Our Therapeutic Approach to Idiopathic Granulomatous Mastitis

Year 2018, , 88 - 92, 20.05.2018

Süleyman Bademler , Muhammed Zubeyr Ucuncu

https://doi.org/10.21673/anadoluklin.418775

Abstract

Aim: Granulomatous mastitis is a rare disease of the breast. Initial findings during admission can be mistaken for breast cancer. In this study, we aimed to present our experience with idiopathic granulomatous mastitis (IGM).

Materials and Methods: Patients who had been treated and followed up after a diagnosis of GM at the surgical clinic of the Istanbul University Institute of Oncology between 2007 and 2017 were categorized into two groups: those who had received steroid treatment only (Group 1), and those who had received steroids in combination with surgical treatment (Group 2). The groups were compared in terms of clinical and demographic characteristics and recurrence rates.

Results: We included a total of seventy-nine patients in our study. The mean patient age was 36.41±6.93 years and the mean follow-up 57.34±20.39 months. There was no significant difference between the two groups in terms of mean age, age at menarche, maternal age at first delivery, and the side involved (right, left, bilateral). The disease had recurred in 19 patients in Group 1 while no recurrence had been observed in Group 2 (p=0.001).

Discussion and Conclusion: IGM is a disease that is rare but easily mistakable for breast cancer. The diagnosis necessitates confirmation through a biopsy. Steroid therapy combined with surgery can be the first choice in the treatment of this disease, on which no consensus has yet been reached. Such combination is capable of reducing recurrence rates. 

Keywords

granulomatous mastitis, autoimmune disease

İdiyopatik Granülomatöz Mastitte Tedavi Yaklaşımımız

Abstract

Amaç: Granülomatöz mastit nadir görülen bir meme hastalığıdır. Müracaat bulguları meme kanseri ile karıştırılabilir. Bu çalışmada idiyopatik granülomatöz mastit (İGM) deneyimimizi sunmayı amaçladık.

Gereç ve Yöntemler: İstanbul Üniversitesi Onkoloji Enstitüsü Cerrahi Polikliniği’nde granülomatöz mastit tanısı ile 2007–2017 döneminde tedavi ve takip edilmiş olan hastalar, sadece steroit tedavisi görmüş olanlar (Grup 1) ve steroit tedavisine ilaveten cerrahi tedavi görmüş olanlar (Grup 2) olarak iki gruba ayrıldı. Gruplar klinik ve demografik özellikleri ile nüks oranları açısından karşılaştırıldı.

Bulgular: Çalışmamız kapsamına toplam 79 hasta alınmıştır. Hastaların ortalama yaşı 36,41±6,93 yıl, ortalama takip süresi 57,34±20,39 ay idi. İki grup arasında yaş ortalaması, ilk adet yaşı, ilk doğum yaşı ve tutulan taraf (sağ, sol, bilateral) yönünden anlamlı fark yoktu. Grup 1’de 19 hastada nüks gözlenirken Grup 2’de hiç nüks gözlenmemişti (p=0,001).

Tartışma ve Sonuç: İGM nadir görülen fakat meme kanseri ile karıştırılabilen bir hastalıktır. Tanıda biyopsi ile teyit şarttır. Tedavisi konusunda henüz konsensüse varılamamış olan bu hastalıkta steroit tedavisiyle cerrahi tedavinin kombine edilmesi ilk tercih olabilir. Bu kombinasyon ile nüks oranları azaltılabilmektedir. 

