肉芽肿性小叶性乳腺炎中医诊疗专家共识（2021 版）

肉芽肿性小叶性乳腺炎(GLM)是一种临床较为难治的慢性炎症性疾病,近年来发病率有逐年上升的趋势。中医治疗GLM具有一定优势,但目前并没有统一的治疗规范。中华中医药学会乳腺病分会专家组基于古今文献和临床实践共同讨论并制定了本共识。内容涉及GLM中医诊断、临床分期分型、病因病机、辨证论治方法,且提出了本病的临床诊断参考标准及疗效评价标准。本共识的制定对全面系统地认识GLM,规范中医内外治法在GLM中的运用,提高中医药防治GLM的临床、科研水平等方面具有一定的作用。     

肉芽肿性小叶性乳腺炎伴发结节性红斑的诊疗进展

肉芽肿性小叶性乳腺炎(granulomatous lobular mastitis, GLM)是一种病因和发病机制尚未阐明的乳腺良性疾病，好发于有生育哺乳史的育龄期女性，多表现为一侧乳房的疼痛性肿块。而结节性红斑的典型表现为双下肢红色触痛的皮下结节，它可作为GLM乳腺外症状出现于病人的病程中，这种伴发现象较为罕见。GLM伴发结节性红斑病人可能具有某些特殊的临床特征。本文对GLM伴发结节性红斑的病因、发病机制、临床表现、诊断和治疗方法等进行综述。     

精神病药物相关性肉芽肿性乳腺炎1例

肉芽肿性小叶性乳腺炎(granulomatous lobularmastitis,GLM)是临床一类较为罕见的乳腺慢性炎症疾病。1972年Kessler等[1]将其界定为一类独立的乳腺良性疾病,自此,掀起了GLM的研究热潮。该病通常发生于30~40岁的育龄妇女,多见于分娩后几年内[2]。目前在细菌感染及自身免疫疾病方面研究较多,但GLM与抗精神病药物相关性报道尚不多见。笔者报道了1例抗精神病药物所致的GLM患者,并回顾文献,系统阐述本病发病机制及治疗方案,为临床工作提供帮助。     

泼尼松在肉芽肿性小叶性乳腺炎中的应用

目的探讨肉芽肿性小叶性乳腺炎临床病理特征及泼尼松治疗的临床疗效。方法对14例肉芽肿性小叶性乳腺炎患者临床病理特征及预后进行回顾性分析。结果 85.7%的患者在产后1～4年发病,平均随访时间11.7个月,临床最常见的症状是乳腺肿块及疼痛,影像学表现为非特异性改变,泼尼松治疗2周后缓解率为92.9%,54.5%患者停药后获得治愈并最终免除手术,未观察到患者复发。结论肉芽肿性小叶性乳腺炎好发于育龄期经产妇女,泼尼松治疗可使大部分患者免除手术获得治愈。     

肉芽肿性乳腺炎的诊治分析

肉芽肿性乳腺炎(granulomatous mastitis,GM)是一种非干酪样坏死、局限于乳腺小叶、以肉芽肿为主要病理特征的慢性炎症性疾病,后期易破溃,形成窦道,呈地道式蔓延.该病较少见,目前尚缺乏充分认识,就其临床表现而论,许多方面与浆细胞性乳腺炎相似,故易与浆细胞性乳腺炎、乳腺结核、乳腺癌等相混淆.近年来该病发病率有上升趋势,自2005年1月至2010年6月云南省第一人民医院共诊治32例GM,结合文献对其诊疗予以分析.     

肉芽肿性乳腺炎7例治疗分析

肉芽肿性乳腺炎为自身免疫反应疾病．表现为非干酪性肉芽肿和局限于乳腺小叶的微小脓肿,临床较少见。本院自1995年至2006年间,共收治肉芽肿性乳腺炎7例．现将该组患者的诊断及治疗情况分析如下。     

