Deng J Q, Yu L, Yang Y, Feng X J, Sun J, Liu J, Fan F S, Liao L Q
Department of Pathology, Affiliated Calmaette Hospital of Kunming Medical University, Kunming, Yunnan, PR China.
J Clin Pathol. 2017 Oct;70(10):827-831. doi: 10.1136/jclinpath-2016-204287. Epub 2017 Mar 17.
The aetiology and treatment options for idiopathic granulomatous mastitis (IGM) are controversial. The aim was to study the clinical and diagnostic features and discuss medical and surgical treatment for IGM in our patients.
Sixty-five patients who met the histological criteria for IGM were retrospectively studied. The diagnosis of IGM was confirmed using Mammotome (an ultrasound-guided, vacuum-assisted biopsy system), core needle biopsy, quadrantectomy or segmental resection. Forty-five patients were treated with prednisolone (69.2%). Immunohistochemical (IHC) staining for immune-related antigens (CD3, CD4, CD8, CD79a, IgG, and IgM) was performed.
Ultrasonography (USG) was carried out in all patients. Among them, 61 were considered to have an inflammatory mass and 15 had accompanying liquefaction. In four patients, the findings mimicked breast carcinoma (6.2%). The IHC results showed CD3, CD4, CD8 and CD79a lymphocytes diffusely distributed in the lesion. Stains for IgG and IgM were negative. Prednisolone was administered to the patients diagnosed with IGM. The success rate was 53 (81.5%) and the whole recurrence was 12 (18.5%). The median follow-up period was 12 months (range 4-42 months).
The aetiology of IGM remains uncertain. The disease has no propensity for the right or left breast. It is a local autoimmune disease, involving humoral and cell-mediated immunity. Hyperprolactinaemia may play a role in some patients. Corticosteroids administered after complete removal of the IGM lesion using the Mammotome biopsy system is an effective treatment option.
特发性肉芽肿性乳腺炎（IGM）的病因及治疗方案存在争议。本研究旨在探讨IGM患者的临床及诊断特征，并讨论其在内科及外科方面的治疗方法。
回顾性研究65例符合IGM组织学标准的患者。采用麦默通（一种超声引导下的真空辅助活检系统）、粗针活检、象限切除术或区段切除术确诊IGM。45例患者接受泼尼松龙治疗（69.2%）。对免疫相关抗原（CD3、CD4、CD8、CD79a、IgG和IgM）进行免疫组织化学（IHC）染色。
所有患者均行超声检查（USG）。其中，61例被认为有炎性肿块，15例伴有液化。4例患者的表现类似乳腺癌（6.2%）。免疫组化结果显示，CD3、CD4、CD8和CD79a淋巴细胞在病变中弥漫分布。IgG和IgM染色均为阴性。确诊为IGM的患者接受泼尼松龙治疗。成功率为53例（81.5%），总复发率为12例（18.5%）。中位随访期为12个月（范围4 - 42个月）。
IGM的病因仍不明确。该疾病无明显的左右乳腺倾向。它是一种局部自身免疫性疾病，涉及体液免疫和细胞介导免疫。高泌乳素血症可能在部分患者中起作用。使用麦默通活检系统完全切除IGM病变后给予糖皮质激素是一种有效的治疗选择。
