141例肉芽肿性小叶性乳腺炎临床病理分析

Clinicopathological Analysis of 141 Cases of Granulomatous Lobular Mastitis

目的:探讨肉芽肿性小叶性乳腺炎(granulomatous lobular mastitis,GLM)临床病理学特点。方法:回顾性分析笔者所在医院2015年2月-2019年10月收治的141例乳腺炎患者的临床资料,经实施手术切除同时将炎性病灶使用穿刺检验,得出病理实验学诊断其均为肉芽肿性病症患者,常规石蜡切片,HE染色,其中对具有囊性中性粒细胞性肉芽肿的组织学形态特征病例102例行PAS、W-S、革兰染色、硼酸亚甲蓝染色。结果:所有病例为女性,年龄25~45岁,中位年龄32.5岁。发病部位:左侧乳腺74例,右侧乳腺63例,双侧乳腺4例,均有哺乳史。所有病例均有可触及的肿块伴疼痛,50例(35.5%)患者血清泌乳素升高。光镜下特点表现为化脓性围绕小叶周边发生的肉芽肿性炎症,其中可见脂质体囊泡为102例,可见空泡中存在些许中性粒细胞。102例组织化学染色中,在脂质囊泡内发现革兰染色43例患者有阳性染色杆菌,占比42.2%;硼酸亚甲染色39例患者有阳性染色杆菌,占比38.2%,PAS、W-S、抗酸染色均为阴性。结论:肉芽肿性小叶性乳腺炎有其独特的临床及病理学特点,囊性脂质空泡是其常见特征,棒状杆菌在病变发生及进展中可能起一定作用,PAS、W-S、革兰染色及硼酸亚甲蓝染色可为治疗GLM提供病理学依据。

Objective:To investigate the clinicopathological features of granulomatous lobular mastitis(GLM).Method:Clinical dates of 141 patients with mastitis admitted to our hospital from February 2015 to October 2019 were retrospectively analyzed.After surgical resection and puncture examination of inflammatory lesions,all patients were pathologically diagnosed as granulomatous diseases.Conventional paraffin section was performed and HE staining was performed.And 102 cases with cystic neutrophilic granuloma were stained with PAS,W-S,Gram and methylene borate blue.Result:All cases were female,aged 25-45 years,the median age was 32.5 years.Location site:74 cases of left breast,63 cases of right breast,4 cases of bilateral breast,all had a history of lactation.All cases had palpable masses with pain,and 50 patients(35.5%)had elevated serum prolactin.Under the light microscope,it was characterized by suppurative granulomatous inflammation around the peripheral lobules,in which 102 cases could be seen liposome vesicles,and some neutrophils could be seen in the vacuoles.Among 102 cases of histochemical staining,43 cases(42.2%)of the patients with Gram staining were found to have positive staining bacteria in lipid vesicles,39 patients with methylene borate staining showed positive staining,accounting for 38.2%,while PAS,W-S and acid-fast staining were negative.Conclusion:Granulomatous lobular mastitis has its unique clinical and pathological characteristics.Cystic lipid vacuoles are the common features.Corynebacterium may play a role in the pathogenesis and progression of the disease.PAS,W-S,Gram staining and methylene blue borate staining can provide pathological basis for the treatment of GLM.