22例特发性小叶性肉芽肿性乳腺炎诊治分析_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 李洁清 ¹ ,  张琳 ²

1. ;
2. ;

Corresponding author：

张琳, Email: 13602097965@163.com

Keywords：

特发性小叶性肉芽肿性乳腺炎; 临床表现; 治疗; 预后

DOI：

10.7507/1007-9424.20150224

Video：

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目的探讨特发性小叶性肉芽肿性乳腺炎（Idiopathic granulomatous lobular mastitis，IGLM）的临床特点、治疗方案及预后。方法回顾性分析笔者所在医院2010年1月至2015年2月期间收治的22例IGLM患者的临床资料。结果 22例患者均为女性，年龄（35.48±11.99）岁（24～64岁）；72.7%（16/22）的患者处于育龄期，全部病例均已育；95.5%（21/22）的患者曾采用母乳喂养，其中19例患者为断乳后发病，距离末次断乳时间3个月～39年（中位时间2年）。以乳房肿块（19/22）和皮肤红肿（13/22）为最常见首发症状；全部病灶均位于单侧乳房，左侧16例，右侧6例；18例为单发病灶，3例为多发病灶，1例未扪及包块；1个病灶波及全乳，8个病灶位于乳晕区，余16个病灶位于乳腺周围区域。13例可扪及腋窝淋巴结肿大，其中11例位于患侧，2例位于双侧。20例患者经乳腺超声及乳腺钼靶X线摄影检查，10例（50.0%）诊断考虑为炎性病变。术前行抗生素治疗12例，有效3例，无效9例。行手术治疗17例：乳房肿块切除15例（其中乳头内陷1例同时行乳头成形术），乳腺脓肿切开引流术 1例，乳房单纯切除术1例；7例术后给予左氧氟沙星治疗，余10例术后未使用抗生素。另外5例行对症治疗。随访1～3个月无复发。结论 IGLM目前病因不明，临床表现提示IGLM可能与自身免疫反应相关。育龄非哺乳期女性如出现乳房肿物伴表面红肿，临床上应考虑IGLM可能。本病确诊依赖空心针活检及术后组织病理学检查。手术治疗可以彻底清除病灶，从而治愈本病。

Citation： 李洁清, 张琳. 22例特发性小叶性肉芽肿性乳腺炎诊治分析. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(7): 858-862. doi: 10.7507/1007-9424.20150224 Copy

