Granülomatöz Mastitte Klinik Özellikler, Tanı ve Tedavi Yaklaşımları: Tek Merkezli Alternatif Tedavi Uygulaması

Öz

Granülomatöz mastit (GM), nadir görülen benign ancak kronik seyirli bir inflamatuvar meme hastalığıdır. Bu çalışmada, GM tedavisinde negatif basınçlı vakum tedavisinin (NPVT) postoperatif seroma oluşumu üzerindeki etkisi araştırıldı. Mayıs 2018–Temmuz 2023 tarihleri arasında GM tanısıyla tedavi edilen 12 hasta retrospektif olarak incelendi. Hastalar iki gruba ayrıldı: Grup 1’de apse drenajı ve biyopsi sonrası 48 saat NPVT uygulandıktan sonra segmental mastektomi yapıldı; Grup 2’de ise drenaj ve mastektomi aynı seansta gerçekleştirildi. Üçüncü ayda yapılan ultrasonografide seroma varlığı değerlendirildi. Gruplar arasında yaş, komorbiditeler ve demografik özellikler açısından fark yoktu (p>0.05). Seroma boyutları Grup 1’de ortalama 1.27 cm, Grup 2’de 3.28 cm idi ve bu fark istatistiksel olarak anlamlıydı (p<0.001). NPVT uygulamasının seroma gelişimini anlamlı derecede azalttığı, doku iyileşmesini hızlandırdığı ve komplikasyon oranlarını düşürdüğü gözlendi. Bulgular, GM’nin cerrahi tedavisinde NPVT’nin etkili bir adjuvan yöntem olarak kullanılabileceğini göstermektedir. Ancak, küçük örneklem büyüklüğü ve kısa takip süresi bu çalışmanın sınırlamalarıdır. Daha geniş örneklemli, prospektif çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• Granülomatöz mastit
• seroma
• vakum tedavisi
• negatif basınç
• segmental mastektomi

Clinical Features, Diagnosis, and Treatment Approaches in Granulomatous Mastitis: A Single-Center Alternative Treatment Experience

Öz

Granulomatous mastitis (GM) is a rare, benign, but chronically progressive inflammatory breast disease. This study evaluated the effect of negative pressure vacuum therapy (NPVT) on postoperative seroma formation in GM. Twelve patients treated between May 2018 and July 2023 were retrospectively analyzed. Patients were divided into two groups: Group 1 underwent abscess drainage and biopsy followed by 48 hours of NPVT before segmental mastectomy, whereas Group 2 underwent drainage and mastectomy in the same session. Seroma formation was assessed by ultrasonography at 3 months. No significant differences were found between groups regarding age, comorbidities, or baseline demographics (p>0.05). Mean seroma size was 1.27 cm in Group 1 and 3.28 cm in Group 2, showing a statistically significant difference (p<0.001). NPVT significantly reduced seroma formation, enhanced tissue healing, and decreased complication rates. These findings suggest that NPVT may serve as an effective adjuvant method in the surgical management of GM. However, the small sample size and short follow-up period are study limitations, indicating the need for larger prospective studies to confirm these results.

Anahtar Kelimeler

• Granulomatous mastitis
• seroma
• vacuum therapy
• negative pressure
• segmental mastectomy

Kaynakça

1. 1. Kessler E, Wolloch Y. Granulomatous mastitis: a lesion clinically simulating carcinoma. Am J Clin Pathol. 1972;58(6):642-6.
2. 2. Dilaveri C, Degnim A, Lee C, DeSimone D, Moldoveanu D, Ghosh K. Idiopathic Granulomatous Mastitis. Breast J. 2024;2024:6693720.
3. 3. Shanbhag NM, Ameri MA, Shanbhag SN, Anandan N, Balaraj K, Bin Sumaida A. Diagnostic Challenges and Insights Into Granulomatous Mastitis: A Systematic Review. Cureus. 2024;16(12):e75733.
4. 4. Fattahi AS, Amini G, Sajedi F, Mehrad-Majd H. Factors Affecting Recurrence of Idiopathic Granulomatous Mastitis: A Systematic Review. Breast J. 2023;2023:9947797.
5. 5. Velidedeoglu M, Umman V, Kilic F, Celik V, Gazioglu E, Hatipoglu E, et al. Idiopathic granulomatous mastitis: introducing a diagnostic algorithm based on 5 years of follow-up of 152 cases from Turkey and a review of the literature. Surg Today. 2022;52(4):668-80.
6. 6. Godazandeh G, Shojaee L, Alizadeh-Navaei R, Hessami A. Corticosteroids in idiopathic granulomatous mastitis: a systematic review and meta-analysis. Surg Today. 2021;51(12):1897-905.
7. 7. Zhou F, Yu LX, Ma ZB, Yu ZG. Granulomatous lobular mastitis. Chronic Dis Transl Med. 2016;2(1):17-21.
8. 8. Akbulut S, Arikanoglu Z, Senol A, Sogutcu N, Basbug M, Yeniaras E, et al. Is methotrexate an acceptable treatment in the management of idiopathic granulomatous mastitis? Arch Gynecol Obstet. 2011;284(5):1189-95.

