特发性肉芽肿性乳腺炎的诊断与治疗(附33例报道)

目的总结特发性肉芽肿性乳腺炎的临床特点、诊断及治疗经验。方法回顾性分析苏州大学附属第一医院和南通大学附属吴江医院2005年1月至2014年12月期间收治的33例特发性肉芽肿性乳腺炎的病例资料。结果患者平均年龄33岁,病理检查28例(85%)为典型肉芽肿,5例(15%)为不成熟肉芽肿,均在排除其他病因后确诊。药物治疗29例,其中单纯口服泼尼松治愈21例,泼尼松联合甲氨蝶呤治愈6例,2例无效,停药后有13例复发。手术治疗有脓肿破溃者4例,术后有2例复发。15例复发患者均口服泼尼松加甲氨蝶呤,除1例因肝功能损害而停药及1例不完全缓解外,其余13例再次治愈。结论特发性肉芽肿性乳腺炎的临床表现无特异性,确诊主要依赖于病理检查,该病早期给予糖皮质激素或联合免疫抑制剂治疗效果良好,一旦破溃或迁延不愈需尽早考虑手术治疗。     

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。     

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。     

囊性中性粒细胞性肉芽肿性乳腺炎的临床病理特征分析北大核心CSCD

目的探讨囊性中性粒细胞性肉芽肿性乳腺炎的病因及临床病理特征。方法回顾性分析2019年1月1日至2020年12月31日重庆市中医院和重庆市梁平区中医院经穿刺组织病理诊断为囊性中性粒细胞性肉芽肿性乳腺炎95例患者的临床病理资料。结果本组95例女性患者中位发病年龄为32(21~50)岁。24例血清泌乳素升高,53例血清类风湿抗体谱一项或多项指标升高,26例血清甲状腺抗体一项或两项指标升高,14例血清抗中性粒细胞抗体谱一项或多项指标升高,33例红细胞沉降率升高,36例血清C反应蛋白升高。革兰染色显示杆菌阳性有78例。组织学形态:以乳腺小叶为中心的化脓性肉芽肿,肉芽肿中心为囊性空泡。免疫组织化学检查显示肉芽肿内及周围的炎症细胞主要以CD3+的T细胞为主,CD4+的T细胞数量多于CD8+的T细胞。结论囊性中性粒细胞性肉芽肿性乳腺炎属于特发性肉芽肿性乳腺炎的少见类型,诊断依赖于其特殊的病理表现。     

肉芽肿性乳腺炎的诊断与处理原则

肉芽肿性乳腺炎不常见,但文献报告近年有增加趋势。临床特征为育龄经产妇突发乳腺肿块,脓肿形成,继发窦道和溃疡,可反复发作或经久不愈。棒状杆菌感染可使病程变得复杂。经皮活检是主要的确诊方法,病理特征为以小叶为中心组织细胞的上皮样和多核巨细胞浸润的非干酪样肉芽肿伴微脓肿,但须做排除性诊断。根据不同临床表现、细菌学检查和病理学检查进行分类,随后可行手术、激素治疗后手术和抗分枝杆菌治疗以及免疫抑制剂治疗等分类处理。     

囊性中性粒细胞性肉芽肿性乳腺炎的临床病理特征分析

目的探讨囊性中性粒细胞性肉芽肿性乳腺炎的病因及临床病理特征。方法回顾性分析2019年1月1日至2020年12月31日重庆市中医院和重庆市梁平区中医院经穿刺组织病理诊断为囊性中性粒细胞性肉芽肿性乳腺炎95例患者的临床病理资料。结果本组95例女性患者中位发病年龄为32(21～50)岁。24例血清泌乳素升高, 53例血清类风湿抗体谱一项或多项指标升高, 26例血清甲状腺抗体一项或两项指标升高, 14例血清抗中性粒细胞抗体谱一项或多项指标升高, 33例红细胞沉降率升高, 36例血清C反应蛋白升高。革兰染色显示杆菌阳性有78例。组织学形态:以乳腺小叶为中心的化脓性肉芽肿, 肉芽肿中心为囊性空泡。免疫组织化学检查显示肉芽肿内及周围的炎症细胞主要以CD3+的T细胞为主, CD4+的T细胞数量多于CD8+的T细胞。结论囊性中性粒细胞性肉芽肿性乳腺炎属于特发性肉芽肿性乳腺炎的少见类型, 诊断依赖于其特殊的病理表现。     

