İDİOPATİK GRANULOMATÖZ MASTİT TANILI HASTALARDA ORAL STEROİD TEDAVİ SONUÇLARI

Abstract

Giriş: İdiopatik granülomatöz (IGM) mastit meme dokusunda granülomatöz bir inflamasyon ile karakterize benign, kronik bir hastalıktır. Hastalığın halen standart bir tedavi modeli bulunmamaktadır. Medikal tedavilerden geniş eksizyonlara kadar uzanan tedavi yöntemlerine rastlanılmaktadır. Bu çalışmada IGM tanılı hastalarda yüksek doz steroid kullanımı ve sonuçlarının retrospektif analizi amaçlanmıştır. Gereç ve yöntem: Bu retrospektif çalışmada 48 granülomatöz mastit tanılı hasta değerlendirildi, bu hastaların 46 tanesinin IGM tanısı aldığı belirlendi. Hastalara histopatolojik tanı core biyopsi ile konuldu. Hastaların yaşı, cinsiyeti, patolojik tanıları, kültür sonuçları, abse varlığı, tedavi dozu, tedavi süresi, tedavi cevapları ve nüks durumları değerlendirildi. Bulgular: Granülomatöz mastit tanısı alan 48 hasta değerlendirildi. Bu hastalardan ikisisinde enfeksiyon ajanları tespit edildiği için çalışma dışı bırakıldı. 46 hasta çalışmaya dahil edildi. Hastaların tamamı kadın idi. Hastaların yaş ortalaması 36,32 yıl, takip süresi 28,52 ay olarak bulundu. Hastaların PPD test sonuçlarının ortalaması 5,58 mm olarak bulundu. Hastalara 0,8 mg/kg/gün metilprednizolon tablet başlandı. 3 hafta sonra haftada 0,1 mg/kg/gün azaltılarak 10 hafta sonra tedavi tamamlandı. 3 hastada (%6,52) nüks görüldü. Hastalara herhangi bir cerrahi işlem yapılmadı. Steroid tedavisi alırken 9 hastada apse formasyonu görüldü. Bu hastalardan aspirasyon ile örnek alınıp kültüre gönderildi. 3 hastada (%6,52) koagülaz (-) stafilokok üredi. Sonuç: IGM olgularında yüksek doz steroid tedavisinin etkin, cerrahi müdahaleye gerek kalmadan düşük nüks oranları ve minimal deformite ile iyi sonuçlar ortaya koyabileceği sonucuna varılmıştır.

Keywords

• İdiopatik granülomatöz mastit
• steroid
• tedavi
• nüks

RESULTS OF ORAL STEROID TREATMENT IN PATIENTS DIAGNOSED WITH IDIOPATHIC GRANULOMATOUS MASTITIS

Abstract

Introduction: Idiopathic granulomatous mastitis (IGM) is a benign, chronic disease characterized by granulomatous inflammation in the breast tissue. There is still no standard treatment model for the disease. Treatment methods range from medical treatments to wide excisions. This study aimed to retrospectively analyze high-dose steroid use and its results in patients diagnosed with IGM. Materials and methods: In this retrospective study, 48 patients diagnosed with granulomatous mastitis were evaluated, and it was determined that 46 of these patients were diagnosed with IGM. Histopathological diagnosis was made by core biopsy. The patients' age, gender, pathological diagnosis, culture results, presence of abscess, treatment dose, treatment duration, treatment responses, and recurrence were evaluated. Results: 48 patients diagnosed with granulomatous mastitis were evaluated. Two of these patients were excluded from the study because infectious agents were detected. 46 patients were included in the study. All patients were women. The average age of the patients was 36.32 years and the follow-up period was 28.52 months. The average PPD test results of the patients was found to be 5.58 mm. Patients were started on 0.8 mg/kg/day methylprednisolone tablets. After 3 weeks, the treatment was reduced by 0.1 mg/kg/day per week and completed after 10 weeks. Relapse was observed in 3 patients (6.52%). No surgical procedure was performed on the patients. Abscess formation was observed in 9 patients while receiving steroid treatment. Samples were taken from these patients by aspiration and sent for culture. Coagulase (-) staphylococcus grew in 3 patients (6.52%). Conclusion: It was concluded that high-dose steroid treatment is effective in IGM cases, and good results can be achieved with low recurrence rates and minimal deformity without the need for surgical intervention.

