乳房部位硬斑病12例临床及组织病理特征分析

Analysis of Clinical and Histopathological Features of 12 Cases of Morphea of the Breast

目的探讨累及乳房部位硬斑病患者的临床及组织病理学特征,为临床诊治提供参考。方法回顾性分析2011年10月-2021年10月于本科确诊的12例乳房部位硬斑病患者的病历资料,总结分析患者的临床、病理特征及其诊断和治疗情况。结果12例患者中,女11例,男1例,中位年龄为35.5(22,47.3)岁,中位病程为12(4.5,33)个月。临床表现为乳房部位暗红色、黄白色或褐色萎缩性或硬化性斑片,部分皮损表面有蜡样光泽。皮损累及右乳8例(66.67%)、左乳3例(25.00%),1例为累及双侧乳房;皮损位于乳房外上象限3例,外下象限3例,内上象限3例,内下象限1例,其余2例广泛累及全乳;12例患者中乳晕受累者共4例(33.33%)。皮损组织病理示:水肿期主要表现为真皮胶原增生伴明显炎症浸润;硬化期及萎缩期则以真皮胶原增生均质化为突出表现,皮肤附属器减少或消失,血管周围炎症浸润较轻。患者早期多无明显自觉症状。结论乳房部位的硬斑病早期不易察觉,容易误诊或漏诊,提示乳房部位出现无症状性局限性皮肤颜色改变应警惕乳房硬斑病。

Objective To investigate the clinical and histopathological features of morphea of the breast,so as to provide reference for clinical diagnosis and treatment.Methods The medical records of 12 patients with morphea of the breast diagnosed in our department from October 2011 to October 2021 were analyzed retrospectively,and the clinical and pathological features,diagnosis and treatment of the patients were summarized.Results Among the 12 patients,there were 11 females and 1 male,with a median age of 35.5(22,47.3)years and a median course of 12(4.5,33)months.The clinical manifestations were red,yellow-white or brown atrophic or sclerosing patches on the breast,with waxy luster on the surface of some lesions.The lesions involved right breast in 8 cases(66.67%),left breast in 3 cases(25.00%),bilateral breast in 1 case;outer upper quadrant in 3 cases,outer lower quadrant in 3 cases,inner upper quadrant in 3 cases,inner lower quadrant in 1 case,and whole breast that was widely involved in the other 2 cases.Of the 12 patients,areola was involved in 4 cases(33.33%).Histopathology showed that the main manifestations during edema stage were dermal collagen hyperplasia with obvious inflammatory infiltration,while in sclerotic and atrophic stage,dermal collagen hyperplasia and homogenization were prominent,skin appendages decreased or disappeared,and inflammatory infiltration around blood vessels was mild.Most of the patients had no obvious symptoms in the early stage.Conclusion Morphea of the breast is less likely to be detected in the early stage,and it is more likely to be misdiagnosed or missed,suggesting that the asymptomatic localized skin color change of the breast should be on guard against morphea of the breast.