Keywords

granülomatöz mastit, otoimmün hastalıklar

References

• 1. Kessler E, Wolloch Y. Granulomatous mastitis: a lesion clinically simulating carcinoma. Am J Clin Pathol. 1972;58:642–6.2. Diesing D, Axt-Fliedner R, Hornung D, Weiss JM, Diedrich K, Friedrich M. Granulomatous mastitis. Arch Gynecol Obstet. 2004;269:233–6.3. Panzacchi R, Gallo C, Fois F, Cucchi MC, Degli Esposti R, Foschini MP. Primary sarcoidosis of the breast: case description and review of the literature. Pathologica. 2010;102:104–7.4. Asoğlu O, Ozmen V, Karanlik H, Tunaci M, Cabioglu N, Igci A, et al. Feasibility of surgical management in patients with granulomatous mastitis. Breast J. 2005;11:108–14.5. Ayeva-Derman M, Perrotin F, Lefrancq T, Roy F, Lansac J, Body G. Idiopathic granulomatous mastitis: review of the literature illustrated by four cases. J Gynecol Obstet Biol Reprod. 1999;28:800–7. 6. Mohammed S, Statz A, Lacross JS, Lassinger BK, Contreras A, Gutierrez C, et al. Granulomatous mastitis: a 10 year experience from a large inner city county hospital. J Surg Res. 2013;184:299–303.7. Dixon JM, Chetty U. Diagnosis and treatment of granulomatous mastitis. Br J Surg. 1995;82:1143–4.8. Erhan Y, Veral A, Kara E, Ozdemir N, Kapkac M, Ozdedeli E, et al. A clinicopathologic study of a rare clinical entity mimicking breast carcinoma: idiopathic granulomatous mastitis. Breast. 2000;9:52–6. 9. Gal-Gombos EC, Esserman LE, Odzer SL, Weisberg S, Wilson C, Poppiti RJ. Granulomatous mastitis: diagnosis by ultrasound-guided core biopsy. Breast J. 2001;7:129–30.10. Sakurai K, Fujisaki S, Enomoto K, Amano S, Sugitani M. Evaluation of follow-up strategies for corticosteroid therapy of idiopathic granulomatous mastitis. Surg Today. 2011;41:333–7.11. Sato N, Yamashita H, Kozaki N, Watanabe Y, Ohtsuka T, Kuroki S, et al. Granulomatous mastitis diagnosed and followed up by fine-needle aspiration cytology, and successfully treated by corticosteroid therapy: report of a case. Surg Today. 1996;26:730–3.12. Erozgen F, Ersoy YE, Akaydin M, Memmi N, Celik AS, Celebi F, et al. Corticosteroid treatment and timing of surgery in idiopathic granulomatous mastitis confusing with breast carcinoma. Breast Cancer Res Treat. 2010;123:447–52. 13. Ocal K, Dag A, Turkmenoglu O, Kara T, Seyit H, Konca K. Granulomatous mastitis: clinical, pathological features, and management. Breast J. 2010;16:176–82. 14. Gurleyik G, Aktekin A, Aker F, Karagulle H, Saglamc A. Medical and surgical treatment of idiopathic granulomatous lobular mastitis: a benign inflammatory disease mimicking invasive carcinoma. J Breast Cancer. 2012;15:119–23. 15. Azlina AF, Ariza Z, Arni T, Hisham AN. Chronic granulomatous mastitis: diagnostic and therapeutic considerations. World J Surg. 2003;27:515–8. 16. Heer R, Shrimankar J, Griffith CDM. Granulomatous mastitis can mimic breast cancer on clinical, radiological or cytological examination: a cautionary tale. Breast. 2003;12:283–6.17. Altintoprak F, Kivilcim T, Yalkin O, Uzunoglu Y, Kahyaoglu Z, Dilek ON. Topical steroids are effective in the treatment of idiopathic granulomatous mastitis. World J Surg. 2015;39:2718–23.18. Han BK, Choe YH, Park JM, Moon WK, Ko YH, Yang JH, et al. Granulomatous mastitis: mammographic and sonographic appearances. AJR Am J Roentgenol. 1999;173:317–20.19. Jorgensen MB, Nielsen DM. Diagnosis and treatment of granulomatous mastitis. Am J Med. 1992;93:97–101. 20. Dursun M, Yilmaz S, Yahyayev A, Salmaslioglu A, Yavuz E, Igci A, et al. Multimodality imaging features of idiopathic granulomatous mastitis: outcome of 12 years of experience. Radiol Med. 2012;117:529–38.21. Akcan A, Akyildiz H, Deneme MA, Akgun H, Aritas Y. Granulomatous lobular mastitis: a complex diagnostic and therapeutic problem. World J Surg. 2006;30:1403–9. 22. Skandarajah A, Marley L. Idiopathic granulomatous mastitis: a medical or surgical disease of the breast? ANZ J Surg. 2015;85:979–82. 23. Sheybani F, Sarvghad MR, Naderi HR, Gharib M. Treatment for and clinical characteristics of granulomatous mastitis. Obstet Gynecol. 2015;125;4;801–7. 24. Karanlik H, Ozgur İ, Simsek S, Fathalizadeha A, Tukenmez M, Sahin D, et al. Can steroids plus surgery become a first-line treatment of idiopathic granulomatous mastitis? Breast Care. 2014;9:338–42.25. Akbulut S, Yilmaz D, Bakir S. Methotrexate in the management of idiopathic granulomatous mastitis: review of 108 published cases and report of four cases. Breast J. 2011;17:661–8.