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中华乳腺病杂志(电子版) ›› 2013, Vol. 07 ›› Issue (03) : 168 -173. doi: 10.3877/cma. j. issn.1674-0807.2013.03.004

所属专题: 经典病例

论著

89 例肉芽肿性乳腺炎的临床病理学特征分析
闵三旭1, 郎荣刚2, 傅西林2, 付丽2,()   
  1. 1.734000 甘肃张掖,张掖医学高等专科学校附属医院外科
    2.300060 天津,天津医科大学附属天津肿瘤医院乳腺病理研究室
  • 收稿日期:2011-07-25 出版日期:2013-06-01
  • 通信作者: 付丽
  • 基金资助:
    国家自然科学基金重点项目(30930038)教育部长江学者创新团队发展计划资助项目(IRT0743)

Analysis on the clinicopathological characteristics of granulomatous mastitis in 89 cases

San-xu MIN1, Rong-gang LANG1, Xi-lin FU1, Li FU1,()   

  1. 1.Department of Surgery, Affiliated Hospital of Zhangye Medical College,Zhangye 734000, China
  • Received:2011-07-25 Published:2013-06-01
  • Corresponding author: Li FU
引用本文:

闵三旭, 郎荣刚, 傅西林, 付丽. 89 例肉芽肿性乳腺炎的临床病理学特征分析[J/OL]. 中华乳腺病杂志(电子版), 2013, 07(03): 168-173.

San-xu MIN, Rong-gang LANG, Xi-lin FU, Li FU. Analysis on the clinicopathological characteristics of granulomatous mastitis in 89 cases[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2013, 07(03): 168-173.

目的

研究肉芽肿性乳腺炎的临床病理学特点,探讨其诊治方法。

方法

回顾性分析天津医科大学附属肿瘤医院2003 年1 月至2011 年3 月期间收治的89 例肉芽肿性乳腺炎的临床病理学特征和随访资料。 所有病例标本经过抗酸染色及过碘酸雪夫氏(PAS)染色。

结果

患者均为女性,年龄为22 ~57 岁,平均年龄为(33.9±6.8)岁,其中85 例有哺乳史,均以乳腺肿块就诊。 组织病理特点为以乳腺小叶为中心的病变,呈结节状多灶性分布,小叶内可见以上皮样细胞、多核巨细胞、淋巴细胞及中性粒细胞为主的炎性细胞浸润,病变组织的切缘未见炎症细胞;所有病例抗酸染色和PAS 染色未见分枝杆菌及霉菌。 89 例患者均选择手术治疗,手术以乳腺小叶区段切除为主,并根据患者具体情况调整术式。术后随访1 ~102 个月,中位随访时间为74 个月,仅1 例复发。

结论

肉芽肿性乳腺炎的临床表现不易与乳腺癌鉴别,组织病理学检查是唯一确诊手段。

Objective

To investigate the clinicopathological characteristics of granulomatous lobular mastitis(GM)and explore the diagnosis and treatment.

Methods

The clinicopathological characteristics and the follow-up data in 89 cases of GM treated in Tianjin Medical University Cancer Institute & Hospital from January 2003 to March 2011 were retrospectively analyzed. All cases underwent the acid-fast staining and PAS staining.

Results

All patients were admitted for breast mass, female, aged from 22 to 57 years, mean (33.9±6.8) years,including 85 patients with history of breast feeding. Histopathology showed the lesions centered at lobules with nodular multifocal distribution, infiltration of inflammatory cells in breast lobules (most were epithelioid cells,multinucleated giant cells, lymphocytes and neutrophils), but no inflammatory cells in the margin of resected tissues. No mycobacterium and mycetes were observed in anti-acid staining and PAS staining. All 89 patients were treated by surgery, and most of them received mammary lobule resection, with a mild adjustment based on the patient’s condition. The patients were followed up for 1-102 months,median 74 months. The recurrence was reported in one patient.

Conclusion

The differential diagnosis between GM and breast cancer is difficult and only histopathological examination can confirm a definite diagnosis.

表1 肉芽肿性乳腺炎的临床分型及特征(例)
图1 肉芽肿性乳腺炎标本 肿块无包膜,切面灰红色间褐色,界限不清,呈颗粒状,可见脓性分泌物
图2 肉芽肿性乳腺炎的病理表现-A(HE ×40) 病变以小叶为中心,呈结节状多灶性分布
图3 肉芽肿性乳腺炎的病理表现-B(HE ×100) 病变小叶内可见淋巴细胞、多核巨细胞、上皮样细胞和中性粒细胞浸润
图4 肉芽肿性乳腺炎的病理表现-C(HE ×100)
图5 肉芽肿性乳腺炎标本抗酸染色结果(×40)
图6 肉芽肿性乳腺炎碘酸雪夫氏染色结果(PAS ×40)
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