Diagnosis of plasmacytoid mastitis Recently, more and more patients with plasmacytoid mastitis have been coming to the clinic. The most important concern of the patients, I specially compiled the following article to talk about. The incidence of plasmacytoid mastitis has long been thought to be low, but it is not. The reason for the “low” incidence is as follows: Lishui People’s Hospital Thyroid Breast Surgery Lin Zhongmin 1, there is no uniformity in the name of the diagnosis around, there is still controversy. Each speaks of its own, artificially causing a “perceived” incidence of few. The name of the disease used in our breast department is “plasmacytoid mastitis”, but perhaps other hospitals in other provinces and cities do not use this diagnostic name; the name of the disease in Chinese medicine is “acne vulgaris”, which is also not found in ancient Chinese medical texts. Personally, I think that if all non-lactating mastitis is grouped into one category – ductal dilation. The incidence would not be very low. Many women (and male patients too, very rarely) find breast lumps, visit various hospitals, and get cured with either medication or surgery, but at that time the doctor does not give a clear diagnosis and the disease gets better without pursuing what it really is. Statistically speaking it was missed. Second, the cause of morbidity: Strictly speaking, all diseases that are not injected after birth, the cause of morbidity is still unclear, common, such as hypertension, diabetes, terrible, such as a variety of cancer are such. The current causes or predisposing factors are the result of long-term observation of cases by medical personnel, which is strictly an “inference” rather than direct evidence. In the case of plasmacytoid mastitis, patients with sunken nipples, localized trauma to the breast, high prolactin levels or clear pituitary tumors are more common. The younger patients are more likely to have a large spread at once after the onset of the disease, while older patients have a relatively limited range of lesions. Clinical manifestations: Initially, the patient may only have a lump in the breast, or it may be accompanied by redness and swelling of the breast skin, which is not particularly typical and misdiagnosis is very common. In some patients, the lump resembles breast cancer and the imaging examination also suggests “breast cancer”, but the diagnosis of “inflammation” is not confirmed until the pathological examination by puncture. Therefore, the experience of the doctor is important in the early stage of the disease. In early stage patients, if medication is administered promptly, surgery can be avoided much more often than after the disease has progressed. Most commonly, patients have progressive enlargement of the lesion, which manifests as red, swollen and ulcerated skin. Fourth, the examination: plasmacytoid mastitis is non-bacterial, so laboratory tests for blood leukocytes are often not high. Instead, sex hormone indicators, especially the level of prolactin, need to be checked, and some indicators related to immunity also need to be checked. In terms of imaging, ultrasound and MRI are more appropriate, while mammography is often more aggravating because of the need to squeeze the breast. V. Treatment: The treatment of some diseases has gained consensus among medical professionals, such as acute appendicitis requiring appendectomy, hernia requiring hernia repair to strengthen the weak area, and uremia requiring hemodialysis. There are also some complex diseases for which consensus has not been achieved. Plasmacytoid mastitis is precisely such a disease. The reason for this analysis is that all treatments have advantages and disadvantages, there are no absolute advantages and all have disadvantages. Simply put, there is no very perfect treatment. The following treatment methods are now applied: 1. Remove most of the diseased tissue, traditional Chinese medicine open wound change. Disadvantages: the treatment time is longer, the pain of changing medicine is greater; sometimes the treatment process requires another surgery on the patient’s psychological blow. 2.Complete removal of lesion tissue, direct suturing of the incision. Disadvantages: more tissues need to be removed, in case they are not cleared and sutured, it is easy to recur and lead to another operation which is a big psychological blow to the patient. 3.Non-surgical treatment, long-term conservative Chinese medicine. Disadvantages: conservative often need more than 6 months to see whether there is a curative effect, if you adhere to a long time but eventually need surgery, the patient psychological blow is larger. 4, foreign countries believe that this disease belongs to autoimmune diseases, often apply corticosteroids and immunosuppressive therapy. Immunosuppressants are sometimes used in patients with malignant tumors, and Chinese people often refuse to see “hormones” and “chemotherapy drugs”. In fact, in many cases, corticosteroid and immunosuppressive therapy are effective. In all of these approaches, I have placed great importance on the psychological impact on the patient, because plasmacytoid mastitis is a benign disease that is not fatal in the end. 40 years ago it was treated by mastectomy, and the patient did not relapse and could accept it. But today, the vast majority of patients would not want to have their breasts removed. It is important to understand, then, that as long as the breast exists, the chance of recurrence of the same disease exists. Many patients are treated in some way and find it difficult to accept that the disease has recurred after they have already suffered a lot. As already mentioned, the cause of the disease is not clear – there is no preventive shot, so none of the above methods has eliminated the recurrence of the disease. There are cases of successful treatment by various methods, and there are also cases of failure. Different doctors have different clinical experience and prefer different treatment methods. I think that the patient’s own attitude or needs are very important in choosing. If you want to get both the fish and the bear’s paw, maybe your doctor will let you find another one.