肉芽肿性小叶性乳腺炎误诊为乳腺结核原因分析

Causes of Misdiagnosis of Granulomatous Lobular Mastitis as Breast Tuberculosis

目的探讨肉芽肿性小叶性乳腺炎(GLM)误诊为乳腺结核的原因,并总结防范误诊措施。方法回顾性分析2014年1月-2018年12月收治的误诊为乳腺结核的GLM 33例的临床资料。结果本组33例均为单侧乳腺发病,其中29例(87.9%)表现为乳腺肿块,18例(54.5%)出现疼痛,11例(33.3%)出现皮肤红肿,4例(12.1%)出现皮肤破溃流脓。33例行乳腺肿块细针穿刺细胞学检查误诊为乳腺结核。误诊时间1周~6个月。本组均行手术完全切除病灶,术后病理诊断为GLM。术后均行抗感染治疗1周左右,21例术后口服醋酸泼尼松1月余。所有患者均治愈出院,2例术后切口少量渗液、经换药治疗后愈合,预后良好,未复发。结论GLM与乳腺结核临床少见,二者临床特征有重叠,仅依赖临床、实验室、影像学及穿刺细胞学检查不易鉴别。对不能明确诊断者应行影像学引导下病灶内空心针多点穿刺活检或手术切除部分组织病理检查,以减少误诊误治。

Objective To investigate the causes of misdiagnosis of granulomatous lobular mastitis(GLM)as breast tuberculosis,and to summarize the preventive measures for misdiagnosis.Methods Clinical data of 33 GLM patients misdiagnosed as breast tuberculosis admitted from January 2014 to December 2018 were retrospectively analyzed.Results All the 33 patients in this group had unilateral breast disease,of whom 29 cases(87.9%)showed breast mass,18 cases(54.5%)showed pain,11 cases(33.3%)showed skin redness and swelling,and 4 cases(12.1%)showed skin ulcers and pus.All the 33 patients were misdiagnosed as breast tuberculosis by fine needle aspiration cytology,and the duration of misdiagnosis was from 1 week to 6 months.All patients in this group underwent complete resection of the lesion and were diagnosed as GLM by postoperative pathology.All the patients received anti-infection treatment for about 1 week after surgery,and 21 of them were treated with oral prednisone acetate for more than 1 month after surgery.All patients were cured and discharged from the hospital,and 2 of them had a small amount of wound exudation after surgery and were healed with dressing change.The prognosis was good and no recurrence was observed.Conclusion GLM and breast tuberculosis are rare in clinical settings,and their clinical features overlap.It is difficult to differentiate them only by clinical,laboratory and imaging examination and fine needle puncture cytopathology.If the diagnosis is not confirmed,multi-point core needle biopsy guided by imaging or surgical resection of part of the tissue should be performed for pathological examination to reduce misdiagnosis and mistreatment.