Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
J Clin Pathol. 2011 May;64(5):405-11. doi: 10.1136/jcp.2011.089565. Epub 2011 Mar 8.
The management of granulomatous mastitis depends on the causative factor, and accurate diagnosis in distinguishing between idiopathic granulomatous mastitis (IGM) and tuberculous mastitis (TBM) is indispensable. This is particularly problematic in the cases of granulomatous mastitis in which the microbiological studies are negative. In this study, in a large cohort, the histological features for IGM and TBM were compared.
The histopathology files from the two participating hospitals were searched for cases of granulomatous inflammation of the breast over an 8-year period. The parameters assessed included age of patient, lesional size, systemic and local symptoms, and histological findings of inflammatory cells, granulomas, necrosis, multinucleated giant cells, fibrosis and calcifications.
29 cases of IGM and 33 cases of TBM were included in this study. A significant difference was seen between the two groups with regard to patient age (t=2.52, p<0.05) and lesional size (t=-5.56, p<0.01). TBM occurred in a significantly younger population, and demonstrated larger lesional sizes than IGM. There was no difference between the number of cases showing mass, local and systemic symptoms. Comparing the different histological features, the TBM group showed significantly more fibrosis, eosinophils and necrosis, whereas the IGM group showed significantly more plasma cells. Taking all the cases together as one group to evaluate the relationship between the histological parameters, there was significant positive correlation between eosinophils and fibrosis (r(s)=0.39, p<0.01), and negative correlation between vague and well-formed granulomas (r(s)=-0.38, p<0.01).
TBM was more likely to occur in younger patients, with a larger clinical mass at presentation. Histologically, TBM tends to show more eosinophils and necrosis, and IGM is associated with more plasma cells. The characteristics of the granulomas and giant cells were not distinguishing features.
肉芽肿性乳腺炎的治疗取决于病因，准确区分特发性肉芽肿性乳腺炎（IGM）和结核性乳腺炎（TBM）至关重要。在微生物学检查阴性的肉芽肿性乳腺炎病例中，这尤其成问题。在这项研究中，我们在一个大队列中比较了 IGM 和 TBM 的组织学特征。
在 8 年期间，我们对来自两个参与医院的肉芽肿性乳腺炎病理文件进行了检索。评估的参数包括患者年龄、病变大小、全身和局部症状以及炎症细胞、肉芽肿、坏死、多核巨细胞、纤维化和钙化的组织学发现。
本研究纳入了 29 例 IGM 和 33 例 TBM。两组患者的年龄（t=2.52，p<0.05）和病变大小（t=-5.56，p<0.01）存在显著差异。TBM 发生在年龄明显较小的人群中，病变大小明显大于 IGM。出现肿块、局部和全身症状的病例数量没有差异。比较不同的组织学特征，TBM 组纤维化、嗜酸性粒细胞和坏死明显较多，而 IGM 组浆细胞明显较多。将所有病例作为一组来评估组织学参数之间的关系，嗜酸性粒细胞与纤维化之间存在显著正相关（r(s)=0.39，p<0.01），模糊和形态良好的肉芽肿之间存在显著负相关（r(s)=-0.38，p<0.01）。
TBM 更可能发生在年轻患者中，初诊时临床表现为更大的临床肿块。组织学上，TBM 倾向于表现出更多的嗜酸性粒细胞和坏死，而 IGM 与更多的浆细胞相关。肉芽肿和多核巨细胞的特征不是鉴别特征。
