副乳肉芽肿性乳腺炎误诊报告并诊治反思

Misdiagnosis of Accessory Breast Granulomatous Mastitis and Reflection of Diagnosis and Treatment

目的探讨副乳肉芽肿性乳腺炎的临床特点及误诊原因、防范措施。方法对误诊为其他疾病的副乳肉芽肿性乳腺炎2例的临床资料进行回顾性分析。结果本文2例均因左腋下或腋前肿物伴疼痛入院,皆曾就诊于外院,1例行乳腺彩色多普勒及穿刺活组织病理检查,考虑为副乳炎症性病变,1例行乳腺彩色多普勒超声检查后考虑乳腺炎,予抗感染等治疗均不理想,后转至我院就诊。入我院后经乳腺超声检查,结合临床经验,2例均考虑为副乳肉芽肿性乳腺炎,皆在术前使用药物促使炎症局限后,行手术治疗后痊愈,术后病理检查均证实为副乳肉芽肿性乳腺炎。术后随访1年,无复发。结论副乳肉芽肿性乳腺炎临床罕见,且缺乏特异性临床表现及检查措施,易误诊。临床及病理科医生应加强对其认识,临床接诊类似本文患者时应拓展诊疗思维,以减少或避免误诊误治。

Objective To explore the clinical characteristics, causes of misdiagnosis and preventive measures of accessory breast granulomatous mastitis. Methods The clinical data of 2 cases of accessory breast granulomatous mastitis misdiagnosed as other diseases were analyzed retrospectively. Results Two cases were admitted to hospital because of left or anterior axillary mass with pain. One case was diagnosed with accessory breast inflammatory disease by breast color doppler ultrasound(CDU) and puncture biopsy, and 1 case was diagnosed with mastitis after breast CDU in other hospitals. Anti-infection drug treatment was ineffective, therefore, they were transferred to our hospital. After admission, based on breast ultrasound examination and clinical experience, 2 cases were diagnosed as accessory breast granulomatous mastitis. Both of them were cured by surgical treatment after using drugs to promote the limitation of inflammation preoperatively. Postoperative pathological examination confirmed accessory breast granulomatous mastitis. One-year follow-up showed no recurrence. Conclusion Accessory breast granulomatous mastitis is rare in clinical settings and lacks specific clinical manifestations and examination measures, so it is more likely to be misdiagnosed. Clinicians and pathologists should strengthen their understanding of the disease, and expand their thinking of diagnosis and treatment when receiving patients similar to those in this study, so as to reduce or avoid misdiagnosis and mistreatment.