病例报告：年轻女性新生乳房肿块一例（上）
病例梗概：患者女性，28岁，无炎症或感染的临床症状，但有疲劳症状，由于左乳上方突发扩散性疼痛伴水肿并可扪及腋窝淋巴结而入院急诊。您的诊断如何？
2017年7月12日，《美国医学会杂志外科学分册》在线发表意大利托斯卡纳西北地区医院、比萨大学的病例报告：年轻女性新生乳房肿块一例。
患者女性，28岁，急诊入院，主诉左乳上方突发扩散性疼痛伴水肿并可扪及腋窝淋巴结，不伴炎症或感染的临床症状（图1A）。无发热、无皮肤发红，但有乏力。
图1、患者初步表现。A、左乳上方不规则肿块。B、乳房超声提示乳腺组织低回声伴导管周围小囊肿。
患者于急诊入院前10个月停止哺乳，近期有肺炎并自行使用抗生素史，无乳腺癌或卵巢癌家族史，无药物成瘾史，无乳房透明质酸或硅胶注射史，否认乳房创伤史。
体检：乳房肿块大小6cm，质硬，无乳头溢液或内陷，左腋可扪及淋巴结。
乳房超声提示乳腺组织弥漫性非特异性低回声伴导管周围小囊肿（图1B）。乳腺钼靶提示左上象限扭曲、密度不均。
左乳上方多次14G超声引导活检和肿大淋巴结细针抽吸细胞学检查提示为肉芽肿性炎症伴上皮样组织细胞、淋巴细胞、浆细胞、嗜酸性粒细胞，淋巴结正常。
血液检测结果：乙型肝炎表面抗原、丙型肝炎抗体、人体免疫缺陷病毒酶联免疫吸附试验、全血γ干扰素释放试验（QuantiFERON）阴性，IgG巨细胞病毒阳性，纤维蛋白原234mg/dL（6.88μmol/L），红细胞沉降率：4mm/h，白细胞计数：7660/uL（7.66×10+9/L）；无获得性免疫抑制；无血液病变。
JAMA Surg. 2017 Jul 12. [Epub ahead of print]
A Young Woman With a New Breast Mass.
Iacconi C, Vatteroni G, Ginori A.
Aziende USL Toscana Nord Ovest, Carrara, Italy; University of Pisa, Pisa, Italy.
A 28-year-old woman without clinical signs of inflammation or infection but with symptoms of fatigue visited the emergency department for a sudden, diffuse, and painful enlargement of the upper quadrants of the left breast with edema and palpable axillary lymph nodes. What is your diagnosis?
A 28-year-old woman visited the emergency department for a sudden, diffuse, and painful enlargement of the upper quadrants of the left breast with edema and palpable axillary lymph nodes without clinical signs of inflammation or infection (Figure 1A). She had neither fever nor skin redness but was experiencing fatigue.
Figure 1. Initial presentation of the patient. A, Asymmetric mass in the upper quadrant of the left breast. B, Breast ultrasonogram revealing hypoechogenicity of the breast tissue with periductal small cysts.
The patient had stopped breastfeeding 10 months before the emergency department admission, and she had a recent history of pneumonia self-medicated with antibiotics. She had no family history of breast or ovarian cancer and no history of drug addiction or hyaluronic acid or free silicone injections in the breast. She denied any trauma to the breast.
On physical examination, the patient had a 6-cm hard mass without nipple discharge or retraction and left axillary palpable lymph nodes. Breast ultrasonography revealed diffuse nonspecific hypoechogenicity of the breast tissue with periductal small cysts (Figure 1B). Mammography revealed asymmetric density and distortion in the left upper quadrants.
Multiple 14-gauge ultrasound-guided biopsies in the upper quadrants of the left breast and fine-needle aspiration cytologic testing of an enlarged lymph node revealed granulomatous inflammation with epithelioid histiocytes, lymphocytes, plasma cells, and eosinophils. Lymph nodes were normal.
Blood test results were as follows: hepatitis B surface antigen, hepatitis C antibody, human immunodeficiency virus enzyme-linked immunosorbent assay, and whole-blood interferon γ release assay (QuantiFERON), negative; IgG cytomegalovirus, positive; fibrinogen level, 234 mg/dL (to convert to micromoles per liter, multiply by 0.0294); erythrocyte sedimentation rate, 4 mm/h; leukocyte count, 7660/uL (to convert to ×10+9/L, multiply by 0.001); no acquired immunosuppression; and no hematologic disorders.
What Is Your Diagnosis?
Inflammatory breast cancer
Tuberculous mastitis
Idiopathic granulomatous mastitis
Mastitis caused by immunosuppression
PMID: 28700787
DOI: 10.1001/jamasurg.2017.2172