肝胆管结石病综合诊疗湖南专家共识（2024版）

肝胆管结石病是我国中西部地区常见疾病,尤以湖南多见。该病诊治困难、严重影响人民健康。因病情复杂多变,治疗方法繁多、千差万别,疗效不佳,导致患者处在手术、术后结石残留或复发、再手术、结石再残留或再复发的恶性循环当中,最后因胆汁性肝硬化、胆管癌变失去生命。因此,规范肝胆管结石病的诊疗十分必要。湖南省医学会肝胆外科专业委员会、湖南省健康管理学会加速康复外科专业委员会、湖南省国际医学交流促进会肝胆外科专业委员会、湖南省肝胆胰外科联盟组织省内肝胆外科专家共同讨论,撰写肝胆管结石病综合诊疗湖南专家共识,旨在为肝胆管结石病的规范诊疗提供依据和指导。     

30例麦默通标本诊断肉芽肿性小叶性乳腺炎临床病理观察北大核心CSCD

肉芽肿性小叶性乳腺炎（granulomatous lobular mastitis,GLM）是一种乳腺少见慢性炎症性疾病[1].本文旨在研究麦默通真空辅助乳腺微创旋切术（mammotome）对于GLM的诊断及GLM的临床病理观察情况.临床资料1.一般资料：本组病例均为女性,平均年龄30.1岁（21～ 55岁）,已婚28例,2例未婚,其中已婚28例中3例患有高泌乳素血症,8例患者曾服用避孕药.22例有哺乳史,其中18例哺乳时间＞6个月.27例乳房有疼痛、肿胀.肿块直径0.5 ～8 cm（平均4.6 cm）,单个肿块10例,双乳肿块2例,多发肿块20例.     

超声征象对非肿块型乳腺癌与肉芽肿性小叶性乳腺炎的鉴别诊断价值

目的:研究超声征象在非肿块型乳腺癌(NMBC)与肉芽肿性小叶性乳腺炎(GLM)鉴别诊断中的价值。方法:回顾性分析2021 年1 月—2021 年12 月于北京中医药大学厦门医院胸外乳腺科就诊、经穿刺或术后病理证实的29 个NMBC 和37 个GLM 病灶的超声征象,包括生长方式、边缘情况、是否有微小钙化、周围组织情况、血流情况、腋窝淋巴结是否肿大等。结果:NMBC 和GLM 病灶的非平行、成角、毛刺、微小钙化、周围组织回声增强、窦道、腋窝淋巴结肿大、丰富血流、穿支血流及阻力指数大于0.7 的比例差异有统计学意义(P <0.05)。结论:超声征象可为NMBC 和GLM 的鉴别诊断及治疗提供有价值的信息。     

肉芽肿性小叶性乳腺炎的诊治(附89例临床分析)

目的:分析肉芽肿性小叶性乳腺炎的临床及病理特点,探讨其最佳诊治方法。方法:回顾性分析89例术后乳腺标本,经组织病理学证实的肉芽肿性小叶性乳腺炎临床和组织病理学资料。89例病人均为女性,平均年龄(33.9±6.8)(22～57)岁,85例有哺乳史,均以乳腺肿块就诊。其中单纯肿块34例,肿块伴疼痛43例,肿块伴乳头溢液5例,肿块伴疼痛、乳头溢液7例,均行手术治疗。结果:平均随访(64.0±3.8)(1～102)个月,复发1例。结论:肉芽肿性小叶性乳腺炎与乳腺癌在临床特征上有许多相似之处,易误诊,应在临床工作中高度重视。组织病理检查是唯一的确诊依据,手术是治疗本病的首选方法。     

Management of Patients with Granulomatous Mastitis: Analysis of 31 Cases

BACKGROUND: Granulomatous mastitis is a benign recurrent disease. Accurate diagnosis is only by histopathology. PATIENTS AND METHODS: 31 cases with histological diagnosis were retrospectively analyzed. RESULTS: Mean follow-up was 42.4 months for recurrent and 27.8 months for non-recurrent cases. Etiology was tuberculosis in 1 case. 5 cases (16%) relapsed. 6 patients (19.3%) treated with abscess drainage healed completely, but 50% relapsed. Relapses were treated with excision or steroids. Steroid therapy was the initial treatment in 12 cases (38.7%), with 1 relapse (8.3%) which was treated in the same manner. 2 patients had incomplete response necessitating excision, and another 2 developed abscesses which were treated with steroids or excision after drainage. Surgical excision was preferred in 12 cases (38.7%) due to suspicion for carcinoma in 8 patients (25.8%) and/or low probability of poor cosmetic outcome. All healed without complication, and recurrence was observed in 1 case (8.3%) which was treated with re-excision. CONCLUSION: Both excision and steroid therapy had low and similar relapse rates, but excision was superior to steroid therapy in providing strict diagnosis with much faster healing and fewer complications. In refractory cases, and when deformity is inevitable, steroid therapy should be preferred.     

