Elsiddig K E, Khalil E A G, Elhag I A, Elsafi M E M O, Suleiman G M, Elkhidir I M, Hussein A M, El-Hassan A M
Department of Surgery, Faculty of Medicine, Khartoum, Sudan.
Int J Tuberc Lung Dis. 2003 Apr;7(4):365-9.
To determine the aetiological types of granulomatous disease of the breast in women presenting with mammary complaints in the Sudan.
Clinical history and physical examination, complete blood counts, Mantoux test, histopathology and fine needle aspiration cytology (FNAC).
Granulomatous mastitis was seen in 11/2500 (0.44%) patients with mammary disease over a 10-year period. All were of childbearing age (mean 26.0 +/- 5.9 years). Common presentations were diffuse swelling, well-circumscribed masses, nipple retraction, multiple sinuses and superficial skin ulcers. Lymphadenopathy was seen in more than 60% of the patients. Diagnosis was based on cytomorphological features in 10/11 cases and histopathology in one. Nine were diagnosed with tuberculous mastitis and two with idiopathic granulomatous mastitis. Acid-fast bacilli (AFB) could not be demonstrated in any of the cytology smears. Tuberculous mastitis responded to empirical anti-tuberculosis treatment, with a minimum follow-up of 2 years in seven women.
Tuberculous mastitis is a rare entity in women with mammary disease in the Sudan. Alternative diagnoses such as idiopathic granulomatous mastitis should be made only after failure of an adequate trial of anti-tuberculosis treatment. FNAC is a useful diagnostic tool even if AFB cannot be demonstrated.
确定苏丹出现乳腺问题的女性乳腺肉芽肿性疾病的病因类型。
临床病史与体格检查、全血细胞计数、结核菌素试验、组织病理学及细针穿刺细胞学检查（FNAC）。
在10年期间，2500例乳腺疾病患者中有11例（0.44%）出现肉芽肿性乳腺炎。所有患者均处于育龄期（平均26.0±5.9岁）。常见表现为弥漫性肿胀、边界清晰的肿块、乳头回缩、多个窦道及浅表皮肤溃疡。超过60%的患者出现淋巴结病。11例中有10例根据细胞形态学特征确诊，1例根据组织病理学确诊。9例诊断为结核性乳腺炎，2例为特发性肉芽肿性乳腺炎。在任何细胞学涂片中均未发现抗酸杆菌（AFB）。结核性乳腺炎对抗结核经验性治疗有反应，7名女性的最短随访时间为2年。
在苏丹，结核性乳腺炎在患有乳腺疾病的女性中是一种罕见疾病。只有在充分的抗结核治疗试验失败后，才应做出诸如特发性肉芽肿性乳腺炎等其他诊断。即使无法发现AFB，FNAC仍是一种有用的诊断工具。
