Granulomatous mastitis: A retrospective review of 49 patients

Öz

Objective: Idiopathic granulomatous mastitis, a rare, benign, chronic inflammatory condition of the breast, which usually mimics breast carcinoma. In this study, we report on the management of 49 cases of idiopathic granulomatous mastitis and their clinical presentation. Methods: The breast and anatomical databases of one center were reviewed from 2007 to 2012 to identify patients with histological diagnosis of idiopathic granulomatous mastitis. Clinical and demographic characteristics were retrieved and treatment modalities were were recorded. Results: The mean patient age was 37.71±7.1 years. There were no differences between the management groups about etiological and demographic factors. The rate of recurrence in group 1, group 2, and group 3 was 8.3%, 14.8% and 20%, respectively; there were no statistically significant difference among the groups. Conclusion: Steroids and surgical methods codified in idiopathic granulomatous mastitis may be preferred. We recommend steroid therapy as first-line treatment. However, prospective, randomized clinical trials are needed to determine the treatment algorithm. Key words: Idiopathic, granulomatous, mastitis, management

Anahtar Kelimeler

• Idiopathic, granulomatous, mastitis, management

Granülamatöz mastit: 49 hastanın retrospektif incelenmesi

Öz

Amaç: İdiopatik granulomatöz mastit, nadir görülen, benign, kronik inflamatuar bir hastalık olup meme kanserini taklit eder. Bu çalışmada idiopatik mastitli 49 hastanın tedavisini ve kliniğini sunmayı amaçladık. Yöntemler: Hastane otomasyon sisteminde 2007-2012 yılları arasında histolojik olarak granulomatöz tanısı konulmuş hastalar incelendi. Hastalara ait klinik bulgular, demografik veriler ve tedavi yöntemleri kaydedildi. Bulgular: Ortalama yaş 37.71±7.1 idi. Tedavi gruplar arasında etiyolojik ve demografik açıdan istatistiksel fark yoktu. Nüks oranları grup 1, grup 2 ve grup 3’te sırasıyla %8,3, %14,8 %20 olup, gruplar arasında istatistiksel anlamlı farklılık yoktu. Sonuç: Steroid ve cerrahi tedavinin idiopatik granulomatöz mastitli hastalarda uygulanabileceğini, steroid tedavisinin ilk basamak tedavi olması gerektiği kanaatindeyiz. Bununla birlikte tedavi algoritması belirlenebilmesi için prospektif, randomize klinik çalışmalara ihtiyaç vardır

Anahtar Kelimeler

• İdyopatik, granülamatöz mastit, tedavi

Kaynakça

1. DeHertogh DA, Rossof AH, Harris AA, Economou SG. Prednisone
2. management of granulomatous mastitis. N Engl J Med
3. ;303:799-800.
4. Fletcher A, Magrath IM, Riddell RH, Talbot IC. Granulomatous mastitis:
5. a report of seven cases. J Clin Pathol 1982;35:941-945.
6. Going JJ, Anderson TJ, Wilkinson S, Chetty U. Granulomatouslobular
7. mastitis J Clin Pathol 1987;40:535-540.
8. Jorgensen MB, Nielsen DM. Diagnosis and treatment of granulomatous

