肉芽肿性乳腺炎误诊为乳癌

目的 总结肉芽肿性乳腺炎误诊为乳癌的经验教训。方法 对误诊为乳癌的４例肉芽肿性乳腺炎的临床资料进行回顾性分析。结果 本组４例均为女性,年龄为４０～５８岁。均表现为质硬、表面不平、活动度差的乳腺肿块,３例有同侧腋窝淋巴结肿大,病程均在３个月以内。其中２例施行了全乳切除。结论 本病少见,易被误诊。作者认为,对于乳腺肿块,尽管酷似癌肿,也不要贸然行根治术,应想到肉芽肿性乳腺炎等良性疾病的可能,应于术前或     

特发性肉芽肿性乳腺炎的手术治疗：附8例报告

目的 探讨特发性肉芽肿性乳腺炎(IGM)的手术治疗方法.方法 回顾性分析近2年确诊的8例IGM的临床病理特点、诊治和预后情况.结果 87.5%的患者已生育和哺乳.100%患者有肿块,肿块内有程度不等的微小脓肿,乳晕旁受累达50.0%.全组术前仅凭临床和影像学检查有50.0%的患者被误诊为乳腺癌.8例均经手术治疗.随访4～25个月,行扩大切除术的6例患者痊愈,而仅行病灶切除术的2例复发,其中1例经泼尼松治疗有效,1例行再次扩大切除术治愈.结论 IGM的病因不清楚,组织病理学检查是确诊IGM的金标准,病灶扩大切除术是一种快速、安全而有效的治疗手段.     

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。     

难治性特发性肉芽肿性乳腺炎病例报告及文献综述

【摘要】〓目的〓介绍三例难治性特发性肉芽肿性乳腺炎(IGM)的诊治经过及治疗效果并文献综述。方法〓三例难治性IGM患者均为年轻生育后女性,均因乳房肿块伴红肿及局部破溃甚至窦道形成等弥漫病变就诊,脓液细菌培养阴性,其中2例患者应用“三联抗分支杆菌”药物联合甲泼尼龙片治疗,1例患者接受甲泼尼龙联合甲氨蝶呤治疗。结果〓三例患者均得到10个月随访,1例接受“三联抗分支杆菌”药物及甲泼尼龙的患者最终行肿块切除及乳头内陷矫正术后痊愈,其他2例患者均保守治疗后痊愈。结论〓“三联抗分支杆菌”或免疫抑制剂联合类固醇激素治疗难治性特发性肉芽肿性乳腺炎的效果良好,但前者用药证据较难获得。     

46例肉芽肿性乳腺炎的声像图分析

目的探讨肉芽肿性乳腺炎(GM)的声像图特征及临床意义。方法对46例经病理证实的GM的超声表现进行回顾性分析。结果超声表现为不均匀的低回声,39例边界不清,形态不规则,其中13例主要表现为多个管道回声延续,26例主要表现为成角和分叶。4例边界清楚,形态尚规则。4例呈现为囊性回声,内见细点状中强回声。余3例主要表现为弥漫性腺体回声紊乱。CDFI示大部分病灶可探及血流信号,但血流信号不十分丰富,3例病灶无血流信号。39例伴有腋下淋巴结肿大。结论 GM的主要超声表现为不均匀的低回声,内可有管道样回声,边缘成角或分叶,病灶内常可探及血流信号,具有一定的超声特征及临床意义。     

男性乳腺炎性肉芽肿二例

乳腺炎性肉芽肿是一种很少见的乳腺疾病,其中女性发病率相对较高,男性极其罕见。因为本病的临床表现酷似乳腺癌,故手术前常常被误诊。我院1995年3月至2001年5月共经手术诊断该病两例,现报道如下。     

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.     

31例肉芽肿性乳腺炎的临床诊治分析

目的探讨肉芽肿性乳腺炎的病因,临床特点,以及诊治方法 ,指导临床实践。方法收集我院2007年6月至2010年1月间住院治疗的31例肉芽肿性乳腺炎。分析其临床、病理特点,以及诊治经过。结果在该研究组中30例(97%)患者有生育史,且11例(35%)有积乳病史。85%(25/29)在产后6年内发病,中位发病间隔期为3年。79%(22/28)不伴有白细胞计数的升高。病理检查病灶为多灶性。93%(29/31)的病例通过I期或II期手术切除病灶得以治愈。结论使用抗生素联合皮质类固醇激素治疗可控制肉芽肿性胰腺炎的病情进展。病灶切除术是根治该病主要方法 。     