Granulomatous mastitis: a 10 year experience from a large inner city county hospital

Background

Granulomatous mastitis (GM) is a rare, chronic, inflammatory condition of the breast with unknown etiology that affects women of child-bearing age. It can be mistaken radiographically and clinically for breast cancer and due to its rarity can cause a delay in establishing a definitive diagnosis and subsequent initiation of treatment. Furthermore, GM has a progressive clinical course with multiple recurrences. To date, there is no universally accepted treatment for GM. The goal of this study is to review the experience with granulomatous mastitis at a large inner-city public hospital over a 10-y period.

Methods

A retrospective review of a prospectively maintained institutional database was queried for all patients with a histopathologic diagnosis of GM between July 1, 2000 and July 1, 2010. A separate database was created for these patients, and data was collected from electronic medical records and paper charts. Demographic, clinical, and outcomes data were analyzed using summary statistics.

Results

A total of 41 cases were identified. The median age at time of diagnosis was 34 y. Thirty-three (80%) patients were of Hispanic ethnicity. The most common physical findings were mass (n = 32, 78%), tenderness (n = 17, 41%), and erythema (n = 12, 29%). Three (7%) patients had a previous history of treatment for tuberculosis whereas 12 (29%) patients were human immunodeficiency virus-positive. Mammography and ultrasonography noted mass (n = 14, 34% and n = 15, 37%, respectively) as the most common radiographic finding. Core needle biopsy and incisional biopsy were used with equal frequency (n = 16, 37%) to establish a definitive pathologic diagnosis. The median number of days between onset of symptoms and definitive diagnosis was 73. Thirteen (32%) patients received antibiotics as initial treatment, whereas 23 (56%) underwent surgical procedures and 1 (2%) received steroid therapy. Steroids were used at any point in the clinical course of 7 (17%) patients, and none of these patients required definitive surgical treatment.

Conclusions

GM affects women of childbearing age and typically presents as an inflamed breast mass with or without pain. The clinical features of GM among Hispanic patients are similar to those among other study populations in the reported literature. This disease is a diagnostic and therapeutic challenge and a high degree of clinical suspicion is warranted. Treatment with steroids may obviate the need for surgery in some patients. Reported recurrence rates for GM are high, and long-term follow-up is essential.     

UK national survey of management of breast lobular carcinoma in situ

Introduction

There is no national standard treatment for patients with breast lobular carcinoma in situ (LCIS). Association of Breast Surgery guidelines for the management of breast cancer suggest that lesions containing LCIS should be excised for definitive diagnosis and recommend close surveillance after excision biopsy. The aim of this study was to form a picture of the current management of LCIS by UK breast surgeons.

Methods

A questionnaire about the management of LCIS was sent to 490 UK breast surgeons.

Results

Of 490 questionnaires sent out, 173 (35%) were returned. When LCIS is present in a core biopsy, 61% of breast surgeons perform surgical excision, 22% would not excise but would continue follow-up and the remainder perform neither or set no clear management plan. Over half (54%) follow patients up with five years of annual mammography. If classic LCIS were found at the margins of wide local excision, 92% would not re-excise. Conversely, if pleomorphic LCIS were found, 71% would achieve clear margins. Respondents were split evenly regarding management of classic LCIS with a family history as 54% would not alter management whereas 43% would treat the disease more aggressively.

Conclusions

Our survey has shown that in cases where LCIS is found at core biopsy, most surgeons follow Association of Breast Surgery guidance, obtaining further histological samples to exclude pleomorphic LCIS, ductal carcinoma in situ or invasive cancer, whereas others opt for annual surveillance and some discharge the patient. This study highlighted the huge variability in LCIS management, and the need for randomised controlled trials and input into national audits such as the Sloane Project to establish evidence-based national standard guidelines.     

An Unusual Bilateral Mastitis in a Postmenopausal Woman Caused by Brucellosis

Breast involvement of brucella can be frequently detected in animals, however, it is extremely rare in humans: Clinical findings and complications may cause difficulties in diagnosis. We report the case of a 52-year old woman with bilateral brucella mastitis, which is difficult to differentiate from inflammatory breast carcinoma.     

