肉芽肿性小叶性乳腺炎21例临床病理观察

Granulomatous lobular mastitis:A clinicopathologic analysis of 21 cases

目的:探讨肉芽肿性小叶性乳腺炎(granulomatous lobular mastitis,GLM)的临床病理学特征、诊断及鉴别诊断。方法:回顾性分析21例GLM,并复习相关文献。结果:21例患者均为女性,年龄24~49岁,中位年龄31岁,均以单侧乳腺肿块就诊,可伴疼痛、皮肤红肿、破溃等。大体上肿块无包膜,切面呈实性或囊实性,实性区灰白或灰黄色,质地较硬韧,囊性区呈腐烂状,内含灰黄灰褐色脓样分泌物。光镜下见以乳腺小叶为中心的肉芽肿性炎,伴有中性粒细胞为主的炎性细胞浸润及脂质吸收空泡形成,小叶结构通常存在。术后随访3~36个月,2例复发。结论:GLM是一种少见的特发性乳腺炎性疾病,有一定的临床病理学特征,临床及病理医师应予以重视,避免误诊、误治。

Objective:To explore the clinicopathologic features,diagnosis and differential diagnosis of granulomatous lobular mastitis(GLM).Methods:21 cases of GLM were analyzed retrospectively and related literature was reviewed.Results:All the 21 patients were female,aged 24~49 years,with a median age of 31 years.All patients visited the clinic with unilateral breast mass,which could be accompanied by pain,skin redness,swelling and ulceration.Grossly,the mass had no envelope,and the section was solid or cystic.The solid area was gray or grayish yellow,with a hard and tough texture.The cystic area was putrid and contains a gray-yellow-gray-brown purulent secretion.Microscopically,it was characterized by centrilobular granulomas inflammation,with neutrophils infiltration and lipid absorption vacuole.The lobular was still preserved usually.The patients were followed up for 3~36 months after operation.2 patients suffered from disease recurrence.Conclusion:GLM is a rare idiopathic breast inflammatory disease with certain clinicopathological characteristics.Clinicians and pathologists should pay attention to it to avoid misdiagnosis and mistreatment.