肉芽肿性小叶性乳腺炎伴发乳腺导管扩张症及结节性红斑4例临床病理分析

Granulomatous lobular mastitis, mammary duct ectasia and erythema nodosum: a clinicopathologic study of 4 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及结节性红斑的临床病理特征.方法 收集4例此类病例,对其临床和组织病理学资料进行回顾性分析.结果 4例肉芽肿性小叶性乳腺炎伴发乳腺导管扩张症、结节性红斑患者年龄为25 ～ 39岁,均有生育史.大体检查乳腺肿块直径9～13 cm,与周围组织界限不清,切面见小脓腔或小囊腔,腔内有灰白或淡黄色分泌物.镜下4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;下肢皮肤呈结节性红斑改变.1例曾行抗生素治疗无效;2例激素治疗曾好转,停药后加重,1例抗结核治疗无效.术后随访6 ～35个月,均未复发.结论 肉芽肿性小叶性乳腺炎可与乳腺导管扩张症、结节性红斑伴发,准确诊断有助于临床针对性治疗和减少复发,对提高患者生活质量具有积极意义.

Objective To analyze the clinical and pathological features of granulomatous lobular mastiffs associated with mammary duct eetasia, erythema nodosum patients. Methods 4 cases of such diseases were collected, and the clinical and pathological data were retrospectively analyzed. Results In the 4 cases of granulomatous lobular mastiffs associated with mammary duct ectasia and erythema nodosum, patients aged 25 - 39, with a reproductive history. Gross examination showed that size of the breast tumor was 9 - 13 cm in diameter, and the boundaries with surrounding tissue was not clear. There were small abscess or follicular cavity on cut section, with the diameter of 0. 1 - 0. 5 cm, and a grey or light yellow secretion. Granulomatous lobular mastitis was noted under microscope, with mammary duct eetasia; lower limb skin presented with erythema nodosum change. 1 cases underwent antibiotic therapy without efficacy, hormone therapy was given in 2 cases and improved, but exacerbated after discontinuation. 1 cases was ineffective to anti-tuberculosis treatment. The patients were followed up for 5 - 26 months, and no recurrence was found . Conclusions The granulomatous lobular mastiffs may be associated with mammary duct ectasia and erythema nodosum. The accurate diagnosis is helpful to clinical targeted therapy, and reduces recurrence and improves the quality of life in those patients with positive significance.