When pathological and radiological correlation is achieved,excision of fibroadenoma with lobular neoplasia on core biopsy is not warranted

BackgroundThe diagnosis and management of lobular neoplasia (LN) including lobular carcinoma in situ (LCIS) and atypical lobular hyperplasia (ALH) remains controversial. Current management options after a core needle biopsy (CNB) with lobular neoplasia (LN) incorporating both ALH and LCIS include excision biopsy or careful clinical and radiologic follow up.MethodsA retrospective analysis of the surgical database at Cork University Hospital was performed to identify all core needle biopsies from January 1st 2010 to 31st December 2013 with a diagnosis of FA who subsequently underwent surgical excision biopsy. All cases with associated LN including ALH and classical LCIS were selected. We excluded cases with coexistent ductal carcinoma in situ (DCIS), invasive carcinoma, LN associated with necrosis, pleomorphic lobular carcinoma in situ (PLCIS) or lesions which would require excision in their own right (papilloma, radial scar, atypical ductal hyperplasia (ADH) or flat epithelial atypia (FEA)). Cases in which the radiologic targeted mass was discordant with a diagnosis of FA were also excluded.Results2878 consecutive CNB with a diagnosis of FA were identified. 25 cases had a diagnosis of concomitant ALH or classical LCIS. Our study cohort consisted of 21 women with a mean age 53 years (age range 41–70 years). The core biopsy diagnosis was of LCIS and FA in 16 cases and ALH and FA in 5 cases. On excision biopsy, a FA was confirmed in all 21 cases. In addition to the FA, residual LCIS was present in 14 cases with residual ALH in 2 cases. One of the twenty-one cases (4.8%) was upgraded to invasive ductal carcinoma on excision.     

Current treatment for lobular carcinoma in situ

Background: We thought that observation for patients with lobular carcinoma in situ (LCIS) had been generally accepted by the mid-1980s. A questionnaire mailed to oncologic surgeons in 1988 revealed that 33% of the respondents still advised unilateral mastectomy, although a slim majority (54%) advised observation. New studies have been published in the intervening 8 years, and we decided it would be worth recirculating the 1988 questionnaire. Methods: The identical questionnaire was mailed to members of the same oncologic societies (Society of Surgical Oncology [SSO] and Society for the Study of Breast Disease), but changes in membership necessitated new mailing lists. Results: Observation has yet to be universally accepted by the oncologic community, but at this time 85% of the respondents suggest it as the preferred option for their patients. Conclusions: Recent studies have questioned some of the tenets laid down by Haagensen in 1978, but it appears clear that his formulation of LCIS as a marker of increased risk continues to gain ground over the original concept of inevitable progression to invasive disease.     

肉芽肿样间质肾炎患者的临床特点及预后分析

目的肾间质呈肉芽肿样改变是少见的病理表现,既往报道的病因多为结节病、药物、感染、结核导致的肾间质肉芽肿样改变。本研究拟了解肾间质呈肉芽肿样改变的病因、临床特点及预后。方法回顾性分析四川省人民医院肾内科2006年7月至2013年6月共2330例肾活检患者资料,其中肾活检组织肾小球数目大于10个的患者纳入分析。免疫组织化学染色方法标记CD3T淋巴细胞、CD20B淋巴细胞、CD68单核巨噬细胞在肾间质的表达。结果表现为肉芽肿样间质肾炎的8例患者占肾活检的0．34％（8／2330）,其中男女各半,发病年龄26~51岁。病因包括系统性红斑狼疮（systemic lupus erythematosus,SLE）、狼疮肾炎（1upus nephritis,LN）、IgA肾病（IgA nephropathy,IgAN）、抗中性粒细胞胞浆抗体（anti-neutrophil cytoplasmic antibody,ANCA）相关性血管炎和结核性肉芽肿、原发性肾病综合征。8例患者均表现为蛋白尿、血尿。24h尿蛋白定量0．153～6．90g／24h;其中有5例患者合并高血压。4例患者合并肾衰竭。间质浸润的炎症细胞以CD3T淋巴细胞为主。随访时间6～64个月,2例SLE合并LN患者死亡,1例患者死亡原因为肺出血,另1例为肺部感染。1例ANCA相关性血管炎进入终末期肾脏疾病。结论肾间质呈肉芽肿样改变是罕见的病理表现。本中心资料显示最常见病因可能是免疫相关疾病,其临床症状重,合并症多,预后极差。     

