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Li H, Zhang G, Wang H, Chen H, Liu X, Zheng C, Lin L, Li L. Ultrasound-guided microwave ablation for the treatment of idiopathic granulomatous mastitis: comparison with surgical excision. BMC Womens Health 2024; 24:248. [PMID: 38637788 PMCID: PMC11025156 DOI: 10.1186/s12905-024-03070-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 04/02/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) results in notable clinical symptoms and breast deformity. This study aimed to evaluate the clinical feasibility of microwave ablation (MWA) for the treatment of IGM through comparison with surgical excision. METHODS From June 2016 to December 2020, a total of 234 consecutive patients admitted to the hospital were retrospectively included in this study. IGM was pathologically confirmed via breast biopsy in all included patients. These patients were divided into the MWA group (n = 91) and surgical group (n = 143) based on the type of treatment. Patients in both groups received oral prednisone prior to intervention. The clinical remission rate, recurrence rate, operative pain, complications, and BREAST Q score were compared between the two groups. RESULTS There were 340 lesions in the MWA group, and 201 lesions in the surgical group were ultimately included. Significant differences in the complete remission rate (96.7% vs. 86.7%, p = 0.020), recurrence rate (3.3% vs. 13.3%, p = 0.020), operation time (48.7±14.6 min vs. 68.1±36.4 min, p < 0.001), postoperative pain (p < 0.001) and postoperative BREAST Q score (p < 0.001) were observed between the MWA and surgical groups. CONCLUSIONS Microwave ablation is feasible for the treatment of IGM, due to its high curative rate and low recurrence rate. Because of the minimal invasiveness of MWA and sufficient preservation of the gland and contour of the breast, patients are more satisfied with the appearance of the breast. Therefore, for patients with complex conditions requiring surgery, MWA is a good alternative treatment.
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Affiliation(s)
- Hang Li
- The School of Clinical Medicine, Fujian Medical University, Fujian, 350000, China
- Department of Breast Surgery, Affiliated Hospital of Putian University, Fujian, 351100, China
| | - Guoliang Zhang
- Department of Thyroid Surgery, Affiliated Hospital of Putian University, Fujian, 351100, China
| | - Hongling Wang
- Department of General Surgery, Xiamen Xinkaiyuan Hospital, Fujian, 361000, China
| | - Haiying Chen
- The School of Clinical Medicine, Fujian Medical University, Fujian, 350000, China
| | - Xiaoli Liu
- Department of Pathology, Affiliated Hospital of Putian University, Fujian, 351100, China
| | - Chuansheng Zheng
- The School of Clinical Medicine, Fujian Medical University, Fujian, 350000, China
| | - Lisheng Lin
- Department of Breast Surgery, Affiliated Hospital of Putian University, Fujian, 351100, China
| | - Lihong Li
- The School of Clinical Medicine, Fujian Medical University, Fujian, 350000, China.
- Department of Breast Surgery, Affiliated Hospital of Putian University, Fujian, 351100, China.
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Wan H, Zhang H, Yu S, Wang Y, Yang F, Luo J. Ultrasound-guided vacuum-assisted excision for idiopathic granulomatous mastitis at the abscess stage. World J Surg 2024; 48:896-902. [PMID: 38479797 DOI: 10.1002/wjs.12103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/27/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) is a rare inflammatory disease of the breast with clinical features that are often confused with those of breast cancer leading to delayed diagnosis and treatment. This retrospective study aimed to evaluate the therapeutic effectiveness and cosmetic results of drainage surgery using ultrasound-guided vacuum-assisted excision (VAE) for the treatment of IGM at the abscess stage. METHODS The time of recovery, cases of further surgical intervention, and cosmetic results were retrospectively collected and analyzed from patients who underwent drainage with VAE or conventional drainage between October 2017 and August 2021. RESULTS A total of 65 patients diagnosed with IGM at the abscess stage who underwent drainage surgery with VAE or conventional drainage surgery were enrolled. Overall, 38 (58.5%) underwent conventional drainage surgery and 27 (41.5%) underwent drainage with VAE. We found that patients who underwent VAE recovered much faster than those who underwent traditional drainage surgery (30.1 vs. 48.0 days). Nine (33.3%) patients in the VAE group required further surgical intervention after drainage, whereas 33 (86.8%) patients in the control group underwent another surgery to resect residual lesions. Additionally, patients in the VAE group were more satisfied with the breast appearance, mainly due to less influence of the scars and better symmetry of their breasts. CONCLUSION Compared with conventional drainage surgery, drainage surgery using VAE for IGM patients at the abscess stage improved therapeutic and cosmetic outcomes. Furthermore, postoperative management of IGM is crucial.
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Affiliation(s)
- Hangyu Wan
- Department of Breast and Thyroid Surgery, Sichuan Provincial Maternity and Child Health Care Hospital (The Affiliated Women's and Children's Hospital of Chengdu Medical College), Chengdu, China
| | - Haiyan Zhang
- Department of Breast and Thyroid Surgery, Sichuan Provincial Maternity and Child Health Care Hospital (The Affiliated Women's and Children's Hospital of Chengdu Medical College), Chengdu, China
| | - Shaolan Yu
- Department of Pathology, Sichuan Provincial Maternity and Child Health Care Hospital (The Affiliated Women's and Children's Hospital of Chengdu Medical College), Chengdu, China
| | - Yan Wang
- Department of Breast and Thyroid Surgery, Sichuan Provincial Maternity and Child Health Care Hospital (The Affiliated Women's and Children's Hospital of Chengdu Medical College), Chengdu, China
| | - Feng Yang
- Department of Breast and Thyroid Surgery, Sichuan Provincial Maternity and Child Health Care Hospital (The Affiliated Women's and Children's Hospital of Chengdu Medical College), Chengdu, China
| | - Jing Luo
- Department of Breast and Thyroid Surgery, Sichuan Provincial Maternity and Child Health Care Hospital (The Affiliated Women's and Children's Hospital of Chengdu Medical College), Chengdu, China
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Wang X, He X, Liu J, Zhang H, Wan H, Luo J, Yang J. Immune pathogenesis of idiopathic granulomatous mastitis: from etiology toward therapeutic approaches. Front Immunol 2024; 15:1295759. [PMID: 38529282 PMCID: PMC10961981 DOI: 10.3389/fimmu.2024.1295759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 02/22/2024] [Indexed: 03/27/2024] Open
Abstract
Idiopathic granulomatous mastitis (IGM) is a noncancerous, chronic inflammatory disorder of breast with unknown causes, posing significant challenges to the quality of life due to its high refractoriness and local aggressiveness. The typical symptoms of this disease involve skin redness, a firm and tender breast mass and mastalgia; others may include swelling, fistula, abscess (often without fever), nipple retraction, and peau d'orange appearance. IGM often mimics breast abscesses or malignancies, particularly inflammatory breast cancer, and is characterized by absent standardized treatment options, inconsistent patient response and unknown mechanism. Definite diagnosis of this disease relies on core needle biopsy and histopathological examination. The prevailing etiological theory suggests that IGM is an autoimmune disease, as some patients respond well to steroid treatment. Additionally, the presence of concurrent erythema nodosum or other autoimmune conditions supports the autoimmune nature of the disease. Based on current knowledge, this review aims to elucidate the autoimmune-favored features of IGM and explore its potential etiologies. Furthermore, we discuss the immune-mediated pathogenesis of IGM using existing research and propose immunotherapeutic strategies for managing this condition.
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Affiliation(s)
- Xiaoli Wang
- Breast Center, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiujing He
- Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Tumor Targeted and Immune Therapy, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Junzhi Liu
- West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Haiyan Zhang
- Department of Breast Surgery, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, China
| | - Hangyu Wan
- Department of Breast Surgery, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, China
| | - Jing Luo
- Department of Breast Surgery, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, China
| | - Jiqiao Yang
- Breast Center, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
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Li C, Wei X, Wang Y, Feng Z, Zhang Y, Li J, Cai Y, Liu M, Zhao F, Qu J, Zhang S, Shan C. Rotational gland dissection for refractory granulomatous mastitis: A single-center retrospective study. Asian J Surg 2024; 47:328-332. [PMID: 37684121 DOI: 10.1016/j.asjsur.2023.08.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/11/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Refractory granulomatous mastitis (RGM) is a chronic benign breast disease that commonly occurred in women of childbearing age and is usually treated with surgery, with numerous cases suffering from unsatisfied postoperative recovery of breast shape, high rates of surgical complications, and even high recurrence. This study tries to evaluate the efficacy of an innovative surgical procedure, the rotational gland dissection for the treatment of RGM. METHODS 129 patients with RGM who underwent surgical treatment at the Second Affiliated Hospital of Xi'an Jiaotong University between Apr. 2017 and May. 2021 were retrospectively included in this study. The article analyzed the age, local symptoms, lesion location, and size, days in hospital, recurrence rate, and satisfaction rate of the patients. RESULTS Patients ranged in age from 19 to 58 years, with a median age of onset of 32 years. In 63 patients (48.84%), their lesions coverage exceeded two quadrants, and 52.71% of patients had lesions larger than 10 cm2. The average days in hospital of patients was 7.5 days, and 85.27% of them were satisfied with their post-surgery breast appearance. Within the median follow-up of 56 months, only 3.10% of patients experienced a recurrence of mastitis on the operation side. CONCLUSION This novel surgical procedure we created is an effective treatment for RGM with a high success rate, high patient satisfaction, and low recurrence rate, and is significantly superior to other studies for it has the largest sample size and longest follow-up in this field.
