22例特發性小葉性肉芽腫性乳腺炎診治分析_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 李潔清 ¹ ,  張琳 ²

1. ;
2. ;

Corresponding?author：

張琳, Email: 13602097965@163.com

Keywords：

特發性小葉性肉芽腫性乳腺炎; 臨床表現; 治療; 預后

DOI：

10.7507/1007-9424.20150224

Video：

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目的探討特發性小葉性肉芽腫性乳腺炎（Idiopathic granulomatous lobular mastitis，IGLM）的臨床特點、治療方案及預后。方法回顧性分析筆者所在醫院2010年1月至2015年2月期間收治的22例IGLM患者的臨床資料。結果 22例患者均為女性，年齡（35.48±11.99）歲（24～64歲）；72.7%（16/22）的患者處于育齡期，全部病例均已育；95.5%（21/22）的患者曾采用母乳喂養，其中19例患者為斷乳后發病，距離末次斷乳時間3個月～39年（中位時間2年）。以乳房腫塊（19/22）和皮膚紅腫（13/22）為最常見首發癥狀；全部病灶均位于單側乳房，左側16例，右側6例；18例為單發病灶，3例為多發病灶，1例未捫及包塊；1個病灶波及全乳，8個病灶位于乳暈區，余16個病灶位于乳腺周圍區域。13例可捫及腋窩淋巴結腫大，其中11例位于患側，2例位于雙側。20例患者經乳腺超聲及乳腺鉬靶X線攝影檢查，10例（50.0%）診斷考慮為炎性病變。術前行抗生素治療12例，有效3例，無效9例。行手術治療17例：乳房腫塊切除15例（其中乳頭內陷1例同時行乳頭成形術），乳腺膿腫切開引流術 1例，乳房單純切除術1例；7例術后給予左氧氟沙星治療，余10例術后未使用抗生素。另外5例行對癥治療。隨訪1～3個月無復發。結論 IGLM目前病因不明，臨床表現提示IGLM可能與自身免疫反應相關。育齡非哺乳期女性如出現乳房腫物伴表面紅腫，臨床上應考慮IGLM可能。本病確診依賴空心針活檢及術后組織病理學檢查。手術治療可以徹底清除病灶，從而治愈本病。

