摘要目的 探讨乳腺肉芽肿性小叶性乳腺炎的临床病理学特征.方法 收集上海中医药大学附属龙华医院2015年1月至2017年11月病理诊断为肉芽肿性小叶性乳腺炎手术切除标本300例及患者资料.常规石蜡制片,HE染色,116例行革兰染色.采用免疫组织化学EnVision法检测CD3、CD20、CD68、IgG、IgG4、CD38、CD138的表达.结果 本组患者年龄23～47岁,中位年龄32岁.患者均为女性,96.7%(290/300)有哺乳史.病变发生于左乳143例,右乳138例,双侧乳腺19例.39.7% (119/300)患者血清泌乳素升高,37.0%(111/300)红细胞沉降率升高,15.7%(47/300)合并下肢结节性红斑或关节肿痛.组织学形态为以小叶为中心的化脓性肉芽肿性炎,可伴随小叶内及小叶间导管扩张,合并导管扩张症者16例.肉芽肿病变中中性粒细胞聚集带外周CD3+淋巴细胞多于CD20+淋巴细胞.51.7%(60/116)病灶可见革兰阳性杆菌.结论 肉芽肿性小叶性乳腺炎有其独特的组织学特征,该病可能与棒状杆菌感染有关,患者可伴随血清泌乳素及红细胞沉降率升高.发病年龄、部位及病史对其诊断及鉴别诊断有重要意义.

abstractsObjective To investigate the clinicopathologic features and possible causes of granulomatous lobular mastitis(GLM). Methods Three hundred cases of GLM were collected from surgical specimens diagnosed at Longhua Hospital, Shanghai University of Traditional Chinese Medicine from January 2015 to November 2017. Morphologic features were reviewed using HE staining. A total of 116 cases were investigated by Gram staining. The expression of CD3, CD20, CD68, IgG, IgG4, CD38 and CD138 was detected by immunohistochemical staining. Results The age of the patients was 23 to 47 years and the median age was 32 years. All patients were female, 96.7% (290/300) had a history of lactation.There were 143 cases of left breasts, 138 cases of right breast and 19 cases of bilateral breasts. Serum prolactin increased in 39.7%(119/300) patients. Within 15.7%(47/300) of patients were associated with nodular erythema or joint swelling and pain of the lower extremities. Pathological observation showed that lobular?centric suppurative granulomatous inflammation, accompanied by dilatation of intralobular and interlobular ducts. There were 16 cases accompanied with duct ectasia. Immunohistochemistry showed CD3?positive lymphocytes were more than CD20?positive lymphocytes in the peripheral aggregation zone of neutrophils within granulomatous lesions. Gram positive bacteria were found in the lipid vacuoles of the 51.7%(60/116) patients. Conclusions GLM has distinctive histologic features. It may be related to corynebacterium infection, or accompanied by the increase of serum prolactin and erythrocyte sedimentation rate. The age, location and history of the disease are importance in the diagnosis and differential diagnosis.