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Affiliation(s)
- Chaofan Li
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Fifth Street, Xi'an, Shaanxi, PR China
| | - Xinyu Wei
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Fifth Street, Xi'an, Shaanxi, PR China
| | - Yusheng Wang
- Department of Otolaryngology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Fifth Street, Xi'an, Shaanxi, PR China
| | - Zeyao Feng
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Fifth Street, Xi'an, Shaanxi, PR China
| | - Yu Zhang
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Fifth Street, Xi'an, Shaanxi, PR China
| | - Jia Li
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Fifth Street, Xi'an, Shaanxi, PR China
| | - Yifan Cai
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Fifth Street, Xi'an, Shaanxi, PR China
| | - Mengjie Liu
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Fifth Street, Xi'an, Shaanxi, PR China
| | - Fang Zhao
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Fifth Street, Xi'an, Shaanxi, PR China
| | - Jingkun Qu
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Fifth Street, Xi'an, Shaanxi, PR China.
| | - Shuqun Zhang
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Fifth Street, Xi'an, Shaanxi, PR China.
| | - Changyou Shan
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Fifth Street, Xi'an, Shaanxi, PR China.
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Zeng Y, Zhang D, Fu N, Zhao W, Huang Q, Cui J, Chen Y, Liu Z, Zhang X, Zhang S, Mansoor KM. Risk Factors for Granulomatous Mastitis and Establishment and Validation of a Clinical Prediction Model (Nomogram). Risk Manag Healthc Policy 2023; 16:2209-2222. [PMID: 37881167 PMCID: PMC10596285 DOI: 10.2147/rmhp.s431228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023] Open
Abstract
Background This study aimed to explore the risk factors and clinical characteristics of granulomatous mastitis (GM) using a case-control study and establish and validate a clinical prediction model (nomogram). Methods This retrospective case-control study was conducted in three hospitals in China from June 2017 to December 2021. A total of 1634 GM patients and 186 healthy women during the same period were included and randomly divided into the modeling and validation groups in a 7:3 ratio. To identify the independent risk factors of GM, univariate and multivariate logistic analyses were conducted and used to develop a nomogram. The prediction model was internally and externally validated using the Bootstrap technique and validation cohort. The receiver operating characteristic (ROC) curve and calibration curve were used to evaluate the discrimination and calibration of the prediction model. Decision curve analysis (DCA) and clinical impact curve (CIC) were used to evaluate the clinical significance of the model. Results The average age of GM patients was 33.14 years (mainly 20-40). The incidence was high within five years from delivery and mainly occurred in the unilateral breast. The majority of the patients exhibited local skin alterations, while some also presented with systemic symptoms. On multivariate logistic analysis, age, high prolactin level, sex hormone intake, breast trauma, nipple discharge or invagination, and depression were independent risk factors for GM. The mean area under the curve (AUC) in the modeling and validation groups were 0.899 and 0.889. The internal and external validation demonstrated the model's predictive ability and clinical value. Conclusion Lactation-related factors are the main risk factors of GM, leading to milk stasis or increased ductal secretion. Meanwhile, hormone disorders could affect the secretion and expansion of mammary ducts. All these factors can obstruct or injure the duct, inducing inflammatory reactions and immune responses. Additionally, blunt trauma, depressed mood, and diet preference can accelerate the process. The nomogram can effectively predict the risk of GM.
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Affiliation(s)
- Yifei Zeng
- Department of Galactophore, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Dongxiao Zhang
- Department of Galactophore, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People’s Republic of China
| | - Na Fu
- Department of Galactophore, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People’s Republic of China
| | - Wenjie Zhao
- Department of Galactophore, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People’s Republic of China
| | - Qiao Huang
- Department of Galactophore, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People’s Republic of China
| | - Jianchun Cui
- Liaoning Provincial People’s Hospital (Department of Thyroid and Breast Surgery, People’s Hospital of China Medical University), Shenyang, People’s Republic of China
| | - Yunru Chen
- Centre for Evidence-Based Chinese Medicine, School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Zhaolan Liu
- Centre for Evidence-Based Chinese Medicine, School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Xiaojun Zhang
- Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Shiyun Zhang
- Guang’ Anmen Hospital, China Academy of Chinese Medical Science, Beijing, People’s Republic of China
| | - Khattak Mazher Mansoor
- Liaoning Provincial People’s Hospital (Department of Thyroid and Breast Surgery, People’s Hospital of China Medical University), Shenyang, People’s Republic of China
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Ma Q, Lu X, Qin X, Xu X, Fan M, Duan Y, Tu Z, Zhu J, Wang J, Zhang C. A sonogram radiomics model for differentiating granulomatous lobular mastitis from invasive breast cancer: a multicenter study. LA RADIOLOGIA MEDICA 2023; 128:1206-1216. [PMID: 37597127 DOI: 10.1007/s11547-023-01694-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/28/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE To construct a nomogram based on sonogram features and radiomics features to differentiate granulomatous lobular mastitis (GLM) from invasive breast cancer (IBC). MATERIALS AND METHODS A retrospective collection of 213 GLMs and 472 IBCs from three centers was divided into a training set, an internal validation set, and an external validation set. A radiomics model was built based on radiomics features, and the RAD score of the lesion was calculated. The sonogram radiomics model was constructed using ultrasound features and RAD scores. Finally, the diagnostic efficacy of the three sonographers with different levels of experience before and after combining the RAD score was assessed in the external validation set. RESULTS The RAD score, lesion diameter, orientation, echogenicity, and tubular extension showed significant differences in GLM and IBC (p < 0.05). The sonogram radiomics model based on these factors achieved optimal performance, and its area under the curve (AUC) was 0.907, 0.872, and 0.888 in the training, internal, and external validation sets, respectively. The AUCs before and after combining the RAD scores were 0.714, 0.750, and 0.830 and 0.834, 0.853, and 0.878, respectively, for sonographers with different levels of experience. The diagnostic efficacy was comparable for all sonographers when combined with the RAD score (p > 0.05). CONCLUSION Radiomics features effectively enhance the ability of sonographers to discriminate between GLM and IBC and reduce interobserver variation. The nomogram combining ultrasound features and radiomics features show promising diagnostic efficacy and can be used to identify GLM and IBC in a noninvasive approach.
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Affiliation(s)
- Qianqing Ma
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Shushan District, Hefei, 230022, Anhui, China
| | - Xiaofeng Lu
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Shushan District, Hefei, 230022, Anhui, China
| | - Xiachuan Qin
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Shushan District, Hefei, 230022, Anhui, China
- Department of Ultrasound, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University Nan Chong), Sichuan, China
| | - Xiangyi Xu
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Shushan District, Hefei, 230022, Anhui, China
| | - Min Fan
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yayang Duan
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Shushan District, Hefei, 230022, Anhui, China
| | - Zhengzheng Tu
- Anhui Provincial Key Laboratory of Multimodal Cognitive Computation, School of Computer Science and Technology, Anhui University, Hefei, China
| | - Jianhui Zhu
- Anhui Provincial Key Laboratory of Multimodal Cognitive Computation, School of Computer Science and Technology, Anhui University, Hefei, China
| | - Junli Wang
- Department of Ultrasound, The Second People's Hospital of Wuhu, No.259 Jiuhuashan Road, Jinghu District, Wuhu, 241001, Anhui, China.
| | - Chaoxue Zhang
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Shushan District, Hefei, 230022, Anhui, China.
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Azzam MI, Alnaimat F, Al-Nazer MW, Awad H, Odeh G, Al-Najar M, Alsayed S, El-Asir L, Addasi R, Melhem JM, Sweiss NJ. Idiopathic granulomatous mastitis: clinical, histopathological, and radiological characteristics and management approaches. Rheumatol Int 2023; 43:1859-1869. [PMID: 37347273 DOI: 10.1007/s00296-023-05375-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/15/2023] [Indexed: 06/23/2023]
Abstract
Idiopathic Granulomatous Mastitis (IGM) is an infrequent, benign breast disease that primarily affects women during their childbearing years and can be mistaken for breast cancer. This study aimed to review the clinical, radiological, and histopathological findings of patients with IGM in addition to management and outcome. Retrospective cross-sectional study of biopsy-confirmed IGM at an academic medical center and a private hospital in Amman, Jordan. Fifty-four patients were included, with a mean age of 37.0 ± 9.04 years, mostly presenting with a breast lump (n = 52, 96.3%) and breast pain (n = 45 patients, 84.9%). Approximately half of the patients (51.9%) were parous, and 50% had breastfed for an average duration of 30.37 ± 22.38 months. Most of the patients had either solitary or multiple abscesses on breast ultrasound. Histopathological analysis (n = 35) showed mostly either moderate inflammation (n = 16, 45.7%) or severe inflammation (n = 14, 40%). Two-thirds of the patients underwent surgical interventions at the time of diagnosis, mostly incision and drainage (n = 16, 29%) or surgical excision (n = 7, 13%), and no mastectomies were performed. The most common medical treatment included a combination of antibiotics, corticosteroids, and methotrexate (n = 21, 38.8%). After follow-up, 31 patients remained in remission, 3 experienced relapses, and 3 had a chronic course. The use of corticosteroids was significantly associated with remission (p = 0.035). The presentation and demographics of IGM patients in Jordan were consistent with the existing literature. Prospective research is needed to explore different treatment options and disease outcomes.