Citation： 李潔清, 張琳. 22例特發性小葉性肉芽腫性乳腺炎診治分析. 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.	馬國華, 傅西林. 乳腺肉芽腫6例報告. 中國腫瘤臨床, 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.	肖薔, 張超杰. 非哺乳期乳腺炎的現代研究進展. 醫學與哲學, 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.	安俐瑩, 丁軍. 男性肉芽腫性乳腺炎誤診為乳腺癌CT診斷1例. 中國實驗診斷學, 2014, 18(2):316-317.
9.	李艷桃, 許銳, 鐘少文. 男性乳房發育合并肉芽腫性乳腺炎一例. 中華乳腺病雜志:電子版, 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.	于海靜, 王頎, 楊劍敏, 等. 肉芽腫性乳腺炎的臨床病理特征及其綜合治療. 中華乳腺病雜志:電子版, 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.	董華英, 湯鵬, 鐘曉捷, 等. 肉芽腫性小葉性乳腺炎26例臨床診治分析. 疑難病雜志, 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.	鐘少文, 李艷桃. 漿細胞性、肉芽腫性乳腺炎主要臨床特點的對比分析. 中國醫藥導刊, 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.	程靜, 唐利, 張燦晶, 等. 非特異性肉芽腫性乳腺炎聲像圖特征及誤診分析. 檢驗醫學與臨床, 2015, 12(2):186-187, 190.
24.	趙穎, 方志沂. 肉芽腫性乳腺炎臨床近紅外掃描圖像特征分析. 天津醫科大學學報, 2000, 6(4):464-465.
25.	魏文, 涂毅, 姚峰, 等. 肉芽腫性乳腺炎18例臨床分析. 中華全科醫師雜志, 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.	湯兵輝, 瞿偉. 肉芽腫性小葉性乳腺炎超聲表現. 中華醫學超聲雜志:電子版, 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, 柳建華, 區文財, 等. 肉芽腫性乳腺炎的彩色多普勒超聲診斷特點及誤診分析. 臨床超聲醫學雜志, 2013, 15(10):710-712.
33.	朱麗萍, 賈文霄, 倪多, 等. 肉芽腫性乳腺炎的臨床表現與X線及MRI診斷特點. 臨床放射學雜志, 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, 龔建安, 梁盛枝, 等. 粗針穿刺活檢鑒別診斷漿細胞性乳腺炎和肉芽性乳腺炎的臨床價值. 中國醫藥指南, 2014, 12(7):170, 172.
37.	杜春海, 靳文勛, 曹志然. 漿細胞性乳腺炎的診斷與治療分析. 醫學研究與教育, 2013, 30(3):23-25.
38.	龍安莉. 漿細胞性乳腺炎的進展研究. 中外醫學研究, 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, 錢軍明. 肉芽腫性小葉性乳腺炎的治療. 實用臨床醫藥雜志, 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. 馬國華, 傅西林. 乳腺肉芽腫6例報告. 中國腫瘤臨床, 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. 肖薔, 張超杰. 非哺乳期乳腺炎的現代研究進展. 醫學與哲學, 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. 安俐瑩, 丁軍. 男性肉芽腫性乳腺炎誤診為乳腺癌CT診斷1例. 中國實驗診斷學, 2014, 18(2):316-317.
9. 李艷桃, 許銳, 鐘少文. 男性乳房發育合并肉芽腫性乳腺炎一例. 中華乳腺病雜志:電子版, 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. 于海靜, 王頎, 楊劍敏, 等. 肉芽腫性乳腺炎的臨床病理特征及其綜合治療. 中華乳腺病雜志:電子版, 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. 董華英, 湯鵬, 鐘曉捷, 等. 肉芽腫性小葉性乳腺炎26例臨床診治分析. 疑難病雜志, 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. 鐘少文, 李艷桃. 漿細胞性、肉芽腫性乳腺炎主要臨床特點的對比分析. 中國醫藥導刊, 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. 程靜, 唐利, 張燦晶, 等. 非特異性肉芽腫性乳腺炎聲像圖特征及誤診分析. 檢驗醫學與臨床, 2015, 12(2):186-187, 190.
24. 趙穎, 方志沂. 肉芽腫性乳腺炎臨床近紅外掃描圖像特征分析. 天津醫科大學學報, 2000, 6(4):464-465.
25. 魏文, 涂毅, 姚峰, 等. 肉芽腫性乳腺炎18例臨床分析. 中華全科醫師雜志, 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. 湯兵輝, 瞿偉. 肉芽腫性小葉性乳腺炎超聲表現. 中華醫學超聲雜志:電子版, 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, 柳建華, 區文財, 等. 肉芽腫性乳腺炎的彩色多普勒超聲診斷特點及誤診分析. 臨床超聲醫學雜志, 2013, 15(10):710-712.
33. 朱麗萍, 賈文霄, 倪多, 等. 肉芽腫性乳腺炎的臨床表現與X線及MRI診斷特點. 臨床放射學雜志, 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, 龔建安, 梁盛枝, 等. 粗針穿刺活檢鑒別診斷漿細胞性乳腺炎和肉芽性乳腺炎的臨床價值. 中國醫藥指南, 2014, 12(7):170, 172.
37. 杜春海, 靳文勛, 曹志然. 漿細胞性乳腺炎的診斷與治療分析. 醫學研究與教育, 2013, 30(3):23-25.
38. 龍安莉. 漿細胞性乳腺炎的進展研究. 中外醫學研究, 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, 錢軍明. 肉芽腫性小葉性乳腺炎的治療. 實用臨床醫藥雜志, 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例特發性小葉性肉芽腫性乳腺炎診治分析

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