Chandanwale Shirish, Naragude Piyusha, Shetty Abhinav, Sawadkar Manoj, Raj Akshi, Bhide Aniket, Singh Madhuri
Department of Pathology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pimpri Pune, India.
Eur J Breast Health. 2020 Apr 1;16(2):146-151. doi: 10.5152/ejbh.2020.5185. eCollection 2020 Apr.
Granulomatous mastitis is an uncommon benign breast disease. Varied aetiologies such as tuberculosis, foreign body reactions, sarcoidosis, fungal and parasitic infections and autoimmunity have been suggested. Pre-operative definitive diagnosis is essential for proper treatment. In developing countries like India, fine needle aspiration is still widely used as a reliable technique for preoperative evaluation of palpable breast lumps. The objective of this study is to study the cytomorphological features of different forms of granulomatous mastitis and correlate with other clinical findings including histological features.
A total of 33 cases of granulomatous mastitis were reviewed. The patients underwent fine needle aspiration. Cytomorphological features were studied in detail and correlated with histopathological features and other clinical findings.
All the 33 patients showed varied cytomorphological features which included epithelioid cells/granuloma with lymphocytes/plasma cells/polymorphs with or without necrosis/caseous necrosis and with or without giant cells. Ziehl Nelson stain showed acid fast bacilli in 13 smears. Out of 17 cases, the eight cases showed positive acid fast bacilli culture. Fungal stain such as Grocott-Gommeri Methane amine did not show fungi. Based on cytomorphological features in aspiration smears, they were grouped into 4 Groups. A total of 27 breast lesions were diagnosed as tuberculous mastitis, the four lesions were diagnosed as idiopathic granulomatous lobular mastitis and two lesions were diagnosed as foreign body granulomatous mastitis. Grocott-Gommeri Methane amine did not showed fungi. Based on cytomorphological features in aspiration smears, they were grouped into 4 Groups. A total of 27 breast lesions were diagnosed as tuberculous mastitis, the four lesions were diagnosed as idiopathic granulomatous lobular mastitis and two lesions were diagnosed as foreign body granulomatous mastitis.
Epithelioid granulomas with caseous necrosis with or without acid fast bacilli in cytology smears are diagnostic of tuberculosis. Cytology smears showing epithelioid granulomas with predominant polymorphs without necrosis and acid fast bacilli, a diagnosis of idiopathic granulomatous lobular mastitis must be considered. Histopathological examination is essential for definitive diagnosis in these cases.
肉芽肿性乳腺炎是一种罕见的良性乳腺疾病。已提出多种病因，如结核病、异物反应、结节病、真菌和寄生虫感染以及自身免疫。术前明确诊断对于恰当治疗至关重要。在印度等发展中国家，细针穿刺抽吸术仍被广泛用作可触及乳腺肿块术前评估的可靠技术。本研究的目的是研究不同形式肉芽肿性乳腺炎的细胞形态学特征，并与包括组织学特征在内的其他临床发现相关联。
共回顾了33例肉芽肿性乳腺炎病例。患者接受了细针穿刺抽吸。详细研究细胞形态学特征，并与组织病理学特征及其他临床发现相关联。
所有33例患者均表现出不同的细胞形态学特征，包括上皮样细胞/肉芽肿伴淋巴细胞/浆细胞/多形核白细胞，有或无坏死/干酪样坏死，有或无巨细胞。齐-尼氏染色在13份涂片上显示抗酸杆菌。17例中，8例抗酸杆菌培养呈阳性。诸如格罗科特-戈默里甲胺银染色等真菌染色未显示真菌。根据穿刺涂片的细胞形态学特征，将它们分为4组。共有27例乳腺病变被诊断为结核性乳腺炎，4例病变被诊断为特发性肉芽肿性小叶性乳腺炎，2例病变被诊断为异物性肉芽肿性乳腺炎。格罗科特-戈默里甲胺银染色未显示真菌。根据穿刺涂片的细胞形态学特征，将它们分为4组。共有27例乳腺病变被诊断为结核性乳腺炎，4例病变被诊断为特发性肉芽肿性小叶性乳腺炎，2例病变被诊断为异物性肉芽肿性乳腺炎。
细胞学涂片上有或无抗酸杆菌的伴有干酪样坏死的上皮样肉芽肿可诊断为结核病。细胞学涂片显示以多形核白细胞为主且无坏死和抗酸杆菌的上皮样肉芽肿，必须考虑诊断为特发性肉芽肿性小叶性乳腺炎。在这些病例中，组织病理学检查对于明确诊断至关重要。
