have reviewed a total of 38 patients with original pathological diagnoses of cystosarcoma phyllodes and phyllodes tumors. METHODS: Thirty-eight cases of phyllodes tumors were reviewed. Microscopic slides were re-examined and reclassified using newly defined histologic criteria which were modified from those of Pietruszka et al. The pathologic criteria examined were the number of mitoses, the invasiveness of the tumor border, the stromal overgrowth, and the stromal cellular pleomorphism. The clinical features evaluated included age, incidence, clinical manifestation, surgical procedure, and recurrence. RESULTS: The mean age was 34.9 +/- 12.4 years with the peak age between 40 and 49. The yearly incidence trend showed a slow increase. Twenty-three tumors (62%) fullfilled the criteria for benign phyllodes tumors, seven tumors (19%) were borderline, and seven tumors (19%) were malignant. The mean ages of the patients with benign, borderline, and malignant phyllodes tumors were 31.9, 39.1, and 40.9 years, respectively. The sizes of the benign phyllodes tumors were smaller than those of the borderline or the malignant tumors. Recurrence was found after initial excision in two patients with benign phyllodes tumors. However, after an initial wide excision, there was no recurrence in five patients with borderline and malignant tumors. CONCLUSIONS: There were no dependable histopathological features to predict recurrence; that is, histologic type does not influence the rate of recurrence or the prognosis after an adequate excision.

Clinical Outcome of Renal Transplants with Multiple Renal Artery / 대한이식학회지

Kidney transplantation is the treatment of choice for the vast majority of patients with end-stage renal disease. A total of 350 living donor renal transplantations were performed by renal transplantation team of Dongsan medical center, Keimyung University between November 1982 and October 1996. In order to evaluate the results of renal transplantation using multiple renal arteries, we reviewed our recipients about their post-transplant renal function, blood pressure, rejection episode and complications according to their arterial anastomosing types. The recipients were divided into 4 groups: Group 1- one donor renal artery anastomosed to one recipient renal artery(n=288), Group 2- two donor renal arteries anastomosed to recipient renal artery as a single lumen(n=38) (2a; smaller renal artery anastomosed to larger renal artery as end to side fashion(n=23), 2b; double barrel type anastomosis after wedge shape excision of each renal artery(n=15)), Group 3-more than one donor renal arteries anastomosed to multiple sites of recipient arteries(n=9), Group 4-small polar artery was ligated(n=15). The BUN, serum creatinine, systolic and diastolic pressure all showed no statistical differences between each group at 1, 6 months and 1, 3, 5 years after transplantation. But the incidence of acute tubular necrosis was frequent in Group 4 compare with Group 1 (14.3% vs 1.4%) and their onset time is delayed than Group 1 (18.5 months vs 8.2 months). Acute rejection episode in Group 4 was also higher than other groups (80.0% vs 34.5%, 24%, 11.1% in group 1, 2, 3). Post-transplant surgical complication including urological complications, however, seems not correlated with type or number of renal artery anastomosis. These results suggest that number of renal artery of donor and renal arterial anastomosis in recipient didn't affect the post-transplant renal function and their clinical courses only if arterial anastomosis be done meticulously, but polar artery ligation must be avoided to reduce the incidence of acute tubular necrosis and acute rejection episode.