1.	Tuli R, O'Hara BJ, Hines J, et al. Idiopathic granulomatous mastitis masquerading as carcinoma of the breast:a case report and review of the literature. Int Semin Surg Oncol, 2007, 4:21.
2.	Kessler E, Wolloch Y. Granulomatous mastitis:a lesion clinically simulating carcinoma. Am J Clin Pathol, 1972, 58(6):642-646.
3.	马国华, 傅西林. 乳腺肉芽肿6例报告. 中国肿瘤临床, 1986,13(5):291-292, 321.
4.	Baslam MM, Khayat HA, Al-Amoudi SA. Idiopathic granulomatous mastitis:a heterogeneous disease with variable clinicalpresentation. World J Surg, 2007, 31(8):1677-1678.
5.	肖蔷, 张超杰. 非哺乳期乳腺炎的现代研究进展. 医学与哲学, 2013, 34(3B):8-13.
6.	Akcan A, Akyildiz H, Deneme MA, et al. Granulomatous lobular mastitis:a complex diagnostic and therapeutic problem. World J Surg, 2006, 30(8):1403-1409.
7.	Erhan Y, Veral A, Kara E, et al. A clinicopathologic study of a rare clinical entity mimicking breast carcinoma:idiopathic granulomatous mastitis. Breast, 2000, 9(1):52-56.
8.	安俐莹, 丁军. 男性肉芽肿性乳腺炎误诊为乳腺癌CT诊断1例. 中国实验诊断学, 2014, 18(2):316-317.
9.	李艳桃, 许锐, 钟少文. 男性乳房发育合并肉芽肿性乳腺炎一例. 中华乳腺病杂志:电子版, 2013, 7(5):389-390.
10.	Pereira FA, Mudgil AV, Macias ES, et al. Idiopathic granulomatous lobular mastitis. Int J Dermatol, 2012, 51(2):142-151.
11.	Binesh F, Shiryazdi M, Bagher Owlia M, et al. Idiopathic granulomatous mastitis, erythema nodosum and bilateral ankle arthritis in an Iranian woman. BMJ Case Rep, 2013, 2013.
12.	于海静, 王颀, 杨剑敏, 等. 肉芽肿性乳腺炎的临床病理特征及其综合治疗. 中华乳腺病杂志:电子版, 2013, 7(3):174-178.
13.	Bes C, Soy M, Vardi S, et al. Erythema nodosum associated with granulomatous mastitis:report of two cases. Rheumatol Int, 2010, 30(11):1523-1525.
14.	Lin CH, Hsu CW, Tsao TY, et al. Idiopathic granulomatous mastitis associated with resperidone-induced hyperprolactinemia. Diagn Pathol, 2012, 7:2.
15.	Murthy MS. Granulomatous mastitis and lipogranuloma of the breast. Am J Clin Pathol, 1973, 60(3):432-433.
16.	董华英, 汤鹏, 钟晓捷, 等. 肉芽肿性小叶性乳腺炎26例临床诊治分析. 疑难病杂志, 2015, 14(4):413-415.
17.	Centers for Disease Control and Prevention (CDC). Idiopathic granulomatous mastitis in Hispanic Women-Indiana, 2006-2008. MMWR Morb Mortal Wkly Rep, 2009, 58(47):1317-1321.
18.	Asoglu O, Ozmen V, Karanlik H, et al. Feasibility of surgical management in patients with granulomatous mastitis. Breast J, 2005, 11 (2):108-114.
19.	Lai EC, Chan WC, Ma TK, et al. The role of conservative treatment in idiopathic granulomatous mastitis. Breast J, 2005, 11(6):454-456.
20.	钟少文, 李艳桃. 浆细胞性、肉芽肿性乳腺炎主要临床特点的对比分析. 中国医药导刊, 2013, 15(S1):95-97.
21.	Al-Khaffaf B, Knox F, Bundred NJ. Idiopathic granulomatous mastitis:a 25-year experience. J Am Coll Surg, 2008, 206(2):269-273.
22.	Ocal K, Dag A, Turkmenoglu O, et al. Granulomatous mastitis:clinical, pathological features, and management. Breast J, 2010, 16(2):176-182.
23.	程静, 唐利, 张灿晶, 等. 非特异性肉芽肿性乳腺炎声像图特征及误诊分析. 检验医学与临床, 2015, 12(2):186-187, 190.
24.	赵颖, 方志沂. 肉芽肿性乳腺炎临床近红外扫描图像特征分析. 天津医科大学学报, 2000, 6(4):464-465.
25.	魏文, 涂毅, 姚峰, 等. 肉芽肿性乳腺炎18例临床分析. 中华全科医师杂志, 2007, 6(12):761.
26.	Diesing D, Axt-Fliedner R, Hornung D, et al. Granulomatous mastitis. Arch Gynecol Obstet, 2004, 269(4):233-236.
27.	汤兵辉, 瞿伟. 肉芽肿性小叶性乳腺炎超声表现. 中华医学超声杂志:电子版, 2007, 4(5):282-284.
28.	Schelfout K, Tjalma WA, Cooremans ID, et al. Observations of an idiopathic granulomatous mastitis. Eur J Obstet Gynecol Peprod Biol, 2001, 97(2):260-262.
29.	Sakurai T, Oura S, Tanino H, et al. A case of granulomatous mastitis mimicking breast carcinoma. Breast Cancer, 2002, 9(3):265-268.
30.	Han BK, Choe YH, Park JM, et al. Granulomatous mastitis:mammographic and sonographic appearances. AJR Am J Roentgenol, 1999, 173(2):317-320.
31.	Bani-Hani KE, Yaghan RJ, Matalka Ⅱ, et al. Diopathic granulomatous mastitis:time to avoid unnecessary mastectomies. Breast J, 2004, 10(4):318-322.
32.	曾功君, 柳建华, 区文财, 等. 肉芽肿性乳腺炎的彩色多普勒超声诊断特点及误诊分析. 临床超声医学杂志, 2013, 15(10):710-712.
33.	朱丽萍, 贾文霄, 倪多, 等. 肉芽肿性乳腺炎的临床表现与X线及MRI诊断特点. 临床放射学杂志, 2011,30(2):193-196.
34.	Seo HR, Na KY, Yim HE, et al. Differential diagnosis in idiopathic granulomatous mastitis and tuberculous mastitis. J Breast Cancer, 2012, 15(1):111-118.
35.	Imoto S, Kitaya T, Kodama T, et al. Idiopathic granulomatous mastitis:case report and review of the literature. Jpn J Clin Oncol, 1997, 27(4):274-277.
36.	姜越, 龚建安, 梁盛枝, 等. 粗针穿刺活检鉴别诊断浆细胞性乳腺炎和肉芽性乳腺炎的临床价值. 中国医药指南, 2014, 12(7):170, 172.
37.	杜春海, 靳文勋, 曹志然. 浆细胞性乳腺炎的诊断与治疗分析. 医学研究与教育, 2013, 30(3):23-25.
38.	龙安莉. 浆细胞性乳腺炎的进展研究. 中外医学研究, 2014, 12(7):161-163.
39.	Hladik M, Schoeller T, Ensat F, et al. Idiopathic granulomatous mastitis:successful treatment by mastectomy and immediate breast reconstruction. J Plast Reconstr Aesthet Surg, 2011, 64(12):1604-1607.
40.	朱惠, 钱军明. 肉芽肿性小叶性乳腺炎的治疗. 实用临床医药杂志, 2014, 18(9):166-168.
41.	Asoglu O, Ozmen V, Karanlik H, et al. Feasibility of surgical management in patients with granulomatous mastitis. Breast J, 2005, 11 (2):108-114.
42.	Akbulut S, Yilmaz D, Bakir S. Methotrexate in the management of idiopathic granulomatous mastitis:review of 108 published cases and report of four cases. Breast J, 2011, 17(6):661-668.
43.	Schmajuk G, Genovese MC. First report of idiopathic granulomatous mastitis treated with methotrexate monotherapy. J Rheumatol, 2009, 36(7):1559-1560.
44.	Blay J, Medina R, Rausell N, et al. Unilateral mastitis obliterans presented as a palpable breast mass in a patient with long-standing diabetes mellitus. Breast Dis, 2012, 34(1):43-46.