雕刻式切除术治疗肉芽肿性小叶性乳腺炎54例

目的:探讨"雕刻式切除术"治疗肉芽肿性小叶性乳腺炎的疗效。方法:回顾性分析110例肉芽肿性小叶性乳腺炎患者的临床资料,其中54例接受"雕刻式切除术"为A组,56例接受传统扩大清创术为B组,观察两组痊愈率、复发率、治疗前后症状体征积分、伤口愈合时间、痊愈后乳腺外形等指标。结果:手术后1个月,A组症状体征积分为(1.7±3.3)分,低于B组(2.9±2.9)分(P0.05);伤口愈合时间两组无统计学差异(P0.05);术后随访6个月,A组痊愈率96%,高于B组(66%,P0.05),A组复发率4%,低于B组(34%,P0.05);乳房外形美学评分总体优于B组(P0.05)。结论:"雕刻式切除术"治疗肉芽肿性小叶性乳腺炎,可有效降低复发率,改善术后症状体征积分,且能维持乳房的良好外形。     

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 。     

外科手术治疗肉芽肿性小叶乳腺炎患者的临床观察

［摘要］ 目的 探讨乳房整形术在肉芽肿性小叶乳腺炎治疗的可行性及其美容效果。方法 收集2013年1月至2017年12月汕头大学医学院附属粤北人民医院接受传统手术及整形保乳技术手术的肉芽肿性小叶乳腺炎患者，比较两组复发率及术后乳房美容效果。结果 复发率在两组间比较，差异均无统计学意义（P>0.05）。整形保乳的术后乳房美容效果优于传统手术组，差异有统计学意义（P< 0.05）。结论 整形保乳术治疗肉芽肿性小叶乳腺炎患者具有安全、有效、术后美容效果好等优点。     

外科手术治疗肉芽肿性小叶乳腺炎患者的临床观察

目的探讨乳房整形术在肉芽肿性小叶乳腺炎治疗的可行性及其美容效果。方法收集2013年1月至2017年12月汕头大学医学院附属粤北人民医院接受传统手术及整形保乳技术手术的肉芽肿性小叶乳腺炎患者,比较两组复发率及术后乳房美容效果。结果复发率在两组间比较,差异均无统计学意义(P0.05)。整形保乳的术后乳房美容效果优于传统手术组,差异有统计学意义(P0.05)。结论整形保乳术治疗肉芽肿性小叶乳腺炎患者具有安全、有效、术后美容效果好等优点。     

Granulomatous lobular mastitis

The clinical and histological features of six cases of granulomatous lobular mastitis are presented. All six patients were parous. 1-6 years after their last pregnancy with a mean age of 34 years; all had unilateral disease and presented with an extra-areolar breast lump. Histologically, all demonstrated a non-caseating granulomatous inflammatory condition centered on breast lobules; in four women there was an acute inflammatory process with micro-abscess formation. Five of the six cases had persistent or recurrent disease despite wide local excision: surgery might not be the best treatment for recurrent disease.     

The role of conservative treatment in idiopathic granulomatous mastitis

Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory disease of the breast that mimics carcinoma of the breast. Its etiology and treatment remain unclear. A retrospective review of nine women with histopathologic diagnosis of IGM was performed. The women had a mean follow-up of 18.7 months and a mean age of 45.7 years (range 32-83 years). The main presentation was breast mass (100%). Clinically and radiologically, 55.6% of the women were suspected to have malignancy. One patient was treated with lumpectomy without recurrence. Eight patients were treated with expectant management with close regular surveillance. No surgery was performed and no medications were given. Fifty percent of the patients had spontaneous complete resolution of disease after a mean interval of 14.5 months. These four patients had no recurrence. Fifty percent of patients had static disease. In conclusion, it is important to differentiate IGM from carcinoma of the breast. Tissue biopsy remains the gold standard to confirm the diagnosis. Expectant management with close regular surveillance is the treatment of choice.     

Granulomatous Mastitis: A New York Public Hospital Experience

Background

Granulomatous mastitis is an uncommon chronic inflammatory breast condition that is characterized by granulomatous inflammation. Granulomatous mastitis presents a challenging clinical scenario, because it can mimic carcinoma. The etiology and optimal treatment remain unclear. We report our experience with granulomatous mastitis patients who presented to our clinic within the past 2 years and describe their response to our treatment modalities.

Methods

Our clinic records were reviewed for the diagnosis of granulomatous mastitis. Charts were used to collect clinical data, patients were reinter viewed, and physicians completed detailed reports on their management of these cases. All cases were diagnosed with granulomatous mastitis based on histological findings and by ruling out other etiologies.

