Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Diagn Cytopathol. 2024 Jan;52(1):50-57. doi: 10.1002/dc.25241. Epub 2023 Oct 13.
Granulomatous mastitis (GM) is often clinico-radiologically misdiagnosed as breast malignancy. Tuberculosis, foreign body reactions, fungal and parastic infections, and autoimmune diseases can cause GM. The present study aimed to assess the spectrum of GM on fine-needle aspiration biopsy (FNAB) smears along with its histopathological and clinico-radiological findings.
It was a retrospective study which included all cases of GM diagnosed on FNAB over a period of 3 years. The histopathological diagnosis was retrieved, wherever possible. All the FNA smears and histopathological sections were reviewed for the presence of epithelioid granulomas, necrosis, epithelioid histiocytes, inflammatory cells including plasma cells, neutrophils, eosinophils, multinucleated giant cells, and epithelial component and associated atypia, if any. The inflammatory cells and multinucleated giant cells were graded on a scale of 0 to 3+ in every case.
Among the 22 cases evaluated, the most common inflammatory infiltrate was lymphocyte followed by neutrophils and eosinophils. Caseous necrosis was appreciated in 7 (31.8%) cases, out of which 5 (22.7%) were diagnosed as tubercular mastitis on FNA smears. Ziehl Neelson stain was done in all FNAB smears and AFB was positive in 7 (31.8%) cases. Histopathological correlation was available for 14 cases (63.6%). The most common diagnosis on histopathology was idiopathic GM having lobulo-centric granulomatous inflammation, epithelioid histiocytes, neutrophils, and lymphocytes.
FNAB is a reliable and minimally invasive tool to diagnose tubercular mastitis, idiopathic GM and also ruling out clinicoradiological suspicion of malignancy. Careful examination of cytological smears can prevent an unnecessary biopsy in granulomatous lesions of breast.
肉芽肿性乳腺炎（GM）常因临床和影像学表现而误诊为乳腺癌。结核病、异物反应、真菌感染和寄生虫感染以及自身免疫性疾病都可能导致 GM。本研究旨在评估细针抽吸活检（FNAB）涂片上 GM 的表现谱，及其组织病理学和临床影像学表现。
这是一项回顾性研究，纳入了 3 年内通过 FNAB 诊断的所有 GM 病例。在可能的情况下，检索了组织病理学诊断。对所有 FNAB 涂片和组织学切片进行了评估，以确定是否存在上皮样肉芽肿、坏死、上皮样组织细胞、炎症细胞，包括浆细胞、中性粒细胞、嗜酸性粒细胞、多核巨细胞以及上皮成分和相关异型性。对每个病例中的炎症细胞和多核巨细胞进行了 0 到 3+的分级。
在评估的 22 例病例中，最常见的炎症浸润是淋巴细胞，其次是中性粒细胞和嗜酸性粒细胞。7 例（31.8%）病例中存在干酪样坏死，其中 5 例（22.7%）在 FNAB 涂片上诊断为结核性乳腺炎。对所有 FNAB 涂片均进行了齐-尼氏染色，7 例（31.8%）结果为抗酸杆菌阳性。14 例（63.6%）获得了组织病理学相关性。组织病理学上最常见的诊断是特发性 GM，表现为小叶中心性肉芽肿性炎症、上皮样组织细胞、中性粒细胞和淋巴细胞。
FNAB 是一种可靠的、微创的诊断工具，可用于诊断结核性乳腺炎、特发性 GM，还可排除临床和影像学怀疑的恶性肿瘤。对乳腺肉芽肿性病变的细胞学涂片进行仔细检查可以避免不必要的活检。
