肉芽肿性小叶性乳腺炎12例临床病理分析

Granulomatous Lobular Mastitis:Clinicopathologic Presentation of 12 Cases

目的探讨肉芽肿性小叶性乳腺炎的临床病理特征、诊断及鉴别诊断。方法对诊断为肉芽肿性小叶性乳腺炎的12例病例临床及病理学特征进行分析并文献复习。结果大体检查乳腺肿块直径3~12 cm,与周围组织界限不清,其中4例切面可见小脓腔或小囊腔,直径0.5~2.5 cm,腔内有灰红坏死样物或淡黄色分泌物。镜下病变为小叶中心性肉芽肿及混合性炎性细胞浸润,小叶内可见最具特征性的大油囊,油囊外为或窄或宽的中性粒细胞聚集带,其外周区见多少不等的类上皮样细胞、多核巨细胞、淋巴细胞、浆细胞及中性粒细胞浸润。结论肉芽肿性小叶性乳腺炎有其独特的组织学特征,病理诊断是确诊肉芽肿性小叶性乳腺炎的重要方法,病理医师应对其镜下形态仔细鉴别。

Objective To investigate the clinicopathologic features,diagnosis and differential diagnosis of granulomatous lobular mastitis.Methods The clinicopathologic features of 12 cases of granulomatous bular mastitis were analysed.The relevant literature was reviewed.Results Gross examination showed that the lesions were poorly circumscribed and varied from 3 to 12 cm in diameter.Four cases had tiny abscess cavities,ranging from 0.5 to 2.5 cm in diameter and containing light yellowish to grayish secretion.Histopathology showed the lesions centered at lobules with nonnecrotizing granulomas and mixed inflammatory cell infiltration.Inside the lobule was the featured giant oil sac,whose outside was aggregated by narrow or wide neutrophils,peripherally infiltrated by varying number of epithelioid cells,multinucleated giant cells,lymphocytes and neutrophils.Conclusions Granulomatous lobular mastitis has distinctive histologic features.Pathological diagnosis is an important method for the diagnosis of granulomatous lobular mastitis.Pathologists should carefully identify its microscopic morphology.