目的

探讨肉芽肿性乳腺炎(GM)的临床病理特征及类固醇激素联合手术综合治疗的效果。

方法

回顾性分析2011 年6 月至2012 年6 月本院收治的45 例GM 的临床病理学特征和治疗方法及效果。

结果

本组GM 的临床表现主要为乳腺肿块,空芯针穿刺病理检查均表现为以乳腺小叶为中心伴微小脓肿及多种炎细胞浸润的肉芽肿性炎症。 21 例(46.7%,21/45)伴脓肿形成者中,19 例(90.5%,19/21)脓液细菌培养为阴性。 本组患者均接受类固醇激素治疗,平均治疗1 周(0.5 ～2 周)后病变开始缩小,平均用药6.2 周(2 ～18 周)后肿块缩小至2 cm 以内,遂行病灶切除术。 术后中位随访5.2 个月(5 ～12 个月),3 例患者复发,复发率为6.7%(3/45),治愈率为93.3%(42/45)。

结论

肉芽肿性乳腺炎需经空芯针穿刺活检等病理学检查方法得到确诊,其诊治涉及多种学科。 类固醇激素联合手术治疗GM 是一种有效的方法,可避免乳房全切术,降低复发率。

Objective

To explore the clinicopathologic characteristics and the outcome of steroid hormones treatment combined with surgery for granulomatous mastitis.

Methods

We retrospectively analyzed the clinicopathologic characteristics and the treatment of 45 patients with granulomatous mastitis admitted in our hospital from June 2011 to June 2012.

Results

All patients had the clinical manifestation of breast mass. They underwent core needle biopsy, which indicated granulomatous inflammation centered at lobules of mammary gland, associated with small abscess and various inflammatory cells infiltration. In 21 patients with breast abscess(46.7%,21/45), bacterial culture of pus was negative in 19 patients (90.5%, 19/21). All patients were given steroid hormone therapy. Breast lesions began to shrink after treatment for a week on average (0.5-2 weeks)and decreased to the diameter of 2 cm after treatment for 6.2 weeks (2-18 weeks) on average. Then the lesion resection was performed. Median follow-up was 5.2 months (5-12 months). There were 3 cases of recurrence (6.7%,3/45). The cure rate was 93.3% (42/45).

Conclusions

Granulomatous mastitis should be diagnosed by pathologic examination such as core needle biopsy. Its diagnosis and treatment requires the cooperation of multiple departments. Steroid hormone treatment combined with surgery is effective for granulomatous mastitis and it can avoid total mastectomy and reduce recurrence.