肉芽肿性小叶性乳腺炎伴发乳腺导管扩张症的临床病理学观察

Granulomatous lobular mastitis associated with mammary duct ectasia： a clinicopathologic study of 32 cases with review of literature

目的分析肉芽肿性小叶性乳腺炎伴发乳腺导管扩张症的临床病理特征。方法收集2005年8月至2013年5月诊断的此类病例32例，对其临床和组织病理学资料进行回顾性分析。结果患者年龄26—45岁，2例未生育，其余有生育史，其中14例患侧乳腺未哺乳或哺乳障碍。大体检查乳腺肿块直径3～12cm，与周围组织界限不清，切面见小脓腔或小囊腔，直径0．1～0．5cm，腔内有灰白或淡黄色分泌物。镜下观察32例均有肉芽肿性小叶性乳腺炎表现，在此基础上均可见乳腺导管扩张症。11例曾行抗生素治疗无效，12例因切开引流致皮肤窦道形成。术后随访5～90个月，3例患侧复发，1例对侧发生肉芽肿性小叶性乳腺炎伴发乳腺导管扩张症，2例对侧发生肉芽肿性小叶性乳腺炎，4例失访。结论肉芽肿性小叶性乳腺炎可与乳腺导管扩张症伴发，准确诊断有助于针对性治疗和减少复发。

Objective To study the clinicopathologic features of granulomatous lobular mastitis and mammary duct ectasia. Methods The clinicopathologic data from August 2005 to May 2013 of 32 cases of granulomatous lobular mastitis and mammary duct ectasia were retrospectively reviewed. Results The age of patients ranged from 26 to 45 years. Two patients had no history of delivery. Fourteen patients had no history of lactation or lactational disorder in the lesional side. Most of the remaining patients had history of breast feeding. Gross examination showed that the lesions were poorly circumscribed and varied from 3 to 12 cm in greatest dimension. Tiny abscess cavities, ranging from 0. 1 to 0.5 cm in diameter and containing light yellowish to greyish secretion, were demonstrated. Histologie examination showed granuloma formation and ductal dilatation. Eleven patients had received antibiotic treatment. Twelve cases were complicated by sinus formation related to skin incision and drainage. The duration of follow-up ranged from 5 to 90 months. Three cases showed ipsilateral recurrence and 3 cases had similar pathology in the contralateral breast. Four patients defaulted follow-up. Conclusions Granulomatous lobular mastitis is associated with mammary duct ectasia. Accurate pathologic diagnosis is prudent for clinical management and control of local recurrence.