非结核分枝杆菌感染性乳腺炎临床病理学特征分析

Analysis of Clinicopathological Features of Non-tuberculous Mycobacterial Infectious Mastitis

目的探讨非结核分枝杆菌(nontuberculous mycobacteria,NTM)感染性乳腺炎的病理学特征,以期提高对这一罕见疾病临床病理学上的认识。方法回顾性分析13例NTM感染性乳腺炎的病理切片,并运用金胺O染色、抗酸染色及结核/非结核荧光定量PCR进一步明确诊断。结果特殊染色结果显示13例确诊患者中11例金胺O染色阳性(84.6%),3例抗酸染色阳性(23.1%)。荧光定量PCR检出7例非结核分枝杆菌(63.6%),所有病例均未检出结核分枝杆菌。结论非结核分枝杆菌感染性乳腺炎光镜下主要表现为以乳腺小叶为中心,多灶性分布的肉芽肿性病变,典型病变表现为弥漫性炎症背景中或脓肿边缘出现结节性病变,结节中或其周围可伴有少量巨细胞浸润。结合光镜特征、金胺O染色及PCR检测对于乳腺NTM感染的诊断具有重要价值。

Objective To summarize the pathological features of mastitis caused by nontuberculous mycobacteria(NTM)infection in order to improve the clinicopathological understanding of this rare disease.Methods The pathological sections of 13 cases of NTM mastitis were retrospectively analyzed,and the diagnosis was further confirmed by auramine O staining,acid-fast staining and tuberculosis/non-tuberculosis fluorescent quantitative PCR.Results Special staining showed that 11 of the 13 patients were positive for auramine O staining(84.6%)and 3 were positive for acid-fast staining(23.1%).No detectable Mycobacterium tuberculosis was detected by real-time PCR,and 7 cases was positive for NTM(63.6%),suggesting that real-time PCR would help to exclude tuberculosis infection.Conclusion Under light microscopy,NTM infectious mastitis mainly presents as granulomatous lesions centered on the breast lobules with a multifocal distribution.The typical lesions are nodular lesions in the background of diffuse inflammation or on the edge of abscess.There may be a small amount of giant cell infiltration around or in the nodular.Combined with light microscopy features,auramine O staining and PCR detection are of great value in the diagnosis of breast NTM infection.