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Affiliation(s)
- Muayad I Azzam
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Fatima Alnaimat
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, University of Jordan, Amman, 11942, Jordan.
| | | | - Heyam Awad
- Department of Pathology, School of Medicine, University of Jordan, Amman, 11942, Jordan
| | - Ghada Odeh
- Department of General Surgery, School of Medicine, University of Jordan, Amman, 11942, Jordan
| | - Mahasen Al-Najar
- Department of Radiology and Nuclear Medicine, School of Medicine, University of Jordan, Amman, 11942, Jordan
| | - Suzan Alsayed
- Department of Rheumatology, Abdali Hospital, Amman, Jordan
| | - Layal El-Asir
- Women's Health and Breast Center, Abdali Hospital, Amman, Jordan
| | - Rami Addasi
- Department of General Surgery, School of Medicine, University of Jordan, Amman, 11942, Jordan
| | - Jamal Masad Melhem
- Department of General Surgery, School of Medicine, University of Jordan, Amman, 11942, Jordan
| | - Nadera J Sweiss
- Division of Rheumatology, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
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Wang YT, Tang YQ, Xu JY, Bian XM. The Disease Experience of Women with Granulomatous Lobular Mastitis. A Qualitative Interview Study. J Inflamm Res 2023; 16:4347-4361. [PMID: 37791120 PMCID: PMC10544261 DOI: 10.2147/jir.s419347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 08/25/2023] [Indexed: 10/05/2023] Open
Abstract
Background The incidence of granulomatous lobular mastitis (GLM) is increasing year by year, and the breast wounds of women patients with GLM can develop into abscesses, fistulas, sinuses, and sometimes orange-like degeneration similar to malignant tumors, which seriously affects the quality of life of women patients with GLM. In China, breast wounds in women patients with GLM have not been better managed. Therefore, the purpose of this study is to explore the disease experience of women patients with GLM, to provide a basis for the development of precise intervention and support strategies for women patients with GLM, and to further improve the quality of nursing management and enrich the research types of GLM. Methods In this study, 10 cases of GLM women patients from a tertiary hospital in Hangzhou, Zhejiang Province were selected by purposive sampling. After obtaining the informed consent of GLM women patients, semi-structured interviews were conducted with GLM women patients using the interview outline to collect qualitative data. The interview was recorded, transcribed verbatim in the local language, and then translated into English, and the content analysis method was used to analyze the data. The Consolidated Criteria for Reporting Qualitative Research (CORE-Q) checklist follows the report 's findings. Results Our study identified six themes: (a) Perception of the disease, (b) Emotional discomfort (c) Variety of changes (d) Lack of specific skills (e) Coping strategies adopted to rebuild health, (f) Expectation. Conclusion The experience of women with GLM is characterized by diversity and specificity. After experiencing physical trauma, most patients use support systems to change negative attitudes and rebuild physical and mental health. Family, hospital and society should be fully linked to strengthen the prevention of GLM and the popularization of nursing management knowledge; nurses should provide targeted nursing services. Nursing leaders should improve the medical security system, broaden the medical channels, and reduce the pain experience and pressure of patients.
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Affiliation(s)
- Yan Ting Wang
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Ya Qin Tang
- Department of Nursing, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Jia Yuan Xu
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Xue Mei Bian
- Department of Nursing, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
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Fattahi AS, Amini G, Sajedi F, Mehrad-Majd H. Factors Affecting Recurrence of Idiopathic Granulomatous Mastitis: A Systematic Review. Breast J 2023; 2023:9947797. [PMID: 37794976 PMCID: PMC10547579 DOI: 10.1155/2023/9947797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 08/12/2023] [Accepted: 09/03/2023] [Indexed: 10/06/2023]
Abstract
Idiopathic granulomatous mastitis is a rare and benign disease that primarily affects young women of reproductive age. Various factors have been suggested as possible causes, including pregnancy, breastfeeding, history of taking birth control pills, hyperprolactinemia, smoking, and history of trauma. Due to unknown etiology, opinions on its treatment have varied, resulting in differing recurrence rates and side effects. Therefore, conducting a comprehensive systematic review and meta-analysis can aid in understanding the causes and recurrence of the disease, thereby assisting in the selection of effective treatment and improving the quality of life. A systematic literature review was conducted using predefined search terms to identify eligible studies related to risk factors and recurrence up to June 2022 from electronic databases. Data were extracted and subjected to meta-analysis when applicable. A total of 71 studies with 4735 patients were included. The mean age of the patients was 34.98 years, and the average mass size was 4.64 cm. About 3749 of these patients (79.17%) were Caucasian. Patients who mentioned a history of pregnancy were 92.65% with 76.57%, 22.7%, and 19.7% having a history of breastfeeding, taking contraceptive pills, and high prolactin levels, respectively. Around 5.6% of patients had previous trauma. The overall recurrence rate was 17.18%, with recurrence rates for treatments as follows: surgery (22.5%), immunosuppressive treatment (14.7%), combined treatment (14.9%), antibiotic treatment (6.74%), and observation (9.4%). Only antibiotic and expectant treatments had significant differences in recurrence rates compared to other treatments (p value = 0.023). In conclusion, factors such as Caucasian race, pregnancy and breastfeeding history, and use of contraceptive hormone are commonly associated with the disease recurrence. Treatment should be tailored based on symptom severity and patient preference, with surgery or immunosuppressive options for recurrence.
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Affiliation(s)
- Asieh Sadat Fattahi
- Endoscopic and Minimally Invasive Research Center, Department of Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ghasem Amini
- Endoscopic and Minimally Invasive Research Center, Department of Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Sajedi
- Department of Persian Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hassan Mehrad-Majd
- Clinical Research Development Unit, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Zeng Y, Zhang D, Zhao W, Fu N, Huang Q, Li S, Gao C, Yu J. Predisposing Factors for Granulomatous Lobular Mastitis: A Case-Control Study. Int J Womens Health 2023; 15:1063-1075. [PMID: 37795195 PMCID: PMC10547110 DOI: 10.2147/ijwh.s414054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/11/2023] [Indexed: 10/06/2023] Open
Abstract
Background Despite the rising incidence rate of granulomatous lobular mastitis (GLM), uncertainties persist about its etiologic and predisposing factors to guide clinical treatment and early prevention. The objective of this study is to explore the predisposing factors for GLM. Patients and methods This case-control study was conducted from 2018 to 2021 at Beijing Hospital of Traditional Chinese Medicine, Capital Medical University. Patients with GLM (cases) were matched with healthy examinees (controls) in a 1:1 ratio according to gender and living area. We analyzed their demographic features and investigated 75 factors that may be relevant to GLM using a standard questionnaire. Univariate and multivariable binary conditional logistic regression analyses were used to compare the differences between the two groups and evaluate the predisposing factors that may induce GLM. Results There were 594 female GLM patients and 594 matched controls included in the study. The average age of the cases was 32.78 years (mainly 20 to 40). The incidence was high within five years after childbirth, and lesions were mainly in the unilateral breast. Univariate and multivariable conditional logistic regression analyses obtained six relevant factors and six high-risk factors. The six relevant factors included age, marriage, emotional abnormality, high prolactin, psychiatric drug intake, and sex hormone intake. Additionally, the independent high-risk factors for GLM included gestation, nipple invagination, blunt trauma, non-iatrogenic massage, lactation disorder, and nipple discharge (odds ratio (OR)=17.378, 8.518, 4.887, 3.116, 2.522, 1.685, P<0.05). Menopause was an independent protective factor (OR=0.249, P<0.05). Conclusion The factors that increase milk and secretion production in the mammary duct are the main risk factors of GLM, especially when the nipples are invaginated. These factors can obstruct the duct and induce inflammation. Additionally, hormonal disorders, extrinsic trauma, and emotional abnormalities can accelerate the occurrence of GLM.
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Affiliation(s)
- Yifei Zeng
- Department of Galactophore, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People’s Republic of China
- Graduate School, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Dongxiao Zhang
- Department of Galactophore, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People’s Republic of China
| | - Wenjie Zhao
- Department of Galactophore, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People’s Republic of China
| | - Na Fu
- Department of Galactophore, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People’s Republic of China
| | - Qiao Huang
- Department of Galactophore, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People’s Republic of China
| | - Shuqi Li
- Graduate School, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Chang Gao
- Graduate School, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Jiale Yu
- Graduate School, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
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Ren Y, Zhang J, Zhang J, Guo R. Combining intralesional steroid injection with oral steroids in patients with idiopathic granulomatous mastitis. Medicine (Baltimore) 2023; 102:e34055. [PMID: 37327292 PMCID: PMC10270520 DOI: 10.1097/md.0000000000034055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/31/2023] [Indexed: 06/18/2023] Open
Abstract
Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory breast disease. Currently, there is no international standard for steroid use in IGM, particularly for intralesional steroid injections. This study aimed to determine whether patients with IGM who received oral steroids could benefit from intralesional steroid injection. We analyzed 62 patients with IGM whose main clinical presentation was mastitis masses and who received preoperative steroid therapy. Group A (n = 34) received combined steroid treatment: oral steroids (starting dose, 0.25 mg/kg/d; tapered off) and intralesional steroid injection (20 mg per session). Group B (n = 28) received oral steroids only (starting dose, 0.5 mg/kg/d; tapered off). Both groups underwent lumpectomy at the end of steroid treatment. We analyzed the preoperative treatment time, preoperative mass maximum diameter reduction rate, side effects, postoperative satisfaction, and rate of IGM recurrence. The mean age of the 62 participants was 33.6 ± 2.3 (range, 26-46) years, and all had unilateral disease. We found that oral steroids combined with intralesional steroid injection yielded better therapeutic effects than did oral steroids alone. The median maximum diameter reduction of the breast mass was 52.06% in group A and 30.00% in group B (P = .002). Moreover, the use of intralesional steroids reduced the duration of oral steroid use; the median durations of preoperative steroid therapy were 4 and 7 weeks in groups A and B, respectively (P < .001). Group A patients were more satisfied (P = .035) with the postoperative results, including postoperative appearance and function. No statistically significant between-group differences were noted regarding side effects and recurrence rates. Preoperative administration of oral steroids combined with intralesional steroid injection yielded better therapeutic effects than did oral steroids alone and may be an effective future treatment for IGM.