Granulomatous Peritonitis After Laparoscopic Cholecystectomy

Background:

Granulomatous peritonitis may indicate a number of infectious, malignant, and idiopathic inflammatory conditions. It is a very rare postoperative complication, which is thought to reflect a delayed cell-mediated response to cornstarch from surgical glove powder in susceptible individuals. This mechanism, however, is much more likely to occur with open abdominal surgery when compared with the laparoscopic technique.

Methods:

We report a case of sterile granulomatous peritonitis in an 80-y-old female after a laparoscopic cholecystectomy. Management was conservative, and no relapse was observed after over 1-y of follow-up.

Discussion:

We propose that peritoneal exposure to bile acids during the laparoscopic removal of the gallbladder was the trigger of granulomatous peritonitis in this patient. Severe complications, such as peritoneal adhesions, intestinal obstruction, and fistula formation, were observed, but no fatalities were reported.

Conclusion:

We should be aware of this rare cause of peritonitis in the surgical setting.     

Optimal surgical treatment of invasive lobular carcinoma of the breast

Background: The roles of breast conservation and surgical evaluation of the contralateral breast in the treatment of lobular carcinoma of the breast remain unclear. The aim of this study was to compare local recurrence, 5-year survival, and incidence of contralateral breast cancer in women with lobular carcinoma to that in women with infiltrating ductal carcinoma. Methods: Women with infiltrating ductal carcinoma (IDC) and invasive lobular breast carcinoma (ILC) diagnosed during the years 1984 to 1994 were identified through a statewide tumor registry. The women were divided into groups based on their histology and treatment (breast conservation or modified radical mastectomy). The incidences of contralateral breast cancer, local recurrence, and 5-year survival were compared within each histologic group and treatment category. Results: During the period 1984 to 1994, 4886 women were diagnosed with invasive lobular or ductal breast carcinoma. Of these, 316 (6.5%) had infiltrating lobular cancer. The 5-year survival rates were 68% and 71% for ILC and IDC, respectively (p=0.5). The local recurrence rates were 2.8% and 4.3% for ILC treated with lumpectomy and axillary nodal dissection (LAND) and modified radical mastectomy (MRM), respectively, which were not significantly different from that obtained with IDC (LAND=2.5%, MRM=2.1%). The incidence of contralateral breast cancer during the period was 6.6% and 6.5% for ILC and IDC, respectively. Conclusions: Invasive lobular carcinoma can be safely treated with breast conservation with no difference in local recurrence or survival. In the absence of a suspicious finding on clinical or radiologic examination, routine contralateral breast intervention is not recommended.Presented at the 50th Annual Cancer Symposium of The Society of Surgical Oncology, Chicago, Illinois, March 20–23, 1997.     

非特异性肉芽肿性前列腺炎(附26例报告)

目的　探讨非特异性肉芽肿性前列腺炎的临床特点。　方法　回顾分析 2 6例经病理证实的非特异性肉芽肿性前列腺炎患者的临床资料 ,其中单纯抗炎治疗 2 0例 ,口服氧氟沙星 2 0 0mg/次 ,2次 /d ,疗程 4～ 6周 ;加用α 受体阻滞剂治疗 4例 ,选用盐酸坦索罗辛 (哈乐 ) 0 .2mg或盐酸特拉唑嗪 (马沙尼 ) 2mg/d。 2例伴尿潴留者行TURP治疗。　结果　 2 6例随访 6～ 4 2个月 ,排尿症状改善 ,最大尿流率 (Qmax)由 4 .6～ 12 .8ml/s提高为 16～ 2 8ml/s ,直肠指检前列腺硬结由 2 .5cm×3.5cm缩小为 0 .5cm× 1.0cm ,质地变软 ,血前列腺特异性抗原 (PSA)由 15 .5～ 6 0 .8ng/ml降至 1.5～ 10 .6ng/ml。　结论　非特异性肉芽肿性前列腺炎极易与前列腺癌混淆 ,应引起重视。确诊依靠病理检查。