1. Tuli R, O'Hara BJ, Hines J, et al. Idiopathic granulomatous mastitis masquerading as carcinoma of the breast:a case report and review of the literature. Int Semin Surg Oncol, 2007, 4:21.
2. Kessler E, Wolloch Y. Granulomatous mastitis:a lesion clinically simulating carcinoma. Am J Clin Pathol, 1972, 58(6):642-646.
3. 马国华, 傅西林. 乳腺肉芽肿6例报告. 中国肿瘤临床, 1986,13(5):291-292, 321.
4. Baslam MM, Khayat HA, Al-Amoudi SA. Idiopathic granulomatous mastitis:a heterogeneous disease with variable clinicalpresentation. World J Surg, 2007, 31(8):1677-1678.
5. 肖蔷, 张超杰. 非哺乳期乳腺炎的现代研究进展. 医学与哲学, 2013, 34(3B):8-13.
6. Akcan A, Akyildiz H, Deneme MA, et al. Granulomatous lobular mastitis:a complex diagnostic and therapeutic problem. World J Surg, 2006, 30(8):1403-1409.
7. Erhan Y, Veral A, Kara E, et al. A clinicopathologic study of a rare clinical entity mimicking breast carcinoma:idiopathic granulomatous mastitis. Breast, 2000, 9(1):52-56.
8. 安俐莹, 丁军. 男性肉芽肿性乳腺炎误诊为乳腺癌CT诊断1例. 中国实验诊断学, 2014, 18(2):316-317.
9. 李艳桃, 许锐, 钟少文. 男性乳房发育合并肉芽肿性乳腺炎一例. 中华乳腺病杂志:电子版, 2013, 7(5):389-390.
10. Pereira FA, Mudgil AV, Macias ES, et al. Idiopathic granulomatous lobular mastitis. Int J Dermatol, 2012, 51(2):142-151.
11. Binesh F, Shiryazdi M, Bagher Owlia M, et al. Idiopathic granulomatous mastitis, erythema nodosum and bilateral ankle arthritis in an Iranian woman. BMJ Case Rep, 2013, 2013.
12. 于海静, 王颀, 杨剑敏, 等. 肉芽肿性乳腺炎的临床病理特征及其综合治疗. 中华乳腺病杂志:电子版, 2013, 7(3):174-178.
13. Bes C, Soy M, Vardi S, et al. Erythema nodosum associated with granulomatous mastitis:report of two cases. Rheumatol Int, 2010, 30(11):1523-1525.
14. Lin CH, Hsu CW, Tsao TY, et al. Idiopathic granulomatous mastitis associated with resperidone-induced hyperprolactinemia. Diagn Pathol, 2012, 7:2.
15. Murthy MS. Granulomatous mastitis and lipogranuloma of the breast. Am J Clin Pathol, 1973, 60(3):432-433.
16. 董华英, 汤鹏, 钟晓捷, 等. 肉芽肿性小叶性乳腺炎26例临床诊治分析. 疑难病杂志, 2015, 14(4):413-415.
17. Centers for Disease Control and Prevention (CDC). Idiopathic granulomatous mastitis in Hispanic Women-Indiana, 2006-2008. MMWR Morb Mortal Wkly Rep, 2009, 58(47):1317-1321.
18. Asoglu O, Ozmen V, Karanlik H, et al. Feasibility of surgical management in patients with granulomatous mastitis. Breast J, 2005, 11 (2):108-114.
19. Lai EC, Chan WC, Ma TK, et al. The role of conservative treatment in idiopathic granulomatous mastitis. Breast J, 2005, 11(6):454-456.
20. 钟少文, 李艳桃. 浆细胞性、肉芽肿性乳腺炎主要临床特点的对比分析. 中国医药导刊, 2013, 15(S1):95-97.
21. Al-Khaffaf B, Knox F, Bundred NJ. Idiopathic granulomatous mastitis:a 25-year experience. J Am Coll Surg, 2008, 206(2):269-273.
22. Ocal K, Dag A, Turkmenoglu O, et al. Granulomatous mastitis:clinical, pathological features, and management. Breast J, 2010, 16(2):176-182.