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Affiliation(s)
- Yun Ren
- Department of Breast Surgery, Changzhi People’s Hospital Affiliated to Shanxi Medical University, Changzhi, Shanxi Province, China
| | - Jiao Zhang
- Department of Diagnostic Radiology, Changzhi People’s Hospital Affiliated to Shanxi Medical University, Changzhi, Shanxi Province, China
| | - Jindan Zhang
- Department of Breast Surgery, Changzhi People’s Hospital Affiliated to Shanxi Medical University, Changzhi, Shanxi Province, China
| | - Ruqi Guo
- Department of Breast Surgery, Changzhi People’s Hospital Affiliated to Shanxi Medical University, Changzhi, Shanxi Province, China
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Capiro N, Naik P, Lo A, Sayre J, Shaheen M, Thomas M, Roth A. Demographic and Socioeconomic Risk Factors for Granulomatous Mastitis in the United States: A Case-Control Study. JOURNAL OF BREAST IMAGING 2023; 5:174-179. [PMID: 38416935 DOI: 10.1093/jbi/wbac099] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Indexed: 03/01/2024]
Abstract
OBJECTIVE Granulomatous mastitis (GM) is a benign breast disease that can have an extended clinical course impacting quality of life and causing breast disfigurement. Granulomatous mastitis has been studied throughout the world; however, less is known about GM patients in the United States. We aim to identify demographic and socioeconomic factors associated with GM in the United States. METHODS An IRB-approved retrospective case-control study was performed of 92 patients with biopsy-proven GM at two institutions in Los Angeles, California: a safety-net hospital and an academic institution. Age-matched controls were selected from patients presenting for diagnostic breast imaging. Demographic and socioeconomic characteristics were collected. Data were analyzed using univariable test for odds ratios (ORs) with 95% confidence intervals (CIs) and multivariable conditional logistic regression. RESULTS Patients with GM were more likely to prefer Spanish language (OR 6.20, 95% CI: 2.71%-14.18%), identify as Hispanic/Latina (OR 5.18, 95% CI: 2.38%-11.30%), and be born in Mexico (OR 3.85, 95% CI: 1.23%-12.02%). Cases were more likely to have no primary care provider (OR 3.76, 95% CI: 1.97%-7.14%) and use California Medicaid for undocumented adults (OR 3.65, 95% CI: 1.89%-7.08%). In the multivariable analysis, participants who preferred Spanish language had four times higher odds of GM versus those who preferred English language (OR 4.32, 95% CI: 1.38%-13.54%). CONCLUSION Patients with GM may have barriers to health care access, such as preferring Spanish language, being an undocumented immigrant, and not having a primary care provider. Given these health care disparities, further research is needed to identify risk factors, etiologies, and treatments for this subset of GM patients.
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Affiliation(s)
- Nina Capiro
- David Geffen School of Medicine at University of California-Los Angeles, Department of Radiological Sciences, Santa Monica, CA, USA
| | - Priyanka Naik
- Massachusetts General Hospital, Department of Radiology, Boston, MA, USA
| | - Amanda Lo
- UCLA-Olive View Medical Center, Department of Pathology, Sylmar, CA, USA
| | - James Sayre
- David Geffen School of Medicine at University of California-Los Angeles, Department of Biostatistics, Los Angeles, CA, USA
| | - Magda Shaheen
- Charles R. Drew University of Medicine and Science, Department of Internal Medicine, Los Angeles, CA, USA
| | - Mariam Thomas
- UCLA-Olive View Medical Center, Department of Radiology, Sylmar, CA, USA
| | - Antoinette Roth
- UCLA-Olive View Medical Center, Department of Radiology, Sylmar, CA, USA
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13
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Yuksekdag S. The efficacy of St John's wort oil macerates on intractable skin lesions of patients with idiopathic granulomatous mastitis: preliminary results. J Wound Care 2022; 31:1006-1010. [DOI: 10.12968/jowc.2022.31.11.1006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: St John's wort (SJW, Hypericum perforatum) has a long history of medicinal use, mainly for its antidepressive effects and for wound healing. However, to the best of our knowledge, this is the first clinical study evaluating the effects of topical SJW oil macerates on the intractable skin lesions of idiopathic granulomatous mastitis (IGM). Method: SJW oil massage (twice daily for two minutes) was recommended between 2016 and 2019, only for patients with persistent or intractable skin lesions, after complete regression of granulomatous mass with two cycles of high-dose oral steroid and empiric antibiotics. Skin lesions were assessed and graded, before and after treatment, as clear, mild, moderate and severe. A questionnaire was also completed for each patient at the end of the six-week treatment. Results: A total of 21 patients with persistent IGM lesions used SJW oil after completion of the standard treatment protocol. All patients were women, and the mean age was 36.6 years. Hyperaemia (100%), scaling (61%), induration (52%) and ulcers (28%) were the predominant skin lesions. Distribution of the lesions according to the degree of severity were graded mild, moderate and severe, and seen in 35%, 41% and 23% of the patients, respectively. When compared with pre-treatment scores, there were very significant regressions (clear: 76.4%, mild: 17.6%, moderate: 3.9%, severe: 1.9%; p<0.001 for each). The overall success rate (total clearance or decrease/decline in lesions) of treatment was 94%. Conclusion: SJW oil massage seems to be very effective in patients with IGM-related persistent skin lesions.
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Affiliation(s)
- Sema Yuksekdag
- Department of General Surgery, Umraniye Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
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14
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Ciftci AB, Bük ÖF, Yemez K, Polat S, Yazıcıoğlu İM. Risk Factors and the Role of the Albumin-to-Globulin Ratio in Predicting Recurrence Among Patients with Idiopathic Granulomatous Mastitis. J Inflamm Res 2022; 15:5401-5412. [PMID: 36158516 PMCID: PMC9499730 DOI: 10.2147/jir.s377804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/09/2022] [Indexed: 11/23/2022] Open
Abstract
Background Idiopathic granulomatous mastitis (IGM) is a rare inflammatory disease of the breast with a high recurrence rate. The serum albumin to globulin ratio (AGR) is a relatively novel biomarker in inflammatory diseases, and one whose role in the recurrence of IGM remains unknown. This study primarily investigated the potential risk factors for IGM recurrence and whether AGR can be used as a predictive factor. Methods Patients diagnosed with IGM from pathology reports between 2016 and 2021 were enrolled in the study, and their medical records were analyzed retrospectively. The patients were divided into two groups – recurrence and non-recurrence. Clinical, demographic characteristics, and laboratory parameters were compared. Results Eighty-five patients were included in the study, recurrence being detected in 16 (18.8%) of these, with a median follow-up time of 39.99±18.93 months. No relationship was determined between childbearing, breastfeeding, disease severity, or therapeutic approaches and IGM recurrence. While AGR was significantly lower in the recurrence group (p < 0.001), neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) results were comparable in the two groups (p = 0.472 and p = 0.421, respectively). Multivariate analysis identified low AGR (odds ratio (OR): 50.7, 95% CI 5.93–434.1 P < 0.001) and smoking (OR: 4.45, 95% CI 1.04–18.9 P = 0.044) as independent risk factors for IGM recurrence. Conclusion The study findings indicated that AGR at a cut-off value of ≤1.179 at diagnosis and smoking exhibited a remarkable performance in predicting the recurrence of IGM. Developing new risk stratification systems for IGM recurrences and using AGR in these classifications may increase the success of treatment. Trial Registration This study was registered with ClinicalTrials.gov, NCT05409586.
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Affiliation(s)
- Ahmet Burak Ciftci
- Department of General Surgery, Samsun University, Samsun Training and Research Hospital, Samsun, Turkey
| | - Ömer Faruk Bük
- Department of General Surgery, Samsun University, Samsun Training and Research Hospital, Samsun, Turkey
| | - Kürşat Yemez
- Department of General Surgery, Samsun University, Samsun Training and Research Hospital, Samsun, Turkey
| | - Süleyman Polat
- Department of General Surgery, Samsun University, Samsun Training and Research Hospital, Samsun, Turkey
| | - İrem Melike Yazıcıoğlu
- Department of Pathology, Samsun University, Samsun Training and Research Hospital, Samsun, Turkey
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15
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Ling J, Xie X, Wang Y, Huang W, Luo J, Su J, Fan H, Wu S, Liu L. Differential expression profiles of miRNA in granulomatous lobular mastitis and identification of possible biomarkers. Exp Ther Med 2022; 24:500. [PMID: 35837043 PMCID: PMC9257833 DOI: 10.3892/etm.2022.11427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/16/2022] [Indexed: 11/06/2022] Open
Abstract
The etiology and pathogenesis of granulomatous lobular mastitis (GLM) remain largely elusive and the expression levels and regulatory roles of microRNAs (miRNAs or miRs) in GLM have remained mostly undetermined. In the present study, the miRNAs that were differentially expressed in breast biopsy samples from patients with GLM and normal tissue adjacent to fibroadenoma were analyzed, a comprehensive differential expression profile of miRNAs was provided and potential biomarkers were screened out. The expression profile of miRNAs was determined by high-throughput sequencing in the tissues of patients with GLM and healthy controls. Significantly differentially expressed miRNAs were screened by threshold setting and cluster analysis and their target genes were analyzed by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment. Finally, circulating differentially expressed miRNAs between the GLM and control groups were further analyzed by reverse transcription-quantitative PCR (RT-qPCR). A total of 31,077 miRNAs were detected by high-throughput sequencing. By using the cutoff criteria of |log2 fold change|>2.5 and q<0.001, 13 miRNAs that were indicated to be GLM biomarkers were screened out. The expression levels of these 13 miRNAs in the GLM group were higher than those in the control group. GO and KEGG enrichment analyses suggested that the occurrence and development of GLM may be associated with autoimmune inflammation, metabolism and pathogenic organisms. miR-451a and miR-5571-3p were confirmed to be significantly increased in the serum of patients with GLM compared with their levels in the serum of healthy volunteers, which suggests that they may be used as biomarkers of GLM. To the best of our knowledge, the present study was the first report detailing genome-wide miRNA profiling of patients with GLM compared with controls. The possible targets and pathways of GLM were evaluated by bioinformatics analysis. The present study identified 13 differentially expressed miRNAs with important theoretical significance and potential application. Furthermore, miR-451a and miR-5571-3p were verified by RT-qPCR as possible biomarkers of GLM.
