脂膜炎乳腺受累七例报道及文献复习

Breast involvement in panniculitis： report of 7 cases with literature review

目的分析脂膜炎乳腺受累患者的临床特点，扩展对脂膜炎器官受累的认识。方法收集我院2012年1月1日至2017年7月1日收治的确诊为脂膜炎并伴有乳腺受累患者的相关资料，包括性别、年龄、临床表现、实验室检查、影像学检查及治疗方案等信息。结果共收集脂膜炎乳腺受累患者7例，均为女性，年龄28～45岁，平均（35±6）岁。临床表现：低热（4／7）、关节痛（4／7）、四肢皮下结节（7，7）、乳腺结节（7，7），皮下结节和乳腺结节均伴有疼痛（7／7）。6例患者乳腺结节发生时问早于四肢皮下结节1～4个月，1例患者乳腺结节发生时间晚于四肢皮下结节11年。实验室检查：7例患者ESR及CRP均升高，2例患者白细胞升高。影像学检查：1例患者行乳腺增强MRI可见T1相低信号，增强后呈环状强化，时间一信号强度曲线呈渐升型。病理活检：7例患者行下肢皮下结节活检，均符合脂膜炎病理特点。3例患者行乳腺结节活检，可见脂肪组织炎症、脂肪消失，中性粒细胞、淋巴细胞、组织细胞等浸润以及肉芽肿的形成。治疗：抗生素治疗无效，糖皮质激素及免疫抑制剂治疗后体温下降、结节缩小或消失、炎性指标下降。结论脂膜炎可累及乳腺，多发生于中青年女性，主要表现为乳腺痛性结节，多先于肢体皮下结节出现，乳腺增强MRI和乳腺结节病理对乳腺脂膜炎的诊断和鉴别诊断具有重要意义。对于以乳腺结节为首发症状、抗生素治疗无效的患者需警惕乳腺脂膜炎可能，及时行病理活检，以减少误诊漏诊。

Objective To analyze the clinical characteristics of patients with panniculitis who had breast involvement and to expand the understanding of the organ involvement of panniculitis. Methods The data of panniculitis patients with breast involvement were collected from our hospital during 2012.1.1 to 2017.7.1, including sex, age, clinical manifestations, laboratory tests, imaging examinations and treatments. Results A total of 7 panniculitis patients were included who had breast involvement. All patients were female, aged 28 to 45 years [mean, （35±6） years]. Clinical manifestations included hypothermia （4/7）, arthralgia （4/7）, limb subcutaneous nodules （7/7） and breast nodules （7/7）. Breast nodules occurred 1 to 4 months earlier than the limbs subcutaneous nodules in 6 cases and 11 years later than the limbs subcutaneous in 1 case. For laboratory tests： all patients had increased of erythroeyte sedimentation rate （ESR） and C-reactive protein （CRP） （7/7） while only 2 patients had elevation of white blood cell count （2/6）. One patient had breast enhanced mag- netic resonance imaging （MRI） scanning. Seven patients underwent biopsy of limb subcutaneous nodules. The pathological findings were all consistent with the pathological characteristics of pannieulitis. Three cases had breast nodules biopsy, which showed inflammation and decrease of fat tissue, several kinds of cells infiltration and granuloma formation. Treatment with antibiotic failed while glucoeorticoid and immunosuppressive agents treatment was effective. Conclusion Pancreatitis can have breast involvement, mostly in young women, with breast painful nodules in most patients early than limb subcutaneous nodules. Breast enhancement MRI scanning and nodules biopsy have important value in the diagnosis of breast panniculitis. For patients with breast nodules as the first symptom and fail to response to antibiotic treatment, clinicians need to be alert to breast panniculitis and perform pathological biopsy to reduce the chance of misdiagnosis.