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。     

肉芽肿性小叶性乳腺炎诊治湖南专家共识（2021版）

肉芽肿性小叶性乳腺炎（GLM）是一种临床上较少见的乳腺慢性炎性疾病,近几年发病率有明显上升趋势。但由于其病因不明、临床医师对该病认识不足,从而导致目前对该病的误诊率较高,特别是治疗不规范、效果欠佳,且病情易反复发作致迁延不愈,俗称“炎症中的癌症”。为此,湖南省健康管理学会乳腺甲状腺健康管理专业委员会、湖南省医学会普通外科学专业委员会乳腺甲状腺外科学组、湖南省预防医学会乳腺疾病防治专业委员会、湖南省中医药和中西结合学会外科专业委员会、湖南乳甲外科联盟5个学术机构,联合省内从事该领域相关专家,就GLM诊治相关内容,多次在线上和线下进行充分研讨,力求不断完善,基本达成共识,共同制定《肉芽肿性小叶性乳腺炎诊治湖南专家共识（2021版）》。     

特发肉芽肿性乳腺炎24例的诊断与治疗

目的 探讨特发肉芽肿性乳腺炎的临床特点及处理方法.方法 总结2002年1月-2010年6月经穿刺病理证实及手术治疗的24例特发肉芽肿性乳腺炎的病例资料并对相关文献进行复习.结果 该研究组24例,患者平均年龄为34.5岁,不同时期表现为乳腺包块、脓肿、窦道形成.影像学检查很难将乳腺炎性介质反应和乳腺肿瘤鉴别.24例患者均行手术治疗随访6～96个月,平均随访(47.38±6.38)个月,复发3例(12.5％).结论 特发肉芽肿性乳腺炎多表现为可触及的乳腺肿块,影像学检查无特异性,最终需病理诊断,完整切除病变组织是其主要的治疗手段.     

The effect of methotrexate monotherapy on treatment-resistant idiopathic granulomatous mastitis patients

BackgroundIdiopathic granulomatous mastitis (IGM) is a disease of unknown etiology, involving a chronic inflammatory process, characterized by noncaseating granuloma formation. IGM can mimic a tumor clinically and radiologically. Since we are a tertiary referral center, most of our patients (n = 56, 87.5%) are secondary admissions who have previously had antibiotics and steroid treatments; therefore, we accept these patients as resistant cases. Here, we aim to present our single-center series of 64 patients with resistant IGM who underwent methotrexate monotherapy. To the best of our knowledge, our study includes the highest number of patients described in the literature with IGM who have undergone this treatment.MethodsThis study included 64 patients, 56 of which were resistant cases, diagnosed with IGM between January 2013 and January 2020 at Istanbul University Cerrahpasa, Cerrahpasa Medical Faculty, General Surgery Breast Outpatient Clinic that were followed-up at least once. These patients were administered oral methotrexate monotherapy 15 mg/week for 24 weeks, and in relapsed cases, the treatment was up to 20 mg/week for 1 year. Folic acid 10 mg/week was given as a supplement to all patients.ResultsComplete recovery was observed in 52 (81.25%) of the 64 patients. Follow-up was discontinued by 4 patients. The dose was increased and the duration of treatment was extended up to 1 year when relapse was observed in 8 patients and complete response was then obtained in these cases. Only 3 patients (4.69%) experienced side effects and were switched to subcutaneous treatment due to nausea.ConclusionConsidering the high patient compliance, low recurrence, minimal side effects, and overall success of the treatment, we believe that methotrexate monotherapy may be used in treatment-resistant IGM patients and may also be the first choice for first-line treatment in the future.     

Idiopathic granulomatous mastitis: A systematic review of 3060 patients

Idiopathic granulomatous mastitis is a rare benign breast disease. A systematic review was designed. Clinical and therapeutic characteristics were analyzed. Human Development Index (HDI) was used to define two groups of study: group A (very high and high HDI) and group B (medium and low HDI). Corticosteroid therapy was done in 69% group A and 78% group B. Surgery was done in 63% in group A and 83% in group B. Antibiotics were used in 68% group A and 88% group B. There is no consensus about optimal treatment for granulomatous mastitis.     

Imaging of granulomatous mastitis: assessment of three cases

Granulomatous mastitis is a benign, inflammatory breast disease of unknown aetiology, which can mimic breast carcinoma in its clinical manifestations. Imaging features of three cases of granulomatous mastitis mimicking breast carcinoma on both clinical and radiographic examination are presented, with special emphasis on the role of dynamic contrast-enhanced-magnetic resonance mammography in the differential diagnosis.     