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Affiliation(s)
- Jie Ling
- Graduate School, Hunan University of Chinese Medicine, Changsha, Hunan 41000, P.R. China
| | - Xianmin Xie
- Department of Hand Surgery, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan 41000, P.R. China
| | - Yue Wang
- Department of Galactophore, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan 41000, P.R. China
| | - Weifang Huang
- Graduate School, Hunan University of Chinese Medicine, Changsha, Hunan 41000, P.R. China
| | - Jun Luo
- Graduate School, Hunan University of Chinese Medicine, Changsha, Hunan 41000, P.R. China
| | - Jingqun Su
- Graduate School, Hunan University of Chinese Medicine, Changsha, Hunan 41000, P.R. China
| | - Hongqiao Fan
- Department of Galactophore, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan 41000, P.R. China
| | - Shiting Wu
- Department of Galactophore, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan 41000, P.R. China
| | - Lifang Liu
- Department of Galactophore, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan 41000, P.R. China
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16
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Lin Q, Fei C, Wu X, Wu Q, Chen Q, Yan Y. Imaging manifestations of idiopathic granulomatous lobular mastitis on cone-beam breast computed tomography. Eur J Radiol 2022; 154:110389. [DOI: 10.1016/j.ejrad.2022.110389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022]
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17
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Deng Y, Xiong Y, Ning P, Wang X, Han XR, Tu GF, He PY. A case management model for patients with granulomatous mastitis: a prospective study. BMC Womens Health 2022; 22:143. [PMID: 35501850 PMCID: PMC9063211 DOI: 10.1186/s12905-022-01726-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/20/2022] [Indexed: 02/01/2024] Open
Abstract
Background Granulomatous mastitis (GM) is a chronic inflammatory mastitis disease that requires long-term treatment and has a high recurrence rate. Case management has been proven to be an effective mechanism in assisting patients with chronic illness to receive regular and targeted disease monitoring and health care service. The aim of this study was to investigate the application of a hospital-to-community model of case management for granulomatous mastitis and explore the related factors associated with its recurrence. Methods This was a prospective study on patients with granulomatous mastitis based on a case management model. Data on demographic, clinical and laboratory information, treatment methods, follow-up time, and recurrence were collected and analyzed. The eight-item Morisky Medication Adherence Scale (MMAS-8) was used to investigate patients' adherence to medications. Logistic regression models were built for analysis of risk factors for the recurrence of granulomatous mastitis. Results By October 2021, a total of 152 female patients with a mean age of 32 years had undergone the entire case management process. The mean total course of case management was 24.54 (range 15–45) months. Almost all the patients received medication treatment, except for one pregnant patient who received observation therapy, and approximately 53.9% of the patients received medication and surgery. The overall recurrence rate was 11.2%, and “high” medication adherence (RR = 0.428, 95% CI 0.224–0.867, P = 0.015) was significantly associated with a lower rate of recurrence, while the rate of recurrence with a surgical procedure + medication was higher than that with medication alone (RR = 4.128, 95% CI 1.026–16.610, P = 0.046). Conclusion A case management model for patients with granulomatous mastitis was applied to effectively monitor changes in the disease and to identify factors associated with disease recurrence. “Low” medication adherence was a significant risk factor for the recurrence of granulomatous mastitis. Patients treated with medication and surgery were more likely to experience recurrence than those treated with medication alone. The optimal treatment approach should be planned for granulomatous mastitis patients, and patient medication adherence should be of concern to medical staff.
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Affiliation(s)
- Yuan Deng
- Department of Breast, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Qingyang District, Chengdu, 611731, Sichuan Province, People's Republic of China.,Department of Nursing, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Qingyang District, Chengdu, 611731, Sichuan Province, People's Republic of China
| | - Ying Xiong
- Department of Breast, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Qingyang District, Chengdu, 611731, Sichuan Province, People's Republic of China
| | - Ping Ning
- Department of Breast, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Qingyang District, Chengdu, 611731, Sichuan Province, People's Republic of China.
| | - Xin Wang
- Department of Nursing, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Qingyang District, Chengdu, 611731, Sichuan Province, People's Republic of China.
| | - Xiao-Rong Han
- Department of Breast, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Qingyang District, Chengdu, 611731, Sichuan Province, People's Republic of China
| | - Guo-Fang Tu
- Department of Nursing, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Qingyang District, Chengdu, 611731, Sichuan Province, People's Republic of China
| | - Pei-Yu He
- Department of Breast, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Qingyang District, Chengdu, 611731, Sichuan Province, People's Republic of China
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18
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Idiopathic granulomatous mastitis - new approach in operative treatment. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh200914006r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction. Idiopathic granulomatous mastitis (GM) is described as a very
rare, non-lactating, chronic mastitis that occurs primarily in women of
childbearing age. Significant clinical problem related to GM is the
diagnostic differentiation from breast cancer. Less advanced forms of GM can
be successfully treated with limited surgical excisions and radical
treatment is recommended only for the most extensive forms. Case report.
First examination of the patient, by the surgeon at Oncology Institute of
Vojvodina was in December 2018., when initial suspicion of breast cancer was
set up. Core needle biopsy was performed and after histopathological (HP)
analysis, confirmation of GM was obtained. The patient was initially offered
Prednisone and Methotrexate therapy, which she refused and accepted only
surgical treatment. Surgical treatment was performed few weeks after needle
biopsy and consisted of performing a nipple spearing mastectomy with
excision of the orifices of all fistulous ducts and their primary sutures.
The HP findings of the operative specimen confirmed the diagnosis of GM.
While there were no signs of dieses relapse, patient was suggested secondary
reconstruction of the left breast. Twelve months after the primary
operation, secondary breast reconstruction was performed with the
interposition of a contoured silicone implant into a muscle pocket in a
standard manner. Conclusion. Nipple spearing mastectomy with secondary
breast reconstruction is aesthetically satisfactory treatment for patients
with locally advanced GM.
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Zhang C, Wu Y, Wang H, Zeng J, Lei S, He J, Zeng Z, Wu R, Li Q, Fan P. A clinical observation of stage I implant breast reconstruction for mass-like granulomatous lobular mastitis. Gland Surg 2021; 10:2663-2672. [PMID: 34733716 DOI: 10.21037/gs-21-417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/02/2021] [Indexed: 11/06/2022]
Abstract
Background Granulomatous lobular mastitis (GLM) is a chronic benign inflammatory breast disease, and mainly mass-like granulomatous lobular mastitis (MGLM) clinically. There are few reports on applications of stage I implant breast reconstruction in GLM. This observational study was conducted to evaluate the safety and efficacy of stage I implant breast reconstruction in the treatment of MGLM. Methods Patients suffering from MGLM who visited at hospital from April 2019 to June 2020 were selected and graded according to the magnetic resonance imaging (MRI) examination. Patients with MGLM were grouped into the prosthesis implantation group and the traditional treatment group according to their preferences. Clinical parameters of the two groups were analyzed before and after surgery, such as postoperative infection, recurrence, and satisfaction with appearance and aesthetics were observed. To evaluate the safety and efficacy of the implant breast reconstruction in MGLM. Results There were 59 cases of MGLM, 31 cases of grade 3-4 GLM, 11 cases of bilateral metachronous GLM. There were 18 patients in the prosthesis implantation group, including 9 patients with bilateral metachronous GLM, 2 patients with synchronous GLM, and 41 patients in the traditional treatment group. All the patients were followed up with a median of 17.5 months. One patient in the observation group had an infection on the reconstructed side 3 weeks after surgery, and the implant was retained after 2 weeks of conservative treatment such as antibiotics. Two patients in the prosthesis implantation group were not satisfied with size of the reconstructed breast was smaller than the opposite side. In the traditional treatment group, there were 3 cases of postoperative infection or delayed wound healing, and 26 cases of postoperative breast asymmetry. Conclusions For patients with MGLM, it is safe to select stage I prosthesis implantation after conservative treatment, with exact effect and high patient satisfaction.
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Affiliation(s)
- Chaojie Zhang
- Department of Breast and Thyroid Surgery, Hunan Provincial People's Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Yaqin Wu
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Hunan Normal University/Hunan Provincial People's Hospital, Changsha, China
| | - Huiling Wang
- The Second Department of Breast and Thyroid Surgery, Hunan Provincial People's Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Jie Zeng
- Department of Breast and Thyroid Surgery, Hunan Provincial People's Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Shanshan Lei
- Department of Breast and Thyroid Surgery, Hunan Provincial People's Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Jie He
- Department of Breast and Thyroid Surgery, Hunan Provincial People's Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Zheng Zeng
- The Second Department of Breast and Thyroid Surgery, Hunan Provincial People's Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Runzhang Wu
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Hunan Normal University/Hunan Provincial People's Hospital, Changsha, China
| | - Qian Li
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Hunan Normal University/Hunan Provincial People's Hospital, Changsha, China
| | - Peizhi Fan
- Department of Breast and Thyroid Surgery, Hunan Provincial People's Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, China
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20
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Lin L, Zheng Z, Zhang J, Liu X, Chen DR, Wang H. Treatment of idiopathic granulomatous mastitis using ultrasound-guided microwave ablation: a report of 50 cases. Int J Hyperthermia 2021; 38:1242-1250. [PMID: 34402370 DOI: 10.1080/02656736.2021.1965225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the efficacy and safety of ultrasound-guided microwave ablation combined with glucocorticoid therapy for treating idiopathic granulomatous mastitis (IGM). METHODS From June 2017 to March 2020, 50 consecutive patients diagnosed with IGM using puncture histology were included. All patients received prednisone and ultrasound-guided microwave ablation and were closely monitored for 12-15 months. RESULTS A total of 222 lesions in 50 patients were ablated. The results indicated that 78% of cases were cured within 12 months and an additional 20% were cured within 15 months; the recurrence rate was 2%. The clinical and pathological remission rate of the entire group was 98%. The main postoperative complications were local pain, skin ulcerations and sinus formation, skin and areola heat damage, subcutaneous congestion, and fat liquefaction, all of which were conservatively treated. CONCLUSION Microwave ablation combined with glucocorticoid therapy was safe and effective for the treatment of IGM, with a low recurrence rate. In addition, the cosmetic appearance of the affected breast was preserved with little trauma. Therefore, microwave ablation is a viable method that can be successfully applied in clinical practice.