9. mastitis. Am J Med 1992;93:97-101.
10. Skandarajah A, Marley L. Idiopathic granulomatous mastitis:a medical
11. or surgical disease of the breast? ANZ J Surg 2014; 24:234-239.
12. doi: 10.1111/ans.12929.
13. Afridi SP, Memon A, Shafiq-ur-Rahman, Memon A. Granulomatous
14. mastitis: a case series. J Coll Physicians Surg Pak 2010;20:365-
15. -
16. Sellitto A, Santoriello A, De Fanis U, et al. Granulomatous lobular
17. mastitis: another manifestation of systemic lupus erythematosus?
18. Breast J 2013;19:331-332.
19. Gurleyik G, Aktekin A, Aker F, et al. Medical and surgical treatment
20. of idiopathic granulomatous lobular mastitis: a benign inflammatory
21. disease mimicking invasive carcinoma. J Breast Cancer
22. ;15:119-123.
23. Bani-Hani KE, Yaghan RJ, Matalka II, Shatnawi NJ. Idiopathic
24. granulomatous mastitis: Time to avoid unnecessary mastectomies.
25. Breast J 2004;10:318-322.
26. Kok KY, Telisinghe PU. Granulomatous mastitis: presentation,
27. treatment and outcome in 43 patients. Surgeon 2010;8:197-201.
28. Sakurai K, Fujisaki S, Enomoto K, et al. Evaluation of follow-up
29. strategies for corticosteroid therapy of idiopathic granulomatous
30. mastitis. Surg Today 2011;41:333-337.
31. Altintoprak F, Kivilcim T, Ozkan OV. Aetiology of idiopathic
32. granulomatous mastitis. World J Clin Cases 2014;2:852-858. doi:
33. 12998/wjcc.v2.i12.852.
34. Erhan Y, Veral A, Kara E, et al. A clinicopathologic study of a rare
35. clinical entity mimicking breast carcinoma: idiopathic granulomatous
36. mastitis. Breast. 2000;9:52-56.
37. Asoglu O, Ozmen V, Karanlik H, et al. Feasibility of surgical
38. management in patients with granulomatous mastitis. Breast J
39. ;11:108-114.
40. Lai ECH, Chan WC, Ma TK, et al. The role of conservative treatment
41. in idiopathic granulomatous mastitis. Breast J 2005;11:454-
42. -
43. Casteren CV, Jacquemyn Y, Himpe E, Verslegers I. Idiopathic ganulomatous
44. mastitis. BMJ Case Rep 2012. doi: 10.1136/bcr-2012-
45. -
46. Ocal K, Dag A, Turkmenoglu O, et al. Granulomatous mastitis:
47. clinical, pathological features, and management. Breast J.
48. ;16:176-182.
49. Gautier N, Lalonde L, Tran-Thanh D, et al. Chronic granulomatous
50. mastitis: Imaging, pathology and management. Eur J Radiol.
51. ;82:e165-175.
52. Ozel L, Unal A, Unal E, et al. Granulomatous mastitis: is it autoimmune
53. disease? diagnostic and therapeutic dilemmas. Surg Today
54. ;42:729-733.
55. Kiyak G, Dumlu EG, Kilinc I, et al. Management of idiopathic
56. granulomatous mastitis: dilemmas in diagnosis and treatment.
57. BMC Surg 2014;14:66. doi: 10.1186/1471-2482-14-66.
58. Salehi M, Salehi H, Moafi M, et al. Comparison of the effect of
59. surgical and medical therapy for the treatment of idiopathic granulomatous
60. mastitis. J Res Med Sci. Mar 2014;19:5-8.
61. Memis A, Bilgen I, Ustun EE Ozdemir N, et al. Granulomatous
62. mastitis: imaging findings with histopathologic correlation. Clin
63. Radiol 2002;57:1001-1006.
64. Wilson JP, Massoll N, Marshall J, et al. Idiopathic granulomatous
65. mastitis: in search of a therapeutic paradigm. Am Surg.
66. ;73:798-802.
67. Heer R, Shrimankar J, Griffith CDM. Granulomatous mastitis can
68. mimic breast cancer on clinical, radiological or cytological examination:
69. a cautionary tale. Breast 2003;12:283-286.
70. Guven HE, Pak I, Oral S. Granulomatous mastitis: surgical outcomes.
71. J Coll Physicians J Coll Physicians Surg Pak 2006;16:431-
72. -
73. Joseph KA, Luu X, Mor A. Granulomatous Mastitis: A New York
74. Public Hospital Experience. Ann Surg Oncol 2014. doi:10.1245/
75. s10434-014-3895-z.
76. Al-Khaffaf B, Knox F, Bundred NJ. Idiopathic granulomatous mastitis:
77. a 25-year experience. J Am Coll Surg 2008;206:269-273.
78. Pereira FA, Mudgil AV, Macias ES, Karsif K. Idiopathic granulomatous
79. lobular mastitis. Int J Dermatol 2012;51:142-151.
80. Pandey TS, Mackinnon JC, Bressler L, et al. Idiopathic granulomatous
81. mastitis - a prospective study of 49 women and treatment
82. outcomes with steroid therapy. Breast J 2014;20:258-266.