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患者,女,34岁,未婚。左乳房肿块7年,发现时位于乳头上方,大小约4cm×3cm×2cm,扁圆形、质硬、无痛,生长缓慢,5年后增至6cm×5cm×4cm。近2年增长加快伴胀痛,肿块充填整个左乳。于2月前中央红肿、破溃,伤口有较多坏死组织及分泌物,味恶性臭,不愈,首次来本院治疗。门诊连续两次取溃疡面组织活检,均报告“慢性炎症,未见癌细胞。”查体:营养中等,左乳房显著增大,巨大肿块占据左乳。大小25cm×18cm×10cm,质地坚硬,表面中央部破溃呈菜花样,创面10cm×8cm,灰黑色,有较多坏死组织及渗液,恶臭味,基底可推动。左腋窝未扪及肿大淋巴结,右乳正常。胸部X线检查心肺膈未见异常。1周后行左乳房单纯切除术,距肿块边缘3～5cm行梭形切口,游离两侧皮瓣,将胸大肌筋膜连同乳腺组织整块切除。标本观察:切面呈灰白色,有直径2.5～4.0cm多个结节,其间有多房性小囊泡,充满淡黄色浆液,可见陈旧性出血坏死灶,无钙化。包
Patient, female, 34 years old, unmarried. The left breast mass was 7 years old. It was found on the nipple, measuring approximately 4cm x 3cm x 2cm in size. It was oblate, hard and painless, and grew slowly. It increased to 6cm x 5cm x 4cm 5 years later. In the last 2 years, the increase has accelerated with pain, and the mass has filled the entire left breast. After 2 months of central swelling, ulceration, wounds have more necrotic tissue and secretions, taste malignancy, unhealed, for the first time to the hospital for treatment. Outpatient clinics took two consecutive biopsy of ulcers and reported “chronic inflammation without cancerous cells.” Physical examination: Moderate nutrition, left breast significantly enlarged, huge mass occupying left breast. Size 25cm × 18cm × 10cm, texture is hard, the central surface of the surface is ulcerated cauliflower, wound surface 10cm × 8cm, gray and black, there are more necrotic tissue and exudate, bad odor, the substrate can promote. The left axillary fossa was not enlarged and the lymph nodes were enlarged. The right breast was normal. Chest X-ray examination showed no abnormalities in cardiopulmonary fistula. One week later, a simple resection of the left breast was performed. A 3-5 cm incision at the edge of the tumor was performed with a spindle-shaped incision and free flaps on both sides. The pectoralis major fascia was removed together with the entire breast tissue. Specimen observation: cut surface was gray, a plurality of nodules 2.5 ~ 4.0cm in diameter, during which there are multi-room small vesicles, full of pale yellow serum, visible old hemorrhage and necrosis, no calcification. package