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Affiliation(s)
- Lisheng Lin
- Department of Breast Surgery, Affiliated Hospital of Putian University, Putian, China
| | - Zifang Zheng
- Department of Breast Surgery, Affiliated Hospital of Putian University, Putian, China
| | - Jinfan Zhang
- Department of Breast Surgery, Affiliated Hospital of Putian University, Putian, China
| | - Xiaoli Liu
- Department of Pathology, Affiliated Hospital of Putian University, Putian, China
| | - Dar-Ren Chen
- Comprehensive Breast Cancer Centre, Changhua Christian Hospital, Changhua City, Taiwan
| | - Hongling Wang
- Department of General Surgery, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
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21
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Chen X, Zhang W, Yuan Q, Hu X, Xia T, Cao T, Jia H, Zhang L. A novel therapy for granulomatous lobular mastitis: Local heat therapy. Exp Ther Med 2021; 22:1156. [PMID: 34504601 DOI: 10.3892/etm.2021.10590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/17/2020] [Indexed: 12/24/2022] Open
Abstract
Granulomatous lobular mastitis (GLM) is a chronic inflammatory breast condition that is characterized by granulomatous inflammation. GLM remains a refractory disease due to its failure to respond to routine anti-inflammatory therapies and its high recurrence rate. Thus, the present study aimed to investigate the application of local heat therapy in GLM as a potential therapeutic strategy. The results revealed that the application of local heat therapy was associated with a shortened remission time for GLM, while the remission and recurrence rates were similar to those of existing therapies. The median first remission time following local heat therapy was significantly decreased compared with that following corticosteroid therapy (5.30 months vs. 11.27 months; P<0.05). The remission rates were not significantly different between the local heat therapy (76.9%), extensive excision (90.4%) and the corticosteroid therapy (85.7%) groups (P>0.05). In addition, the recurrence rates were not statistically different between the groups (local heat therapy, 8.3%; extensive excision, 10%; and corticosteroid therapy, 10%; P>0.05). The local heat therapy showed mild adverse effects and shortened healing times compared to the other therapies; however, further confirmation is required.
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Affiliation(s)
- Xinxin Chen
- Department of Breast Surgery, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510260, P.R. China.,Guangdong Provincial Education Department, Key Laboratory of Nano-Immunoregulation Tumor Microenvironment, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510260, P.R. China
| | - Wangjian Zhang
- Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, NY 12144, USA
| | - Qiuer Yuan
- Department of Breast Surgery, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510260, P.R. China
| | - Xiaowu Hu
- Department of Breast Surgery, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510260, P.R. China
| | - Ting Xia
- Department of Breast Surgery, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510260, P.R. China
| | - Tengfei Cao
- Department of Breast Surgery, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510260, P.R. China
| | - Haixia Jia
- Department of Breast Surgery, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510260, P.R. China
| | - Lehong Zhang
- Department of Breast Surgery, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510260, P.R. China
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22
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Basim P, Argun D, Argun F. Risk Factors for Idiopathic Granulomatous Mastitis Recurrence after Patient-Tailored Treatment: Do We Need an Escalating Treatment Algorithm? Breast Care (Basel) 2021; 17:172-179. [PMID: 35707181 PMCID: PMC9149487 DOI: 10.1159/000517399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/21/2021] [Indexed: 11/19/2022] Open
Abstract
<b><i>Objective:</i></b> Idiopathic granulomatous mastitis (IGM) is a rare, relapsing, benign inflammatory breast disease. Due to the conflicting etiology and differential diagnosis, the effect of varied treatment regimens on high recurrence is controversial. Therefore, we aimed to report our clinical experience in determining risk factors for recurrence after patient-tailored treatment. <b><i>Methods:</i></b> This study evaluated 122 patients diagnosed with IGM according to sociodemographic characteristics, reproductive history, clinical presentation, time of diagnosis and radiological examinations, treatment management, and outcomes. The patients were classified into three groups based on curative treatment settings: medical therapy alone, surgery alone, and combined therapy. <b><i>Results:</i></b> The rates of patients receiving medical therapy alone, surgical therapy alone, and combined therapy were 23, 15.6, and 62.4%, respectively. Low vitamin B<sub>12</sub> levels, accompanying rheumatological disease, complaints-fistulae, number of complaints ≥3, presence of erythema nodosum, multicentricity, and treatment modality had a significant effect on disease recurrence (<i>p</i> < 0.05). The effect on IGM recurrence was 2.8 times greater for the patients with lower vitamin B<sub>12</sub> levels, 4.5 times greater for those with rheumatological disease, 3.3 times greater for those with fistulae, 2.4 times greater for those presenting with ≥3 complaints, 2 times greater for the presence of multicentricity, 2.3 times greater for the presence of erythema nodosum, and 4.5 times greater for the patients receiving medical therapy alone. <b><i>Conclusion:</i></b> Describing a low-risk patient profile can be an alternative while choosing monotherapy methods. For IGM patients at high risk of recurrence, an escalating treatment system may be effective in preventing relapses.
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Affiliation(s)
- Pelin Basim
- Department of General Surgery, Medical Faculty, Istanbul Medipol University, Istanbul, Turkey
- *Pelin Basim,
| | - Derya Argun
- Department of Internal Medicine, Medical Faculty, Istanbul Aydin University, Istanbul, Turkey
| | - Ferit Argun
- Department of Internal Medicine, Medical Faculty, Istanbul Aydin University, Istanbul, Turkey
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23
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Bell S, Villasmil R, Lattanzio N, Abdelal Q, King A, Farhangi V. Idiopathic Granulomatous Mastitis Presenting in a Patient With Hypothyroidism and Recent Hospitalization for Myxedema Coma: A Rare Case Report and Review of Literature. J Investig Med High Impact Case Rep 2021; 8:2324709620949325. [PMID: 32779533 PMCID: PMC7425251 DOI: 10.1177/2324709620949325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Idiopathic granulomatous mastitis (IGM) is a rare, benign inflammatory disorder of the breast. Clinical features may include painful breasts, erythema, subcutaneous nodules, and ulcerative lesions. It can mimic various other breast pathologies, and it is a diagnosis of exclusion after infection, malignancy, and other inflammatory conditions have been ruled out. In this article, we present a case of IGM developing in a 40-year-old female 3 months after hospitalization for myxedema coma. A contrast-enhanced magnetic resonance imaging of the breasts showed bilateral edema, and a biopsy was negative for malignancy or infection. She was started on prednisone and had noticeable improvement of ulcerations within several weeks. IGM is a rare condition that requires a multimodal treatment approach. Often recalcitrant disease is encountered and requires surgical intervention, immunosuppression, and antimicrobial therapy. The diagnosis should be entertained in patients with bilateral breast inflammation to avoid unnecessary surgical resection early on.
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Affiliation(s)
| | | | | | | | - Alan King
- Florida State University, Sarasota, FL, USA
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24
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Williams MS, McClintock AH, Bourassa L, Laya MB. Treatment of Granulomatous Mastitis: Is There a Role for Antibiotics? Eur J Breast Health 2021; 17:239-246. [PMID: 34263151 PMCID: PMC8246047 DOI: 10.4274/ejbh.galenos.2021.2021-3-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/01/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To perform a retrospective review of the clinical characteristics, microbiological data, and clinical outcomes in patients with granulomatous mastitis (GM) who were treated at our institution with a unique strategy of prolonged antibiotic therapy as the primary treatment modality. MATERIALS AND METHODS A retrospective case series was performed on patients (n = 42) with GM seen at the breast specialty clinic of our institution between the years 2004 and 2014. Patients were primarily treated with lipophilic antibiotics, and steroids and surgery were reserved for refractory cases. RESULTS Bacteria were identified in 34 samples from 22/42 patients (52.3%). Diphtheroids (presumptive Corynebacterium spp.) were most commonly identified, followed by Corynebacterium spp. and Propionibacterium acnes (now Cutibacterium acnes). Antibiotics were our preferred first-line medical therapy and were used in 33/36 (91.7%) patients. The mean duration of antibiotic therapy was 7.0±4.5 months. Clarithromycin was our antibiotic of choice and was the initial antibiotic used in 15 of the 33 patients (45.5%) treated with antibiotics. Eleven patients required adjunctive therapy with prednisone. The mean duration of steroid therapy was 4.3±2.5 months. Surgery for therapeutic purposes included incision and drainage in seven patients, fine needle aspiration in eight patients, and excision of the fistulous tract in one patient. No patients had large-volume excisions. The average time from the first breast clinic visit to clinical resolution was 8.0±4.6 months. CONCLUSION GM may be the result of a bacterial process that induces a unique form of inflammatory response. Clinicians should consider special requests to microbiology laboratories to attempt to isolate Corynebacterium spp. in the evaluation of samples sent to the laboratory for analysis. An extended course of a lipophilic antibiotic is a largely unexplored but potentially effective treatment option with low associated morbidity. More research is needed in this area.