9. 9. Hovanessian Larsen LJ, Peyvandi B, Klipfel N, Grant E, Iyengar G. Granulomatous lobular mastitis: imaging, diagnosis, and treatment. AJR Am J Roentgenol. 2009;193(2):574-81.
10. 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(3):333-7.
11. 11. Sarkar DK, Banerjee R, Gupta S, Singhal AK, Halder A. Management of idiopathic granulomatous mastitis: a prospective study. Ann R Coll Surg Engl. 2023;105(3):218-24.
12. 12. DeHertogh DA, Rossof AH, Harris AA, Economou SG. Prednisone management of granulomatous mastitis. N Engl J Med. 1980;303(14):799-800.
13. 13. Esmaeil NK, Salih AM, Pshtiwan LRA, Muhialdeen AS, Abdullah AM, Hama JI, et al. Management of Idiopathic Granulomatous Mastitis: A Single Institution Experience. Breast Care (Basel). 2023;18(4):231-8.
14. 14. Qiu L, Wang F, Xu Q, Lin Z, Lin B, Huang M, et al. Negative pressure wound therapy promotes healing and reduced pain in patients with acute suppurative mastitis. BMC Womens Health. 2022;22(1):243.
15. 15. Kvist LJ. Toward a clarification of the concept of mastitis as used in empirical studies of breast inflammation during lactation. J Hum Lact. 2010;26(1):53-9.
16. 16. Asoglu 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(2):108-14.
17. 17. Dixon JM. Breast infection. BMJ. 2013;347:f3291.
18. 18. Kok KY, Telisinghe PU. Granulomatous mastitis: presentation, treatment and outcome in 43 patients. Surgeon. 2010;8(4):197-201.
19. 19. Şen-Oran E, Gürdal SÖ, Soybir GR. Mastitler. Meme Sağlığı Dergisi/Journal of Breast Health. 2013;9(1).
20. 20. 20. Baslaim MM, Khayat HA, Al-Amoudi SA. Idiopathic granulomatous mastitis: a heterogeneous disease with variable clinical presentation. World J Surg. 2007;31(8):1677-81.
21. 21. Ozturk M, Mavili E, Kahriman G, Akcan AC, Ozturk F. Granulomatous mastitis: radiological findings. Acta Radiol. 2007;48(2):150-5.
22. 22. Bani-Hani KE, Yaghan RJ, Matalka II, Shatnawi NJ. Idiopathic granulomatous mastitis: time to avoid unnecessary mastectomies. Breast J. 2004;10(4):318-22.
23. 23. Tse GM, Poon CS, Ramachandram K, Ma TK, Pang LM, Law BK, et al. Granulomatous mastitis: a clinicopathological review of 26 cases. Pathology. 2004;36(3):254-7.
24. 24. Maráz R, Venczel L, Sikorszki L, Serfőző O, Ambrózay É, Patyi M, et al. Negative pressure wound therapy of Corynebacterium jeikeium associated granulomatous mastitis. Breast J. 2020;26(3):508-10.
25. 25. Namdaroğlu OB, Yazıcı H, Öztürk AM, Yakan S, Yıldırım M, Uçar AD, et al. Negative-pressure wound therapy in chronic inflammatory breast diseases. J Breast Health. 2016;12(2):91-3.
26. 26. Jones SM, Banwell PE, Shakespeare PG. Advances in wound healing: topical negative pressure therapy. Postgrad Med J. 2005;81(956):353-7.