Results

Twenty-four patients were identified. The mean age was 34 years. Fifty-three percent of our patients emigrated from Mexico. Most patients were treated with prednisone and/or methotrexate with overall response rate greater than 80 %. Cases that failed to improve were treated with other modalities, including antituberculosis drugs.

Conclusions

Granulomatous mastitis remains a difficult entity to diagnose and to treat. The clinical course of patients often is prolonged. Exclusion of other causes of granulomatous conditions is essential before initiating anti-inflammatory treatment.     

The value of cytology in granulomatous mastitis: a report of 16 cases from Malaysia

BACKGROUND: Granulomatous mastitis is a rare condition of the breast that can mimic a carcinoma. There are characteristic histological features, the most important of which is a predominantly lobular inflammatory process. It must be differentiated from known causes of granulomatous inflammation, such as tuberculosis. METHODS: In the present paper, the clinical and pathological features of 16 patients with granulomatous mastitis seen over a 3-year period in the University Hospital, Kuala Lumpur, are described. RESULTS: A clinical suspicion of malignancy was present in 10 cases. One of the patients was nulliparous. One had an associated hyperprolactinaemia, while two had systemic lupus erythromatosis. One of the patients was pregnant at the time of presentation. Four patients had localized lumps excised, five were treated conservatively because the lesion was too extensive to resect, and seven patients required drainage procedures for abscess formation. CONCLUSION: Awareness of this condition is important because it mimics a carcinoma, and surgery may not be the best treatment for recurrent disease.     

Granulomatous mastitis: Presentation,treatment and outcome in 43 patients

BackgroundGranulomatous mastitis is a rare benign breast condition commonly affecting women of child-bearing age. It is characterised histopathologically by the presence granuloma and microabscess formation. It is frequently mistaken for inflammatory breast carcinoma both clinically and mammographically. The aim of this study was to retrospectively review the clinical presentation, radiological investigation, histopathological features, treatment and outcome of granulomatous mastitis of women presenting to Ripas Hospital between October 1997 and June 2009.ResultsForty-three patients with a mean age of 34 years presented with a diagnosis of granulomatous mastitis. All patients presented with a palpable breast lump; 24 (56%) patients also experienced pain in the lump and 3 (7%) patients also had associated nipple discharge on presentation. The role of radiological imaging is found to be limited in differentiating GM from other inflammatory and malignant conditions of the breast. Forty (93%) patients underwent a surgical procedure as the main treatment; in the form of excision or incision and drainage of the breast lesions. Mean follow-up was 15 (range 1–80) months with recurrence in 10 (23%) patients.ConclusionGranulomatous mastitis presents clinically with a palpable breast lump. The diagnosis is often only made histopathologically after surgical excision or core biopsy. Complete surgical excision or incision and drainage of the lesion are the main treatment modalities. Treatment with corticosteroids and immunosuppression remains controversial and there is tendency for this condition to recur after treatment.     

Granulomatous Lobular Mastitis: A Complex Diagnostic and Therapeutic Problem

Background Granulomatous lobular mastitis is a rare chronic inflammatory disease of the breast. Clinical and radiological features may mimic breast carcinoma. Since this entity was first described, several clinical and pathologic features of the disease have been reported, but diagnostic features and treatment alternatives are still unclear. The purpose of this study is to evaluate diagnostic difficulties and discuss the outcome of surgical treatment in a series of 21 patients with granulomatous lobular mastitis. Methods A retrospective review of 21 patients with histologically confirmed granulomatous lobular mastitis treated in our center between January 1995 and May 2005 was analyzed to identify issues in the diagnosis and treatment of this rare condition. Results The most common presenting symptoms were a mass in the breast and pain. Four patients had no significant mammographic findings (MMG), but on ultrasound (US), 2 had irregular hypoechoic mass, and 2 hypoechoic nodular structures had abnormalities—one parenchymal distortion and 1 mass formation in 2 of these 4 patients’ magnetic resonance imaging (MRI). In recurrent cases, limited excision under local anesthesia was performed, as the clinical examination suggested carcinoma. Conclusions Although some findings on MMG and US are suggestive of benign breast disease, these modalities do not rule out malignancy. MRI may be helpful in patients who do not have significant pathology at MMG or US. Fine-needle aspiration cytology may be useful in some cases but diagnosis is potentially difficult because of its cytologic characteristics. Wide excision, particularly under general anesthesia, can be therapeutic as well as useful in providing an exact diagnosis.     