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Affiliation(s)
- Meagan S. Williams
- Department of Medicine, Division of General Internal Medicine, University of Washington, Washington, USA
| | - Adelaide H. McClintock
- Department of Medicine, Division of General Internal Medicine, University of Washington, Washington, USA
| | - Lori Bourassa
- Department of Laboratory Medicine and Pathology, Division of Clinical Microbiology, University of Washington, Washington, USA
| | - Mary B. Laya
- Department of Medicine, Division of General Internal Medicine, Breast Care Program, University of Washington, Washington, USA
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25
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Zuo X, Shi X, Gao X, Lai R, Liu P, Zhao Z. Treatment Effect of Mammary Duct Exploration Combined with Focal Resection on Granulomatous Lobular Mastitis. J Inflamm Res 2021; 14:2641-2646. [PMID: 34188514 PMCID: PMC8232890 DOI: 10.2147/jir.s309101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/27/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study aims to summarize the treatment of granulomatous lobular mastitis with a low recurrence rate and high satisfaction rate. METHODS In this study, the epidemiology and treatment effect was analyzed based on the general data and treatment effects. Patients treated for granulomatous lobular mastitis at the Dongzhimen Hospital, Beijing University of Chinese Medicine, and Beijing Contemporary Hospital from October 24, 2016, to May 8, 2019, were selected as subjects for the study. RESULTS The results revealed that the common features of granulomatous lobular mastitis were nipple retraction, history of induced abortion, nipple discharge, history of thyroid disease, history of lactation mastitis, and mental illness. The cure rate of the disease was 100%, the recurrence rate was 0.38%, and the patient satisfaction rate was 97.71%. CONCLUSION The combination of mammary duct exploration and focal resection has a positive effect on the treatment of this disease and is worthy of clinical popularization.
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Affiliation(s)
- Ximeng Zuo
- Department of General Surgery, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, People’s Republic of China
| | - Xiaoguang Shi
- Department of General Surgery, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, People’s Republic of China
| | - Xiang Gao
- Department of General Surgery, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, People’s Republic of China
| | - Rui Lai
- Department of General Surgery, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, People’s Republic of China
| | - Pengzhou Liu
- Department of General Surgery, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, People’s Republic of China
| | - Ze Zhao
- Department of General Surgery, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, People’s Republic of China
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26
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Chen R, Chen J, Peng A, Yang L, Zhou R. Clinical therapeutic evaluation of vacuum sealing drainage and precise ultrasound-guided debridement in the treatment of non-lactational mastitis. Exp Ther Med 2021; 21:480. [PMID: 33767775 PMCID: PMC7976372 DOI: 10.3892/etm.2021.9911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 02/10/2021] [Indexed: 12/02/2022] Open
Abstract
The aim of the present study was to compare the efficacy of vacuum sealing drainage (VSD) and precise ultrasound-guided debridement in the treatment of non-lactational mastitis and to determine the optimal surgical treatment. A set of 60 cases diagnosed with non-lactational mastitis who had received surgical treatment at the Department of Thoracic and Breast Surgery of Xiamen Hospital of Traditional Chinese Medicine (Xiamen, China) between July 2017 and June 2019 were included. According to the surgical method, 30 patients were assigned to the VSD group and 30 patients were assigned to the precise ultrasound-guided debridement group. The clinicopathological data of the two groups were compared. The overall rates of recurrence and new incidence were 6.8 and 8.5%, respectively. The mean total disease course was 5.3 months and all of the patients were cured after treatment. Except for the hospitalization time and postoperative pain scores, the clinicopathological data between the two groups were similar. The hospitalization time in the VSD group was significantly longer than that in the precise ultrasound-guided debridement group. Pain scores on the first and third days after the operation in the precise ultrasound-guided debridement group were significantly higher than those in the VSD group (P=0.008 and 0.001, respectively). In conclusion, the efficacies of VSD and precise ultrasound-guided debridement for the treatment of non-lactational mastitis were generally both satisfactory without significant differences. Of note, the former is suitable for patients with inverted nipples and obvious skin ulcerations, while the latter is mainly suitable for patients with abscesses, small surgical incisions and those who require short hospital stays.
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Affiliation(s)
- Ruifu Chen
- Department of Thoracic and Breast Surgery, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, Fujian 361000, P.R. China
| | - Junpeng Chen
- Department of Thoracic and Breast Surgery, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, Fujian 361000, P.R. China
| | - Ajing Peng
- Department of Thoracic and Breast Surgery, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, Fujian 361000, P.R. China
| | - Lihua Yang
- Department of Thoracic and Breast Surgery, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, Fujian 361000, P.R. China
| | - Ruijuan Zhou
- Department of Thoracic and Breast Surgery, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, Fujian 361000, P.R. China
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27
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Yin Y, Liu X, Meng Q, Han X, Zhang H, Lv Y. Idiopathic Granulomatous Mastitis: Etiology, Clinical Manifestation, Diagnosis and Treatment. J INVEST SURG 2021; 35:709-720. [PMID: 33691563 DOI: 10.1080/08941939.2021.1894516] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Idiopathic granulomatous mastitis (IGM) is a rare form of chronic inflammatory breast disease. Although it is a benign breast lesion, it may be sometimes difficult to distinguish from breast cancer. The cause of IGM is unknown, but may be associated with autoimmunity, abnormal hormone levels and infection. While the clinical manifestations of IGM involve various manifestations of inflammation, the diagnosis is principally established by histopathology, characterized by non-caseating granulomas and microabscess formation centered on the breast lobules. Therapeutic options for IGM range from observation to various medical treatments, such as steroids, immunosuppressants, and antibiotics, to surgical intervention, particularly if secondarily infected. Given that the controversy on etiology and treatment choices, we accomplished the present review through reviewing IGM-related literature published in 'Pubmed' and 'Web of science' databases during 1997 to 2020, aiming to provide the basis for rational clinical diagnosis and treatment.
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Affiliation(s)
- Yulong Yin
- Department of Thyroid Breast Surgery, The Affiliated Hospital of Northwest University, Xi'an, Shaanxi Province, China
| | - Xianghua Liu
- Department of Thyroid Breast Surgery, The Affiliated Hospital of Northwest University, Xi'an, Shaanxi Province, China
| | - Qingjie Meng
- Department of Thyroid Breast Surgery, The Affiliated Hospital of Northwest University, Xi'an, Shaanxi Province, China
| | - Xiaogang Han
- Department of Thyroid Breast Surgery, The Affiliated Hospital of Northwest University, Xi'an, Shaanxi Province, China
| | - Haomeng Zhang
- Department of Thyroid Breast Surgery, The Affiliated Hospital of Northwest University, Xi'an, Shaanxi Province, China
| | - Yonggang Lv
- Department of Thyroid Breast Surgery, The Affiliated Hospital of Northwest University, Xi'an, Shaanxi Province, China
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28
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Li XQ, Wu HL, Yuan JP, Liu TG, Sun SR, Chen C. Bacteria Associated with Granulomatous Lobular Mastitis and the Potential for Personalized Therapy. J INVEST SURG 2020; 35:164-170. [PMID: 33059500 DOI: 10.1080/08941939.2020.1833262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Granulomatous lobular mastitis (GLM), also known as idiopathic granulomatous mastitis (IGM), is a chronic inflammatory lesion of the breast. The incidence of GLM has been increasing in recent years, especially among young women. The etiologies of GLM have not been fully elucidated but are associated with autoimmunity and bacterial infection. Bacteria, especially Corynebacterium species, play important roles in GLM. In this article, we review research progress regarding the bacteriology of GLM attained with the application of several new high-throughput detection techniques. Accurate detection might be important for deepening our understanding of the pathogenesis of GLM and hold promise for personalized GLM therapy.
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Affiliation(s)
- Xin-Qian Li
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, PR China
| | - Hong-Li Wu
- Department of Breast Surgery, People's Hospital of Ningxia Autonomous Region, Yinchuan, Ningxia, PR China
| | - Jing-Ping Yuan
- Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, Hubei, PR China
| | - Tian-Gang Liu
- Key Laboratory of Combinatorial Biosynthesis and Drug Discovery, Ministry of Education and School of Pharmaceutical Sciences, Wuhan University, Wuhan, China
| | - Sheng-Rong Sun
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, PR China
| | - Chuang Chen
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, PR China
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29
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Basim P, Argun D. A Comparison of the Circulating Endocan Levels between the Inflammatory and Malignant Diseases of the Same Organ: The Breast. J INVEST SURG 2020; 34:1207-1213. [DOI: 10.1080/08941939.2020.1792008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Pelin Basim
- Department of General Surgery, Medipol University Medical Faculty, Istanbul, Turkey
| | - Derya Argun
- Department of Internal Medicine, Medipol University Medical Faculty, Istanbul, Turkey
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30
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Treatment Efficacy of Chuang Ling Ye, a Traditional Chinese Herbal Medicine Compound, on Idiopathic Granulomatous Mastitis: A Randomized Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:6964801. [PMID: 32714413 PMCID: PMC7341429 DOI: 10.1155/2020/6964801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/26/2020] [Indexed: 12/17/2022]
Abstract
Objective To explore whether Chuang Ling Ye (CLY), a traditional Chinese herbal medicine compound, could improve the treatment of idiopathic granulomatous mastitis (IGM) via decreasing inflammatory response. Methods Herein, 40 patients with IGM who had wounds requiring dressing change were enrolled and randomly divided into two groups: the CLY group and the control group. The size of the neoplasm and pain score of patients were followed-up for 4 weeks. Local tissues were taken during dressing change and examined by commercial enzyme-linked immunosorbent assay (ELISA) kits. The levels of inflammatory markers, including interleukin-1β (IL-1β), IL-2, IL-6, interferon gamma (IFN-γ), and tumor necrosis factor-α (TNF-α) were measured. Results After treatment, the size of the neoplasm in the CLY group was significantly smaller than that in the control group (14.28 cm ± 8.96 cm vs. 21.14 cm ± 0.12 cm, P=0.038), and the pain scores were markedly reduced (P=0.004). Besides, CLY downregulated the expression levels of IL-1β, IFN-γ, and TNF-α. Conclusion External use of CLY could reduce the neoplasm of IGM by inhibiting local inflammation. This trial is registered with ChiCTR1800017744.
