Granulomatous mastitis is a group of chronic inflammatory diseases of the breast with granulomas as the main pathological feature, including several clinical conditions, one of which is more common, the etiology is unknown, granulomatous inflammation centered on the lobules of the breast, so it is called granulomatous lobular mastitis (GLM), first reported by Kessler in 1972, the name of the disease is recognized by most scholars. It was previously called idiopathic granulomatous mastitis, mammary granulomatosis or granulomatous lobulitis, a granulomatous lesion of the breast with non-caseous necrosis confined to the lobules, in which no pathogen can be identified, probably an autoimmune disease, like granulomatous thyroiditis and granulomatous orchitis, easily confused with tuberculous mastitis.
Etiology.
1. autoimmune diseases: local immune phenomena and local hypersensitivity reactions induced by breast milk. Non-bacterial infections, associated with the application of oral contraceptives. It may also be related to infection, trauma, chemical irritation causing inflammation, destruction of the ductal epithelium, entry of luminal contents into the lobular mesenchyme, causing granulomatous reaction and further destruction of lobular structures. It is more likely to occur in women of childbearing age and married women who have given birth.
2.It may be due to the milk, secretions and keratinized epithelium in the ducts escaping into the lobular mesenchyme, causing local inflammatory reaction and hypersensitivity reaction, resulting in the formation of granuloma.
3, Microabscesses, epithelioid macrophages and foreign body granuloma formation are seen in the lesion. It is believed that the disease occurs as a result of local infection, trauma and chemical substance-induced inflammation, which causes granulomatous inflammation due to inflammatory injury resulting in destruction of the ductal epithelium and entry of ductal luminal contents into the interlobular stroma.
Pathological changes.
Macroscopic examination: masses of varying sizes without envelope, some with solid cut surfaces, grayish, hard and stained. Scattered necrotic foci in the form of rotten flesh filling, multiple abscesses of varying sizes, rice soup-like or yellowish-white thick pus, in short, a variety of lesions. Light microscopy: the lobular structure of the breast was still contoured, and at low magnification the lobules were observed to have most granulomas, some of which were fused with each other. High magnification showed foreign body type multinucleated giant cells, epithelioid cells, eosinophils, neutrophils and lymphocytes constituting granuloma lesions. The microscopic findings were chronic inflammation of the breast tissue with scattered or large necrotic fusion of granulomas with multinucleated giant cell reaction, lymphocyte and monocyte infiltration, some with eosinophil infiltration, and mostly with abscess formation.
Pathological diagnosis: granulomatous lobular mastitis, abbreviated GLM.
Diagnosis of granulomatous lobular mastitis
Clinical manifestations: the average age is 30 years and the duration of the disease is short, all within 5 months.
The main manifestations are: breast lumps, painful, hard, irregular in shape and poorly defined from normal tissues, and also ipsilateral axillary lymph node enlargement. The onset of the disease is sudden or the lump suddenly increases in size, and a few days later the skin becomes red and forms a small abscess, which breaks down with little pus and does not heal for a long time, and the redness and swelling breaks down one after another.
The initial lump phase is similar to breast cancer, which may lead to misdiagnosis and mistreatment. Some people rashly perform radical mastectomy for breast cancer and should wait patiently for the results of paraffin section on the table. The disease must also be differentiated from breast tuberculosis and fat necrosis of the breast.
When there is redness and pus, it may be misdiagnosed as plasmacytoid mastitis, ductal dilatation, breast tuberculosis, or bacterial abscess in general, with incorrect incision and drainage.
The main causes of misdiagnosis
1. Patients who present with a painless lump that is hard, not smooth, and mildly adherent to the skin and surrounding tissues, without pressure pain or light pressure pain, or with enlarged lymph nodes in the ipsilateral axilla, with features resembling breast cancer;
2. No preoperative cytological examination of lump aspiration smear was performed, if the needle aspiration cytological examination is inflammatory cells, it will help to differentiate it from breast cancer;
3. Because of the rarity of this disease, clinicians are not aware of it and lack vigilance;
To reduce misdiagnosis, the following points should be noted.
1. Patients are mostly young women with a short course of disease;
2, for patients with breast lumps, needle aspiration cytology should be performed to help the clinical differential diagnosis; needle aspiration mostly sees inflammatory cells, no cancer cells;
3. When there is suspicion on the operating table, on-stage freezing or waiting for paraffin results should be done, and the breast should not be removed rashly.
Treatment of granulomatous lobular mastitis
1, granulomatous lobular mastitis once diagnosed, surgical treatment is more effective, and the key is to clarify the diagnosis. Surgery is the main means of treating this disease, both to completely remove the lesion to prevent recurrence, and to maximize the preservation of normal tissue, plastic surgery on stage, and try to maintain the perfection of the breast.
2, post-operative Chinese medicine treatment for at least six months, change the body hypersensitive state, purge residual lesions, reduce recurrence.