乳腺脂肪坏死的超声表现及病理对照分析

Ultrasonographic manifestations and pathologic study of fat necrosis of the breast

目的:探讨乳腺脂肪坏死的超声表现及病理基础。方法:回顾性分析经病理证实的33例(其中4例为双侧乳腺脂肪坏死,共37个病变)乳腺脂肪坏死超声表现,并与病理结果对照。结果:主要超声表现:等回声病灶5个(13.5%),低回声病灶16个(43.2%),无回声病灶10个(27.0%),囊实混合回声病灶6个(16.2%)。所有病灶均无血流信号,部分病灶可伴钙化,边界不清,低、无回声病灶后方回声可增强或衰减。病灶位于皮下组织层内7个,腺体内30个。病理表现:①脂肪细胞坏死液化,融合成大的脂肪空泡,周边可见上皮样细胞及泡沫细胞聚集,外围有薄层肉芽组织,伴有大量淋巴细胞和部分浆细胞浸润;②囊壁不同程度增厚,纤维化和玻璃样变,可出现钙盐沉积;③病灶已部分或全部被纤维组织取代,周围残留部分纤维组织形成小腔或瘢痕。通常不同病理形式的超声表现常同时出现。结论:超声检查对诊断乳腺脂肪坏死具有重要价值。

Objective： To discuss mammographic findings and pathologic basis of fat necrosis of the breast. Methods： The uhrasonographic findings in 33 cases with pathologically proved breast fat necrosis were analyzed retrospectively, of which 4 cases were bilateral breast fat necrosis, and a comparison with pathological results was made. Results： The sonographic find- ings included： isoechoic masses（n=5, 13.5%）, hypoechoic masses（n=16, 43.2%）, anechoic nodules（n=10, 27.0%）, complex with mural nodules（n=6, 16.2%）. Doppler sonography did not show vascularity in all lesions, some demonstrated sonographic illdefined margins and calcification. Posterior acoustic shadowing and posterior acoustic enhancement could also be found in hypoechoic masses and anechoic nodules. Seven lesions lying in subcutaneous fatty tissues of breast, and 30 lesions located in the breast parenchyma. The pathologic interpretations： ①There is local adipose cell destruction and the development of vacuoles filled with necrotic lipid material, which surrounded by phagocytic lipid-laden histiocytes（＂foam cells＂）, with an accumulation of muhinucleared giant cells at the edges of the lesion and accompanied by an inflammatory cell infiltrate; ②Fibroblasts proliferate at the periphery of the lesion, surrounding areas of necrotic fat and cellular debris, calcifications may appear, ③ Fibrosis may replace the areas of necrotic fat and debris or leave persistent cavities. Loculated and degenerated fat may persist within a fibrotic scar. These histopathologic appearances also can occur simultaneously with various degrees of intensity. The imaging features of fat necrosis of the breast reflect the intensity of each of these histological events at the time of the imaging study. Conclusion： Sonography is very helpful for making the diagnosis of breast fat necrosis.