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31
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Zhang X, Li Y, Zhou Y, Liu D, Chen L, Niu K, Sun Q, Huang H. A systematic surgical approach for the treatment of idiopathic granulomatous mastitis: a case series. Gland Surg 2020; 9:261-270. [PMID: 32420250 DOI: 10.21037/gs.2020.02.06] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Surgical resection can be performed for idiopathic granulomatous mastitis (IGM), but recurrence and tissue defects remain issues. Here we report our 6-year experience with a four-pattern surgical approach for IGM that involves the use of a random breast dermo-glandular flap (BDGF). Methods Sixty-eight consecutive patients with IGM were prospectively enrolled from 01/2012 and 03/2017. Based on the extent, shape, and location of the lesions, four different patterns of surgery based on BDGF were used to remove the lesion and repair the defect. Operative data (time, blood loss, and intraoperative complications), primary healing time, recurrence, and patient-reported outcomes (cosmetic outcome, and improvement in dressing change and bathing) at 2 years were evaluated. Results Patients' median age was 35 (range, 22-55) years. Duration of IGM was 3-22 months, with a median lesion size of 3.5 (range, 0.9-9.1) cm. The operative time was significantly longer, and blood loss was more important with the increasing lesion size (both P<0.05). No significant intraoperative complications occurred. All wounds healed by primary intention. IGM relapsed in three patients (3/68, 4.4%); they were treated successfully with a second operation. The self-evaluated cosmetic outcome was "much better" in 45 patients (66.2%), "a little better" in 18 (26.5%), and "same or worse" in five (7.3%). The self-evaluated improvement in dressing change and bathing was "improved a lot" in 51 patients (75.0%), "improved a little" in 11 (16.2%), and "not improved or getting worse" in six (8.8%). Conclusions The BDGF-based systematic four-pattern surgical approach is effective in the treatment of IGM. Recurrence rate is low, there are no complications, and the cosmetic results and improvement in dressing change and bathing are generally favourable.
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Affiliation(s)
- Xiaohui Zhang
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science (CAMS) and Peking Union Medical College, Beijing 100730, China
| | - Yan Li
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science (CAMS) and Peking Union Medical College, Beijing 100730, China
| | - Yidong Zhou
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science (CAMS) and Peking Union Medical College, Beijing 100730, China
| | - Deshun Liu
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science (CAMS) and Peking Union Medical College, Beijing 100730, China
| | - Linlin Chen
- Department of Breast Surgery, Beijing Dangdai Hospital, Beijing 100010, China
| | - Kunying Niu
- Department of Breast Surgery, Beijing Dangdai Hospital, Beijing 100010, China
| | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science (CAMS) and Peking Union Medical College, Beijing 100730, China
| | - Hanyuan Huang
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science (CAMS) and Peking Union Medical College, Beijing 100730, China
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32
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Wu JM, Turashvili G. Cystic neutrophilic granulomatous mastitis: an update. J Clin Pathol 2020; 73:445-453. [PMID: 32094275 DOI: 10.1136/jclinpath-2019-206180] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 02/07/2023]
Abstract
Cystic neutrophilic granulomatous mastitis (CNGM) is a rare subtype of granulomatous mastitis with a highly distinct histological pattern often associated with Corynebacterium species. CNGM is characterised by suppurative lipogranulomas that are composed of central lipid vacuoles rimmed by neutrophils and an outer cuff of epithelioid histiocytes. Some of the lipid vacuoles may contain sparse, rod-shaped, gram-positive bacilli that can be easily missed or dismissed. The surrounding mixed inflammatory infiltrate contains Langhans-type giant cells, lymphocytes and neutrophils. CNGM occurs in reproductive age women with a history of pregnancy and typically presents as a palpable mass that can be painful. CNGM has many mimickers, most significantly breast carcinoma. In many cases, CNGM has significant pathological and clinical overlap with other forms of granulomatous mastitis. Given the association with Corynebacterium species, early diagnosis of CNGM is essential in offering patients the most appropriate treatment. Prolonged antibiotic therapy specifically directed to corynebacteria is required, sometimes even beyond resolution of clinical symptoms. This comprehensive review of the existing literature on CNGM describes clinical-pathological features, microbiological findings, challenges associated with the microscopic differential diagnosis, clinical implications of this diagnosis and emerging treatment options. Morphological criteria and suggested comments to convey the degree of diagnostic certainty are also proposed for standard pathology reporting.
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Affiliation(s)
- Jessie M Wu
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Gulisa Turashvili
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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33
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Wang Y, Song J, Tu Y, Chen C, Sun S. Minimally invasive comprehensive treatment for granulomatous lobular mastitis. BMC Surg 2020; 20:34. [PMID: 32087717 PMCID: PMC7035639 DOI: 10.1186/s12893-020-00696-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/11/2020] [Indexed: 12/22/2022] Open
Abstract
Objective To describe a minimally invasive comprehensive treatment for granulomatous lobular mastitis (GLM) and compare its effect with the existing methods, particularly in terms of its recurrence rate and esthetic outcomes. Methods This retrospective study reviewed 69 GLM patients receiving the minimally invasive comprehensive treatment. Patients’ information, including age, clinical features, image characteristics, histopathological findings, mastitis history, treatment process, operative technique, recurrence, and esthetic effect, was evaluated. Results All patients were female with a median age of 32 (range 17–55) years. Hospital stays ranged from 2 to 34 days, with a median of 6 days. The shortest time for complete rehabilitation was 2 days and the longest time was 365 days, with a median of 30 days. After a median follow-up of 391 days (range 162–690), 7 patients (10.14%) relapsed. The average cosmetic score was 2.62 ± 0.57 points and was mainly related to the past treatment, especially the surgical history. Conclusion Minimally invasive comprehensive treatment is a new method for the treatment of GLM, ensuring a therapeutic effect while maintaining breast beauty.
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Affiliation(s)
- Yaohuai Wang
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, No.99 Zhang Road, Wuchang District, Wuhan, 430060, China
| | - Junlong Song
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, No.99 Zhang Road, Wuchang District, Wuhan, 430060, China
| | - Yi Tu
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, No.99 Zhang Road, Wuchang District, Wuhan, 430060, China
| | - Chuang Chen
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, No.99 Zhang Road, Wuchang District, Wuhan, 430060, China
| | - Shengrong Sun
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, No.99 Zhang Road, Wuchang District, Wuhan, 430060, China.
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Ma X, Min X, Yao C. Different Treatments for Granulomatous Lobular Mastitis: A Systematic Review and Meta-Analysis. Breast Care (Basel) 2020; 15:60-66. [PMID: 32231499 PMCID: PMC7098302 DOI: 10.1159/000501498] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 06/14/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Granulomatous lobular mastitis (GLM) is infrequently diagnosed. This study aimed to evaluate the efficacy and safety of managements for GLM in the nonlactation period. METHODS Publications were retrieved from PubMed, EMBASE, and the Cochrane library on September 10, 2018. We pooled and compared the outcome parameters and complete remission (CR) rates between different treatments using a meta-analysis. RESULTS Twenty-one publications including 970 patients treated with surgical excision, steroids, abscess drainage, antibiotics, and observation were included. Surgery significantly improved CR rate compared with steroids (p = 0.0003). There was no difference in the CR rate in patients treated with surgery alone or combined with steroids (p = 0.28). Surgery showed borderline significant efficacy in the CR rate compared with antibiotics (p = 0.06) and abscess drainage (p = 0.06). No difference was observed in effectiveness between observation and surgical management in patients diagnosed with early GLM and mild symptoms. CONCLUSIONS Although surgery was the ideal management for GLM, steroids and antibiotics might be ideal managements for GLM patients who are worried about surgical scars. Observation was an impressive alternative for patients with early GLM.
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Affiliation(s)
- Xiaojia Ma
- Nanjing University of Chinese Medicine, Nanjing, China
- Yunnan Provincial Hospital of Traditional Chinese Medicine, Kunming, China
| | - Xiaoli Min
- Department of Cerebrovascular Diseases, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Chang Yao
- The First Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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Wang J, Zhang Y, Lu X, Xi C, Yu K, Gao R, Bi K. Idiopathic Granulomatous Mastitis with Skin Rupture: A Retrospective Cohort Study of 200 Patients Who Underwent Surgical and Nonsurgical Treatment. J INVEST SURG 2019; 34:810-815. [PMID: 31818161 DOI: 10.1080/08941939.2019.1696905] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) can clinically and radiographically mimic an abscess or breast cancer. Although IGM is benign, it can cause the breast skin to appear "riddled with holes" and can even result in the loss of the breast. The optimal treatment has not been established. METHODS We retrospectively studied the medical records of 200 patients with IGM who were treated for skin rupture from June 2015 to June 2017 in our institute. The patients' treatment modalities (including surgery after steroid therapy and steroid therapy alone), outcomes, and scores of satisfaction questionnaires were analyzed. The time to healing and recurrence rate were compared with a focus on the treatment modalities to identify the most effective treatments for IGM. RESULTS The median follow-up time was 15.64 months (range, 12-36 months). In total, 156 patients were treated with surgery after steroid therapy and 44 were treated with steroid therapy alone. The median times to healing in the surgical and nonsurgical groups were 25 and 258 days, respectively (p = 0.003). Four of 156 (2.56%) patients developed post-excision wound complications. Eight of 156 patients (5.1%) in the surgical group and 10 of 44 (22.7%) patients in the nonsurgical group developed recurrence (p < 0.01). The scores of the satisfaction questionnaire were 36 ± 4.28 in the surgical group and 24 ± 8.62 in the nonsurgical group (p = 0.017). CONCLUSION IGM is a benign disease but can have serious consequences. Surgery after steroid therapy is an effective and more satisfactory treatment than steroid therapy alone.
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Affiliation(s)
- Jiangfen Wang
- Department of General Surgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | - Yafen Zhang
- Department of General Surgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | - Xiaoting Lu
- Department of General Surgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | - Chunfang Xi
- Department of General Surgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | - Keda Yu
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Runfang Gao
- Department of General Surgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | - Kaixin Bi
- Shanxi Medical University, Shanxi, China
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