乳腺脂肪坏死的X线表现及病理对照研究

目的 探讨乳腺脂肪坏死的X线表现及病理基础，提高对脂肪坏死的认识。方法 回顾性分析经手术、病理证实的91例（其中2例为双侧乳腺脂肪坏死，共93个病变。）脂肪坏死X线表现，并与病理结果对照。结果 主要X线表现：（1）无任何异常X线发现14例（15．4％）；（2）脂性囊肿6例（6．6％）；（3）表现为肿物20例（22．0％），其中1例为双侧乳腺脂肪坏死；（4）表现为小结节13例（14．3％）；（5）脂肪层内星芒影、斑片影、索条影混杂出现28例（30．8％），其中1例为双侧乳腺脂肪坏死；（6）脂肪层内索条影交织呈网状5例（5．5％）；（7）结构不良者5例（5．5％）。分布部位：（1）位于脂肪层内55例；（2）向脂肪层突出或位于脂肪层与腺体交界处13例，常规位摄片位于脂肪层与腺体交界处的脂肪坏死，切线位投照有利于将病变显示于脂肪层内；（3）位于腺体之间9例；（4）乳腺平片未见异常发现14例。病理表现：（1）脂性囊肿是病变早期的特征性X线表现。（2）脂肪层内不均匀密度肿物影或小结节影为病变中期的特征性表现，反应了纤维组织逐渐替代了液化坏死的脂肪组织。（3）脂肪层内或浅层腺体内局限星芒状致密影以及不规则的网状影最常见，是病变后期的特征性表现。反应了坏死脂肪组织被吸收，周围残留部分纤维组织。通常不同病理时期的X线表现常同时出现。结论 乳腺X线摄影对于脂肪坏死具有重要诊断价值。

Mammographic manifestations and pathologic study of fat necrosis of the breast

Objective To discuss mammographic findings and pathologic foundation of the fat necrosis of the breast and to improve the imaging diagnosis of the fat necrosis of the breast. Methods The mammographic findings of 91 cases with pathologically proved breast fat necrosis were retrospectively analyzed, of which 2 cases were bilateral breast fat necrosis, and a comparison with pathological results was made. Results The mammographic findings included (1)No abnomal mammographic findings (n=14, 15.4%);(2) Single and multiple lipid-cysts (n=6, 6.6%);(3) Masses (n=20, 22.0%), of which 1 case was bilateral breast mass;(4) Nodules (n=13, 14.3%);(5) Focal opacities like stars or pieces in the subcutaneous fat layer (n=28, 30.8%), of which 1 case was bilateral breast lesion;(6) Faint reticular opacity in the subcutaneous fat layer (n=5, 5.5%);(7) Structure distortion (n=5, 5.5%). The location of the liesions:(1) 55 lesions located in fat layer;(2) 13 lesions standed out to the fat layer or located the boundary of the fat layer and breast parenchyma. When routine mammography demonstrated the disease located the boundary of the fat layer and breast parenchyma, there will be helpful with tangent location mammography to show the disease in the subcutaneous fat layer;(3) 9 lesions located in the breast parenchyma;(4) 14 lesions did not find abnormity in the mammography. The pathologic appearance (1) A lipid cyst is the characteristic mammographic finding in the early stage of the lesion;(2) Asymmetry density masses or nodules in the subcutaneous fat layer is the characteristic mammographic finding in the metaphase stage of the lesion, which hinted necrotic fatty tissue gradually be replaced by fibrous tissue;(3) Focal opacities like stars and irregular reticulation findings in the subcutaneous fat layer or superficial layer adenoid tissues are the characteristic mammographic findings in the later stage of the lesion, which hinted that necrotic fatty tissue was licked up, circumference remained some fibrous tissue.The mammographic findings of the different pathological stages often appear in the same time. Conclusion The mammographic findings of fat necrosis of breast was different in its different stage. The mammography is very helpful for making the diagnosis of breast fat necrosis.