Idiopathic granulomatous mastitis: time to avoid unnecessary mastectomies

Idiopathic granulomatous mastitis is a rare disease of the breast. Clinically and radiologically it may mimic breast carcinoma. Awareness of surgeons, pathologists, and radiologists is essential to avoid unnecessary mastectomies. Data regarding 24 patients with histologically confirmed idiopathic granulomatous mastitis treated at our center over 8 years were analyzed. The mean age of patients was 34.3 years. Breast lump was the most common presentation. The right breast was affected in 16 cases. Four patients were pregnant at the time of presentation. Lactation within 6 months of presentation was documented in four patients. Two patients used contraceptives pills. A clinical suspicion of malignancy was present in 17 cases. Mammography was performed in 16 patients and showed focal asymmetrical dense lesions in 9, well-circumscribed opacity in 4, spiculated lesion in 1, and was normal in 2. Fine-needle aspiration was performed in 17 patients, of which 2 were reported as malignant. Wide local excision was the mainstay of treatment. One patient underwent mastectomy upon clinical, mammographic, and repeated cytologic findings consistent with malignancy, and the final histology confirmed idiopathic granulomatous mastitis with no evidence of malignancy. Four patients developed recurrence after a mean follow-up of 31.2 months. A greater awareness of the rare entity of idiopathic granulomatous mastitis is mandatory to avoid unnecessary mastectomies. Clinical, radiologic, and even cytologic findings are sometimes confused with malignancy. To the best of our knowledge, our patient who developed the disease at the age of 11 years is the youngest reported case.     

Granulomatous Lobular Mastitis: a Rare Chronic Inflammatory Disease of the Breast which Can Mimic Breast Carcinoma

Granulomatous lobular mastitis is a rare chronic inflammatory disease of the breast. The differential diagnosis with malign breast disease is often not easy. In most cases a surgical biopsy is needed for correct diagnosis. Idiopathic granulomatous mastitis is an exclusion diagnosis, based on the demonstration of a characteristic histological pattern, combined with the exclusion of other possible causes of granulomatous breast lesions. There is still no generally accepted optimal treatment. If surgery forms part of the treatment, a conservative approach seems to be adequate in most cases. Another option is a long-term steroid treatment. It is mandatory to exclude infectious causes of granulomatous mastitis before corticoid therapy is started.     

Granulomatous lobular mastitis: a rare chronic inflammatory disease of the breast which can mimic breast carcinoma

Granulomatous lobular mastitis is a rare chronic inflammatory disease of the breast. The differential diagnosis with malign breast disease is often not easy. In most cases a surgical biopsy is needed for correct diagnosis. Idiopathic granulomatous mastitis is an exclusion diagnosis, based on the demonstration of a characteristic histological pattern, combined with the exclusion of other possible causes of granulomatous breast lesions. There is still no generally accepted optimal treatment. If surgery forms part of the treatment, a conservative approach seems to be adequate in most cases. Another option is a long-term steroid treatment. It is mandatory to exclude infectious causes of granulomatous mastitis before corticoid therapy is started.     

Mammary duct fistulae: classification and management

BACKGROUND: The aim of the present study was to review the management of mammary duct fistulae and propose a classification that could be useful in planning the management of mammary duct fistulae. METHODS: Sixteen women presented with a mammary duct fistula, two of whom had two fistulae. The data analysed included age, smoking habit, previous abscesses, nipple abnormalities, imaging, culture, operative technique and histopathological findings. RESULTS: The average follow up was 28 months, the mean age was 36.5 years and two women were heavy smokers. Nipple abnormalities were found in five (32%) patients, the average number of abscesses before the presentation was 1.8 and Staphylococcus coagulase negative predominated the culture. Eleven (69%) patients underwent total excision of the ductal system and fistulous tract using a technique modified by the author. Five patients were offered conservative treatment; however, one of the patients refused surgical treatment, but was still followed up in the present study. Histopathological results revealed periductal mastitis in 10 patients, idiopathic granulomatous mastitis in five patients and tuberculous mastitis in one patient. CONCLUSION: Deep mammary duct fistulae are directly related to a diseased ductal system and should be differentiated from superficial fistulae, which result from the infection of the subepidermal mammary glands. Deep fistulae that result from periductal mastitis should be treated by total excision of the ductal system in conjunction with the fistulous tract under antibiotics to ensure the lowest rate of recurrence. The technique used in the present study resulted in negligible morbidity and good cosmetic appearance. A trial of conservative treatment should be recommended for fistulae resulting from idiopathic granulomatous mastitis; however, further studies are required to establish the best treatment.