肉芽肿性小叶性乳腺炎误诊临床分析  

Clinical Analysis of Misdiagnosis of Granulomatous Lobular Mastitis

作　　者：周海洋 李浩 王石林 魏学明 王妍 郑子阳 张玉辉 ZHOU Haiyang;LI Hao;WANG Shilin;WEI Xueming;WANG Yan;ZHENG Ziyang;ZHANG Yuhui(Department of General Surgery,Air Force Specialty Medical Center,Beijing 100036,China)

机构地区：[1]空军特色医学中心普通外科,北京100036

出　　处：《临床误诊误治》2024年第6期10-13,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨肉芽肿性小叶性乳腺炎的临床特点、误诊原因和防范措施。方法回顾性分析2018年1月—2023年12月收治的曾误诊的18例肉芽肿性小叶性乳腺炎的临床资料。结果本组16例以乳腺肿块就诊,2例以皮肤破溃流脓就诊;13例误诊为炎性乳腺癌,5例误诊为乳腺结核。误诊时间7~22(9.31±1.36)d。误诊为炎性乳腺癌患者手术切除病灶进行病理学检查,确诊为肉芽肿性小叶性乳腺炎。误诊为乳腺结核患者抗结核治疗后反复发作,行手术治疗,分泌物行细菌培养及病原学检查均为阴性,病理学检查确诊为肉芽肿性小叶性乳腺炎。所有患者进行外科手术治疗,将乳腺病灶完整切除,切除后行抗感染治疗7 d,14例术后口服醋酸泼尼松30 d,其余4例未使用口服药物。本组18例均治愈。结论肉芽肿性小叶性乳腺炎较为罕见且无典型临床表现,容易与乳腺癌、结核性乳腺炎等疾病混淆,发生误诊。临床医生需加强对肉芽肿性小叶性乳腺炎的疾病知识学习,提高对其警惕性,综合分析病情,认真鉴别诊断,以减少肉芽肿性小叶性乳腺炎误诊的发生。Objective To investigate the clinical features,causes of misdiagnosis and preventive measures of granulomatous lobular mastitis(GLM).Methods The clinical data of 18 misdiagnosed patients with GLM treated from January 2018 to December 2023 were retrospectively analyzed.Results In this group,16 patients presented with breast mass,and 2 patients presented with skin ulceration and pus.Thirteen patients were misdiagnosed as inflammatory breast cancer and 5 patients were misdiagnosed as breast tuberculosis.The duration of misdiagnosis was 7-22(9.31±1.36)d.The patient misdiagnosed with inflammatory breast cancer was diagnosed with GLM after surgical resection and pathological examination.The patient misdiagnosed with breast tuberculosis had recurrence after anti-tuberculosis treatment,and underwent surgical resection.The secretions were tested by bacterial culture and pathogen testing,all of which were negative.The pathological examination confirmed the diagnosis as GLM.All patients underwent surgical treatment,the breast lesions were completely removed,and anti-infective treatment was given for 7 d after resection.Of them,14 patients took oral prednisone acetate for 30 d after surgery,and the other 4 patients did not take oral drugs.All the 18 patients were cured.Conclusion GLM is rare and has no typical clinical manifestations.It is more likely to be confused with breast cancer and tuberculous mastitis and misdiagnosed.It is necessary for clinicians to strengthen the knowledge of GLM,enhance the vigilance of the disease,comprehensively analyze the condition,and perform the differential diagnosis carefully,so as to reduce the misdiagnosis of GLM.

关 键 词：肉芽肿性小叶性乳腺炎 误诊 炎性乳腺癌 乳腺结核 病理学 磁共振成像 诊断 鉴别诊断 

分 类 号：R655.8[医药卫生—外科学]