Methotrexate in the management of idiopathic granulomatous mastitis: review of 108 published cases and report of four cases

This study aimed to discuss the role of agents, such as steroids and methotrexate (MTX), in the treatment of patients with idiopathic granulomatous mastitis (IGM). Using Pubmed and Google Scholar data bases, a retrospective study was carried out on IGM cases treated with steroids and/or MTX between 1972 and 2010. Four IGM cases treated with MTX at our clinic were also summarized in this study. A total of 541 IGM cases since 1972, including ours, were retrospectively analyzed. Steroid treatment 5-85 mg was administered over 5 days-22 months to 112 patients aged 21-48 years. Recurrence occurred in 22 patients, steroid-induced diabetes mellitus in 5 patients, no response to treatment was observed in 4 patients, in 2 patients, the mass decreased in size, and static disease was observed in one. The steroid treatment was changed to MTX treatment in 4 patients who had recurrence, 5 with steroid-induced DM and in 4 who were nonrespondents. Three patients were started on steroid together with MTX as a primary treatment. Of the patients treated with MTX, a satisfactory result was obtained in 14 cases and in 2, mastectomy was performed because of recurrence despite the treatment with MTX. IGM is a troublesome condition that presents management problems due to the side effects of steroids. Our study demonstrates that the use of MTX in IGM cases has been effective in preventing complications, in resolving the inflammatory process, and in limiting side effects of corticosteroids.     

Feasibility of surgical management in patients with granulomatous mastitis

Granulomatous mastitis (GM) is a rare inflammatory breast disease of unknown etiology. Although it usually presents with sinus formation and abscesses, it may mimic the clinical characteristics of breast cancer. The aim of this study was to identify the clinical, radiologic, and pathologic characteristics of patients with GM and to show the results of surgical treatment in these patients. A chart review was performed for patients that were treated with a diagnosis of GM at the Breast Unit, Department of Surgery, Istanbul Medical Faculty, University of Istanbul, between September 1998 and January 2003. Eighteen patients were eligible for this study. The median age was 41.5 years (range 16-80 years). Seventeen patients were evaluated by both ultrasonography and mammography; whereas one young patient only had ultrasonography. Three patients were further examined with color Doppler ultrasonography and magnetic resonance imaging (MRI). Fourteen patients (78%) presented with a mass as the chief symptom, with a median size of 3.9 cm (range 1-8 cm), whereas four patients presented with fistula in their breasts. None of the radiologic techniques distinguished benign disease from cancer in any of the 14 patients that presented with a mass except one patient with normal mammography findings. Ultrasonography was only helpful to localize the abscess associated with a fistula tract in one patient. Therefore fine-needle aspiration biopsy (FNAB) was performed in six patients, followed by surgical excisional biopsy. The remaining eight patients with a clinical suspicion of malignancy underwent wide surgical excision with frozen section analysis under general anesthesia. All of the FNAB and frozen section evaluations revealed benign findings. All of the 18 patients underwent a wide excisional biopsy and had a definitive histopathologic diagnosis of GM. The median follow-up was 36 months (range 6-60 months). Only one patient had a recurrent disease, which was diagnosed at 12 months. GM is a rare breast disease that mimics cancer in terms of clinical findings. Preoperative radiologic diagnosis might be difficult. Complete surgical excision is the treatment of choice.     

特发性腹膜后纤维化误诊一例并文献复习

目的提高对特发性腹膜后纤维化的认识,避免或减少对该病的误诊。方法报告我院1例特发性腹膜后纤维化的临床表现,辅助检查和治疗情况,并结合文献资料进行复习。结果人院后给以彩色多普勒超声、MR、ECT、血管造影等辅助检查明确诊断后,行左肾动脉放置支架和血液透析,同时联合免疫抑制治疗,近期临床治疗效果满意。结论IRPF临床表现缺乏特异性．影像学检查是明确诊断的重要举措。解除梗阻后继续给以免疫抑制治疗,对获得远期治疗效果有重要意义,但仍需要大宗资料进行临床论证。     

Radiologic features of granulomatous mastitis

Granulomatous mastitis (GM) is a recognized, but an uncommon cause of breast mass. Awareness of this condition is important, because it can clinically as well as radiologically mimic breast carcinoma. In this study, we present the imaging features of a series of 10 cases with proved diagnosis of granulomatous mastitis with emphasis on magnetic resonance (MR) findings. All those patients who were histologically proven to have GM of the breast were analyzed. Their files were reviewed and data recorded for demographic, clinical presentation and imaging appearances. The imaging features of the lesions by mammography, ultrasound, and magnetic resonance imaging were analyzed. Of the 305 patients who were surgically treated, 10 (3%) cases proved to have GM. All the patients were females with age ranging from 27 to 53 years (average 38 years and median age 36 years). Guided core biopsy was performed in all cases for confirmation of diagnosis followed by either excision biopsy (in five cases) or lumpectomy (in five cases). The final histopathologic results were chronic granulomatous inflammation consistent with tuberculosis in four cases and GM with acute inflammation, but unknown etiology in four cases and GM due to duct ectasia in two cases. GM, a rare breast condition, should be considered in the differential diagnosis of patients with a breast mass associated with inflammatory change. Routine breast imaging with US, MG, or MRI, the condition from malignant lesions and biopsy, still remains the only method of definite diagnosis.