Plasmacytoid mastitis, or PCM for short, is also known as parareolar abscess, fistula, and ductitis. Granulomatous lobular mastitis, or GLM for short, is the most common of the ambiguous names for granulomatous mastitis, also known as idiopathic granulomatous mastitis. The two diseases are sometimes so similar in appearance that many physicians cannot distinguish between them and often refer to them collectively as plasma cell mastitis, diagnosing “plasma milk” when in fact many are “granulomas” and even making obvious conceptual errors in the discharge summary documentation. The patient is even more confused and does not know which article to consult online. If you have seen the scattered rotten flesh-like lesions of sarcoidosis, you will understand how helpless local incision and drainage is. In order for you to distinguish between these two sisters, a brief overview is as follows: 1. Age and breastfeeding: The age of onset of plasma milk is small, often unmarried girls, mostly in their 20s. Sarcoidosis is mostly menstrual, with onset within 3-5 years after childbirth, on average over 30 years old, and is associated with breastfeeding disorders, hormonal drugs, etc. In terms of age, pulpy breast is the sister and sarcoidosis is the sister. Why are they called sisters? Because both belong to the same family of non-lactating chronic inflammatory diseases, both are related to the stimulation of their own substances (lipidic substances in the large ducts or milk in the alveoli), and both have autoimmune granuloma formation. It is only the degree and nature of the reaction that differs (irritant inflammation and hypersensitivity), with the sister being gentler and having a slightly slower onset. The sister is violent in nature, with sudden onset or lightning aggravation. The sister is a local inflammation, the sister is a whole breast inflammation. 2, etiology and pathogenesis: pulpy breast is related to nipple deformity, nipple entropion, splitting to form a place to hide dirt, do not get cleaned, large ducts under the nipple twisted and blocked, the contents of the overflow, inducing plasma cells, lymphocyte invasion, gradually forming small lumps, followed by redness, breaking out of pus, although repeated, but can be temporarily relieved or short-term cure. Granuloma is a hypersensitive reaction to the previous accumulation of milk, the follicular lobules are the place of secretion and accumulation of milk, so the inflammatory reaction is centered on the lobules, scattered and widespread, not connected to each other, once the onset will not stop, late large lesions necrosis, fusion, redness, swelling, pus, one after another, can not be stopped. The first site is around the areola, while the granuloma is centered on the lobe. The first site is in each quadrant, far away from the nipple. Both of them are mainly manifested by lumps, pain, redness and swelling, and pus out of breaking, and the systemic symptoms are not obvious. However, plasma breast lumps are small, painful and tolerable, and the onset is relatively slow, mostly small abscesses next to the areola, and only when secondary bacterial infection occurs do the abscesses become larger and form a single abscess cavity with normal surrounding glandular fat. The percentage of misdiagnosis of granuloma as cancer is higher if the initial mass is not painful. However, granuloma often becomes large suddenly or distantly, with multiple abscesses, severe pain and deep impression, so the patient can remember the specific date of onset and the onset of the disease. 5. Difficulty of treatment: Although pulpy breast is prone to recurrence, it will not recur as long as the subpapillary lesion is completely removed, but it may affect papillary blood flow and partial necrosis occurs. The effect of early complete excision of granuloma is still good, but when the lesions spread to the whole breast, local excision does not help, the lesions are scattered, not connected to each other, all cut can only be identified by the naked eye. The total excision must have a great impact on the appearance of the breast, so the doctor faces a difficult choice, the operation is time-consuming and laborious, and bleeding is also much more difficult than that of the pulpy breast.