Department of Pathology, Tepecik Education and Research Hospital, University of Health Sciences, IZMIR, TURKEY.
Turk Patoloji Derg. 2022;38(1):40-45. doi: 10.5146/tjpath.2021.01554.
Granulomatous mastitis (GM) is a challenging inflammatory disorder of the breast. In this study we aimed to present the detailed clinical and morphological features of GM cases, diagnostic clues for specific and idiopathic etiologies, the difficulties in evaluating trucut biopsies, and the results of different therapeutic approaches.
We retrospectively analysed the clinical, radiological and morphological features of 114 GM cases diagnosed with fine needle aspiration, and trucut, incisional, and excisional biopsy.
The mean age was 35.8. Only eight cases were older than 45 years. Bilateral involvement was observed in 4 (3.5%) cases. The most common clinical symptoms were breast mass/abscesses, tenderness, and skin changes. Microbiological culture was positive in 4 cases for gram-positive bacteria. Only 3 cases showed a positive tuberculin/PCR test for tuberculosis. The major USG finding was a hypoechoic well-defined or ill-defined mass/abscess; MRI finding was heterogeneous non-mass contrast enhancement. Cases diagnosed with cytology (35 cases) did not have breast malignancy either in their history or clinical follow up period. Fine needle aspiration cytology materials revealed epitheloid granulomas mixed with neutrophils, lymphocytes accompanied by giant cells, and suppurative necrosis. Histopathological reevaluation of 65 trucut/incisional/ excisional biopsies revealed granuloma formation in 65 (100%), Langhans type giant cells in 59 (90.7%), microabscess formation in 41 (63%), caseous necrosis in 1 (1.5%), neutrophilic cysts in 30 (46.1%), eosinophilic infiltration in 48 (73.8%), interlobular inflammation in 14 (21.5%), fat necrosis in 5 (7.6%), ductal ectasia in 6 (9.2%), and lactational changes in 4 (6.1%) cases. Granulomas were lobulocentric in 58 cases, foreign body type/fat necrosis-related in 6 case, and periductular in 1 case. Cystic neutrophilic granulomatous mastitis was observed in one case. We also evaluated the histochemical stains of these 65 biopsies. Only one sample was positive for acido-resistant bacilli (ARB) by the EZN method and one sample was positive for gram-positive bacilli by gram stain.
Small, superficial trucut biopsies may cause difficulties in determining the etiology and differential diagnosis of granulomatous mastitis. For optimal management and timing the appropriate therapy, the ideal biopsy procedure, special stains, and a multidisciplinary team consisting of the surgeon, pathologist, and radiologist are the most important issues.
肉芽肿性乳腺炎（GM）是一种具有挑战性的乳腺炎症性疾病。本研究旨在介绍 GM 病例的详细临床和形态学特征、特定和特发性病因的诊断线索、切取活检的困难以及不同治疗方法的结果。
我们回顾性分析了 114 例经细针抽吸、切取活检、切开活检和切除活检诊断为 GM 的病例的临床、放射学和形态学特征。
平均年龄为 35.8 岁。仅有 8 例年龄大于 45 岁。4 例（3.5%）为双侧受累。最常见的临床症状是乳腺肿块/脓肿、触痛和皮肤改变。4 例的微生物培养结果为革兰阳性菌阳性。仅有 3 例结核菌素/PCR 试验阳性提示结核。主要的超声表现为低回声边界清楚或不清楚的肿块/脓肿；MRI 表现为不均匀非肿块样对比增强。通过细胞学诊断的 35 例患者在病史或临床随访期间均未发现乳腺恶性肿瘤。细针抽吸细胞学材料显示混合中性粒细胞、淋巴细胞和巨细胞的上皮样肉芽肿，伴有化脓性坏死。对 65 例切取活检、切开活检和切除活检的组织病理学重新评估显示，65 例（100%）形成肉芽肿，59 例（90.7%）形成朗汉斯型巨细胞，41 例（63%）形成微脓肿，1 例（1.5%）形成干酪样坏死，30 例（46.1%）形成中性粒细胞性囊肿，48 例（73.8%）形成嗜酸性粒细胞浸润，14 例（21.5%）形成小叶间炎症，5 例（7.6%）形成脂肪坏死，6 例（9.2%）形成导管扩张，4 例（6.1%）形成哺乳期改变。58 例为小叶中心性肉芽肿，6 例为异物型/脂肪坏死相关型，1 例为小叶间型。1 例为囊性中性粒细胞性肉芽肿性乳腺炎。我们还评估了这 65 例活检的组织化学染色。仅 1 例样本经 EZN 法抗酸杆菌染色（ARB）阳性，1 例样本革兰染色阳性提示革兰阳性杆菌。
小的、表浅的切取活检可能导致肉芽肿性乳腺炎的病因和鉴别诊断困难。为了进行最佳管理和选择适当的治疗时机，最关键的问题是包括外科医生、病理学家和放射科医生在内的多学科团队进行适当的活检操作、特殊染色检查。