23. 程静, 唐利, 张灿晶, 等. 非特异性肉芽肿性乳腺炎声像图特征及误诊分析. 检验医学与临床, 2015, 12(2):186-187, 190.
24. 赵颖, 方志沂. 肉芽肿性乳腺炎临床近红外扫描图像特征分析. 天津医科大学学报, 2000, 6(4):464-465.
25. 魏文, 涂毅, 姚峰, 等. 肉芽肿性乳腺炎18例临床分析. 中华全科医师杂志, 2007, 6(12):761.
26. Diesing D, Axt-Fliedner R, Hornung D, et al. Granulomatous mastitis. Arch Gynecol Obstet, 2004, 269(4):233-236.
27. 汤兵辉, 瞿伟. 肉芽肿性小叶性乳腺炎超声表现. 中华医学超声杂志:电子版, 2007, 4(5):282-284.
28. Schelfout K, Tjalma WA, Cooremans ID, et al. Observations of an idiopathic granulomatous mastitis. Eur J Obstet Gynecol Peprod Biol, 2001, 97(2):260-262.
29. Sakurai T, Oura S, Tanino H, et al. A case of granulomatous mastitis mimicking breast carcinoma. Breast Cancer, 2002, 9(3):265-268.
30. Han BK, Choe YH, Park JM, et al. Granulomatous mastitis:mammographic and sonographic appearances. AJR Am J Roentgenol, 1999, 173(2):317-320.
31. Bani-Hani KE, Yaghan RJ, Matalka Ⅱ, et al. Diopathic granulomatous mastitis:time to avoid unnecessary mastectomies. Breast J, 2004, 10(4):318-322.
32. 曾功君, 柳建华, 区文财, 等. 肉芽肿性乳腺炎的彩色多普勒超声诊断特点及误诊分析. 临床超声医学杂志, 2013, 15(10):710-712.
33. 朱丽萍, 贾文霄, 倪多, 等. 肉芽肿性乳腺炎的临床表现与X线及MRI诊断特点. 临床放射学杂志, 2011,30(2):193-196.
34. Seo HR, Na KY, Yim HE, et al. Differential diagnosis in idiopathic granulomatous mastitis and tuberculous mastitis. J Breast Cancer, 2012, 15(1):111-118.
35. Imoto S, Kitaya T, Kodama T, et al. Idiopathic granulomatous mastitis:case report and review of the literature. Jpn J Clin Oncol, 1997, 27(4):274-277.
36. 姜越, 龚建安, 梁盛枝, 等. 粗针穿刺活检鉴别诊断浆细胞性乳腺炎和肉芽性乳腺炎的临床价值. 中国医药指南, 2014, 12(7):170, 172.
37. 杜春海, 靳文勋, 曹志然. 浆细胞性乳腺炎的诊断与治疗分析. 医学研究与教育, 2013, 30(3):23-25.
38. 龙安莉. 浆细胞性乳腺炎的进展研究. 中外医学研究, 2014, 12(7):161-163.
39. Hladik M, Schoeller T, Ensat F, et al. Idiopathic granulomatous mastitis:successful treatment by mastectomy and immediate breast reconstruction. J Plast Reconstr Aesthet Surg, 2011, 64(12):1604-1607.
40. 朱惠, 钱军明. 肉芽肿性小叶性乳腺炎的治疗. 实用临床医药杂志, 2014, 18(9):166-168.
41. Asoglu O, Ozmen V, Karanlik H, et al. Feasibility of surgical management in patients with granulomatous mastitis. Breast J, 2005, 11 (2):108-114.
42. Akbulut S, Yilmaz D, Bakir S. Methotrexate in the management of idiopathic granulomatous mastitis:review of 108 published cases and report of four cases. Breast J, 2011, 17(6):661-668.
43. Schmajuk G, Genovese MC. First report of idiopathic granulomatous mastitis treated with methotrexate monotherapy. J Rheumatol, 2009, 36(7):1559-1560.
44. Blay J, Medina R, Rausell N, et al. Unilateral mastitis obliterans presented as a palpable breast mass in a patient with long-standing diabetes mellitus. Breast Dis, 2012, 34(1):43-46.

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22例特发性小叶性肉芽肿性乳腺炎诊治分析

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