Keywords

• Idiopathic granulomatous mastitis
• steroid
• treatment
• recurrence

References

1. Skandarajah A, Marley L. Idiopathic granulomatous mastitis: a medical or surgical disease of the breast? ANZ J Surg. 2015 Dec;85(12):979-82. doi: 10.1111/ans.12929. Epub 2014 Nov 26. PMID: 25424519.
2. Altintoprak F, Karakece E, Kivilcim T, et al. Idiopathic granulomatous mastitis: an autoimmune disease? ScientificWorldJournal. 2013 Sep 4;2013:148727. doi: 10.1155/2013/148727. PMID: 24082849; PMCID: PMC3777118.
3. Benson JR, Dumitru D. Idiopathic granulomatous mastitis: presentation, investigation and management. Future Oncol. 2016 Jun;12(11):1381-94. doi: 10.2217/fon-2015-0038. Epub 2016 Apr 12. PMID: 27067146.
4. Al Awfi MM, Al Rahbi SK. Idiopathic Granulomatous Mastitis: Six years of experience and the current evidence in literature. Sultan Qaboos Univ Med J. 2023 Feb;23(1):36-41. doi: 10.18295/squmj.4.2022.030. Epub 2023 Feb 23. PMID: 36865415; PMCID: PMC9974032.
5. Ocal K, Dag A, Turkmenoglu O, Kara T, Seyit H, Konca K. Granulomatous mastitis: clinical, pathological features, and management. Breast J. 2010 Mar-Apr;16(2):176-82. doi: 10.1111/j.1524-4741.2009.00879.x. Epub 2009 Dec 16. PMID: 20030652.
6. Sinha R, Rahul. Breast tuberculosis. Indian J Tuberc. 2019 Jan;66(1):6-11. doi: 10.1016/j.ijtb.2018.07.003. Epub 2018 Jul 11. PMID: 30797285.
7. Tan QW, Zhang YN, Jia YP, Gou J, Lv Q, Yang XQ. Methylprednisolone for idiopathic granulomatous mastitis: a prospective observational cohort study. Gland Surg. 2022 Sep;11(9):1538-1545. doi: 10.21037/gs-22-484. PMID: 36221278; PMCID: PMC9547707.
8. Karanlik H, Ozgur I, Simsek S, et al. Can Steroids plus Surgery Become a First-Line Treatment of Idiopathic Granulomatous Mastitis? Breast Care (Basel). 2014 Oct;9(5):338- 42. doi: 10.1159/000366437. PMID: 25759614; PMCID: PMC4322692.

9. Montazer M, Dadashzadeh M, Moosavi Toomatari SE. Comparison of the Outcome of Low Dose and High-Dose Corticosteroid in the Treatment of Idiopathic Granulomatous Mastitis. Asian Pac J Cancer Prev. 2020 Apr 1;21(4):993-996. doi: 10.31557/APJCP.2020.21.4.993. PMID: 32334460; PMCID: PMC7445984.
10. Yuan QQ, Xiao SY, Farouk O, et al. Management of granulomatous lobular mastitis: an international multidisciplinary consensus (2021 edition). Mil Med Res. 2022 Apr 26;9(1):20. doi: 10.1186/s40779-022-00380-5. Erratum in: Mil Med Res. 2022 Aug 23;9(1):47. PMID: 35473758; PMCID: PMC9040252.
11. Çetin K, Sıkar HE, Güllüoğlu BM. Idiopathic granulomatous mastitis with erythema nodosum: Is it a variant of clinical presentation indicating treatment resistance? A retrospective cohort study. Breast J. 2020 Sep;26(9):1645-1651. doi: 10.1111/tbj.13944. Epub 2020 Jun 19. PMID: 32562354.
12. Azlina AF, Ariza Z, Arni T, Hisham AN. Chronic granulomatous mastitis: diagnostic and therapeutic considerations. World J Surg. 2003 May;27(5):515-8. doi: 10.1007/s00268- 003-6806-1. Epub 2003 Apr 28. PMID: 12715214.