Granulomatous lobular mastitis GLM, referred to as sarcoidosis. Ductal dilatation, known as plasmacytic mastitis until 1951, is now referred to as plasma milk. These are pathologically two completely separate diseases, and although 20% of sarcoidosis can be associated with ductal dilatation, GLM has its own unique pathology that a senior pathologist can identify. Some less experienced pathologists may also be confused with plasma milk. Now we will not talk about how to differentiate pathologically, but only talk about the top ten clinical differences between sarcoidosis and plasma milk, which we hope will be helpful to you. 1, the onset of the site is different: granuloma occurs in the glandular lobules, that is, the terminal ducts and many glandular follicles constitute the glandular lobules, which is where the milk is produced. In contrast, pulpy milk occurs in the subareolar collection of ducts or larger ducts, which are the duct system that carries milk. Because of this, 85% of granuloma masses start in the peripheral area of the breast, while 95% of pulpy breasts start in the central area of the areola, within 2 cm of the areola. The central area is where the ducts are concentrated, and the glandular lobules can be dispersed very far away. The nature of the inflammation is different: granuloma is a type IV delayed hypersensitivity reaction and is an autoimmune inflammatory disease. In contrast, plasma milk belongs to reactive inflammation, which is an inflammatory reaction of surrounding tissues triggered by the overflow of ductal contents. The average duration of granuloma is only 3 or 4 months, while the duration of plasma milk can be decades. The average age of sarcoidosis is 33 years old and rarely exceeds 40 years old, unless the child is born too late. The age of predilection for plasma milk is greater, often reaching over 50 years. 5, the clinical course is different, that is, the natural history of the disease is different: sarcoidosis has a sudden onset, rapid progression, heavy disease, with a 10% tendency to develop bilaterally at the same time or successively, a few cases can also have a remission period of 3-10 months, often mistaken for the effect of conservative treatment, but eventually there will be a sharp attack. The skin is red, swollen, and pus-filled, and the lumps may be repeated or the wounds may not heal for a long time; in a few cases, they may heal spontaneously after much suffering. The average duration of disease in our 333 breasts is only 4 or 5 months, and the longest duration of disease found so far is 4 years in one case. Pulpy breast can be clinically cured for years or decades, and the interval can be completely as normal, and then recur many times. 6, surgical recurrence rate is different: sarcoidosis currently done to expand the excision or mass excision, segmental resection, foreign literature statistics post-operative recurrence rate is 16-50%, an average of 38%, as for incision and drainage is not included in the statistics. The recurrence rate is 8-10% even though we keep improving the surgical method, and there is no guarantee that there will be no recurrence, especially local recurrence due to skin ulceration. On the contrary, as long as the ducts in the central area are removed, recurrence is rare, and the total surgical recurrence rate of plasma breast is less than 2%. 7, the tendency to invade the dermis is different: granuloma has a special affinity for the dermis, when the inflammation spreads to the skin, often forming purulent granulomatous inflammation in the dermis, the local formation of skin “crane red”. Sometimes the skin color is normal, but also can not completely exclude the involvement of small pieces of dermis, the invaded dermis if postoperative residual, it may local skin ulceration, the need to remove again. 8, lower extremity nodular erythema: so far, have not found that kind of medical books recorded nodular erythema and breast disease related. However, I can confirm that 20% of sarcoidosis is associated with erythema nodosum of the lower extremities and even the whole body, especially erythema nodosum of the feet, and confirmed by pathological biopsy sections. I now use erythema nodosum of the lower extremities as an important indicator for the diagnosis of sarcoidosis. That is, whenever inflammation of the breast is accompanied by erythema nodosum it is certain to be GLM and not plasma breast. This is because in my decades of experience in treating plasma milk, there has not been a single case of erythema nodosum of the lower extremities. 9. Multiple arthralgias and other systemic symptoms: 10% of GLM is associated with multiple arthralgias, often involving the knee and ankle joints, or small finger joints. The joint pain or redness prevents walking and even requires a wheelchair. There are also inexplicable toothache, neck and elbow pain, headache, backache, generalized lethargy, soreness and weakness, recurrent urticaria, angioneurotic edema of the face, recurrent rashes all over the body, and fever or even high fever of 40 degrees, elevated white blood cells, elevated plasma globulin IgG4, 20% hyperprolactinemia, etc. In contrast, plasma milk rarely has systemic symptoms. 10. The degree of difficulty of surgery varies greatly: although most scholars in the world currently prefer surgery for sarcoidosis, there is no recognized optimal surgical procedure for sarcoidosis, and they are all in the figuring out stage. The dramatic increase of sarcoidosis patients in our country is an excellent time for us to study sarcoidosis surgery. In contrast, surgical treatment of plasma breast has a long history and the results have long been established. The surgical approach, scope and difficulty of the two diseases, sarcoidosis and plasma breast, cannot be compared in the same way.