副乳肉芽肿性乳腺炎误诊误治反思  

Reflection on Misdiagnosis and Mistreatment of Granulomatous Mastitis in the Accessory Axillary Breast

作　　者：李楠 李丹 赵素梅 白云翠 耿晓旭 LI Nan;LI Dan;ZHAO Sumei;BAI Yuncui;GENG Xiaoxu(Department of Functional Medicine,the First Rongjun Youfu Hospital of Hebei Province,Xingtai,Hebei 054000,China)

机构地区：[1]河北省第一荣军优抚医院功能科,河北邢台054000

出　　处：《临床误诊误治》2025年第4期17-21,共5页Clinical Misdiagnosis & Mistherapy

基　　金：邢台市重点研发计划项目(2022ZC163)。

摘　　要：目的分析副乳肉芽肿性乳腺炎临床误诊原因及防范措施。方法回顾分析2021年6月至2023年6月被误诊的2例副乳肉芽肿性乳腺炎患者的临床资料。结果1例因“发现左腋下肿块伴疼痛2个月余”就诊,超声及乳腺MRI检查提示恶性病变,初步考虑为左侧副乳腺癌,遂行手术切除,术中见左副乳外侧肿物,质偏硬,边界欠清,术后病理诊断为左侧副乳肉芽肿性乳腺炎。误诊时间13 d。术后随访6个月,情况良好。1例因“右腋前肿物及红肿、疼痛1个月”入院,经彩色多普勒超声检查诊断为乳腺炎,接受抗感染治疗,治疗期间肿物增大并伴红肿。进一步行彩色多普勒超声检查考虑右侧副乳肉芽肿性乳腺炎,予中药口服和药物外敷后肿块溃破,流出黄色脓性分泌物,行乳腺增强MRI示右乳内下象限非肿块强化灶,炎症可能。予乳腺区段+副乳切除术,术后病理检查诊断为右侧副乳肉芽肿性乳腺炎。误诊时间11 d。术后3个月复查示右乳切口愈合良好,未见复发与其他异常情况。结论副乳肉芽肿性乳腺炎临床较为罕见,且缺乏特异性临床表现及检查措施,易被误诊为乳腺癌、乳腺炎等疾病。对于乳腺肿块,临床及病理科医生应加强认识,考虑到肉芽肿性乳腺炎等良性疾病的可能,以减少或避免误诊误治。Objective To analyze the causes of clinical misdiagnosis and preventive measures of granulomatous mastitis(GM)in the accessory axillary breast.Methods The clinical data of 2 patients with GM in the accessory axillary breast who were misdiagnosed from June 2021 to June 2023 were retrospectively analyzed.Results One patient presented with left axillary mass with pain for more than 2 months.Ultrasound and breast magnetic resonance imaging(MRI)indicated malignant lesions,which was initially considered to be left accessory breast cancer(ABC),and surgical resection was performed.During the operation,lateral mass of left accessory breast with hard quality and poorly defined boundary was found,and the postoperative pathological diagnosis was GM in the left accessory axillary breast.The misdiagnosis lasted 13 d.The postoperative follow-up was favorable for 6 months.One patient was admitted with right anterior axillary mass,redness,and pain for 1 month,was diagnosed with mastitis by color Doppler ultrasonography and received anti-infection treatment,during which the mass was enlarged with redness and swelling.GM in the right accessory axillary breast was considered by color Doppler ultrasound in our hospital.After oral administration of traditional Chinese medicine and external application of drugs,the mass burst and yellow purulent secretions were discharged.Enhanced MRI of the breast was performed to show non-tumor enhancement in the lower quadrant of the right breast,indicating the possibility of inflammation.The patient was treated with breast segment plus para-mastectomy and the postoperative pathological examination revealed GM in the right accessory axillary breast.The misdiagnosis lasted 11 d.Reexamination at 3 months after operation showed that the right breast incision healed well,and no recurrence or other abnormal conditions were found.Conclusion GM in the accessory axillary breast is rare in clinical practice,and lacks specific clinical manifestations and examination measures;therefore,it is more likely to be

关 键 词：副乳肉芽肿性乳腺炎 误诊 乳腺癌 乳腺炎 鉴别诊断 钼靶X线 磁共振成像 病理 

分 类 号：R655.8[医药卫生—外科学]