31例肉芽肿性小叶性乳腺炎的临床病理特征

Clinicopathological characteristics of 31 cases of granulomatous lobular mastitis

目的:探讨肉芽肿性小叶性乳腺炎(granulomatous lobular mastitis,GLM)的临床病理特征。方法:收集武汉市肺科医院2015年1月至2018年11月期间病理诊断为GLM的31例患者的病历资料,分析其临床、影像、实验室及病理特点。结果:31例患者均为女性,年龄18~48(中位31)岁,29例具有生育及哺乳史,发病部位为左侧乳腺15例,右侧16例。临床均表现为单侧乳腺肿块,可伴压痛、皮肤红肿、破溃、腋窝淋巴结肿大及乳头凹陷等。30例细针穿刺细胞学提出“可疑乳腺结核”诊断。乳腺超声显示以乳腺低回声不均质团块为主,MRI平扫示多数肿块不规则,在T1WI呈高信号,在T2WI呈高信号或稍高信号。31例患者均经手术后病理确诊,手术标本均未检测出结核分枝杆菌,仅1例检测出龟分枝杆菌龟亚种。大体上肿块无包膜,切面灰白灰黄、质韧,可见小脓腔及黄白色粟粒样病灶。镜下特点为多灶,以终末乳腺小叶导管为中心的化脓性肉芽肿,无干酪样坏死,其内可见脂质吸收空泡及微脓肿,小叶结构可破坏。结论:GLM是少见的乳腺慢性炎性疾病,有一定的临床、影像及病理特点,临床及病理医师应予以重视,减少误诊误治。

Objective: To investigate the clinicopathological characteristics of granulomatous lobular mastitis (GLM). Methods: The archives of 31 cases of GLM diagnosed by pathology from January 2015 to November 2018 in Wuhan Pulmonary Hospital were collected and the clinical, imaging, laboratory and pathological features were analyzed. Results: All the 31 patients were female, aged 18–48 years, with a median age of 31 years. Twentynine patients had a history of reproduction and lactation. The lesion location:15 cases in left breast and 16 case in right breast. All cases presented with unilateral breast mass clinically and may accompany by pain, skin swelling, ulceration, axillary lymph node enlargement and nipple depression. Fine needle aspiration cytology of 30 cases proposed suspicious breast tuberculosis. Hypoechoic heterogeneous masses were detected by breast gland ultrasound mainly. On MRI the masses were irregular with high signal on T1WI and high or slightly high signal on T2WI. All cases were confirmed by pathology after operation. No Mycobacterium tuberculosis was detected in surgical specimens, and only one case was detected Mycobacterium tortoise subspecies. Grossly, the mass had no envelope, with grey-white , grey-yellow section and tough texture and small pus cavity and yellow-white miliary lesions. Microscopically, it was characterized by multiple foci of suppurative granuloma centered on the terminal lobular duct of the breast without caseous necrosis, often with lipid absorption vacuoles and microabscesses, and lobular structure could be destroyed. Conclusion: GLM is a rare chronic inflammatory disease of the breast and has certain clinical, imaging and pathological characteristics. Clinicians and pathologists should pay attention to it to reduce misdiagnosis and mistreatment.