基于病理学特征探讨肉芽肿小叶性乳腺炎诊断及手术术式

Diagnosis and surgical procedure of granulomatous lobular mastitis based on pathological characteristics

目的:以HE染色及免疫组织化学为途径探讨肉芽肿性小叶性乳腺炎的临床病理特征,并为手术术式选择提供合理依据。方法:对北京中医药大学东直门医院病理诊断为肉芽肿性小叶性乳腺炎患者的病灶及阴性切缘行HE染色及天冬氨酸蛋白水解酶-1(caspase-1)/消皮素-D(gasdermin D,GSDMD)/雌激素受体(estrogen receptor,ER)/孕激素受体(progesterone receptor,PR)免疫组织化学染色,并分析患者的临床资料。结果:40例经乳腺导管探查+乳房再造+乳头乳晕成形术患者均治愈,至2020年11月无同侧复发;6例免疫组织化学可见阴性切缘组织的caspase-1、GSDMD、PR表达均低于病灶组,组间对比差异有统计学意义(P<0.05)。结论:肉芽肿小叶性乳腺炎的组织病理学独特,其诊断仍旧依靠病理诊断,经免疫组织化学分析乳腺终末导管外组织病变可能为乳腺导管诱发的继发改变,故肉芽肿小叶性乳腺炎根治手术的术式应包含针对乳腺小叶导管的探查,以避免疾病的反复发作。

Objective: To investigate the clinicopathological features of granulomatous lobular mastitis by HE staining and immunohistochemistry, and to provide a rational basis for the selection of surgical procedure. Methods: HE staining and immunohistochemical staining for caspase-1/gasdermin D(GSDMD)/estrogen receptor(ER)/progesterone receptor(PR) were performed on the lesions and negative cut edges of patients with pathological diagnosis of granulomatous lobular mastitis in Dongzhimen Hospital of Beijing University of Chinese Medicine, and patient cases were analyzed. Results: Forty patients treated with breast duct exploration, breast reconstruction and nipple areola plasty were cured and no same side recurrence by November 2020. Six immunohistochemistriy showed that the expression of caspase-1, GSDMD, and PR in the negative surgical margins were lower than what in the lesion group, and the difference was statistically significant(P<0.05). Conclusion: The histopathology of granulomatous lobular mastitis is unique, and its diagnosis still relies on pathology, and the immunohistochemical analysis of extra-ductal tissue lesions in the terminal mammary gland may be secondary changes induced by breast ducts, so the radical surgery of granulomatous lobular mastitis should include exploration of the lobular ducts to avoid recurrent disease episodes.