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Zhang M, Pu D, Feng D, Shi G, Li J. Rare and Complicated Granulomatous Lobular Mastitis (2000-2023): A Bibliometrics Study and Visualization Analysis. J Inflamm Res 2024; 17:3709-3724. [PMID: 38882188 PMCID: PMC11179654 DOI: 10.2147/jir.s465844] [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: 02/25/2024] [Accepted: 05/28/2024] [Indexed: 06/18/2024] Open
Abstract
Purpose Granulomatous mastitis (GLM) is a rare and complex chronic inflammatory disease of the breast with an unknown cause and a tendency to recur. As medical science advances, the cause, treatment strategies, and comprehensive management of GLM have increasingly attracted widespread attention. The aim of this study is to assess the development trends and research focal points in the GLM field over the past 24 years using bibliometric analysis. Methods Using GLM, Granulomatous mastitis (GM), Idiopathic granulomatous lobular mastitis (IGLM), and Idiopathic granulomatous mastitis (IGM) as keywords, we retrieved publications related to GLM from 2000 to 2023 from the Web of Science, excluding articles irrelevant to this study. Citespace and VOSviewer were employed for data analysis and visualization. Results A total of 347 publications were included in this analysis. Over the past 24 years, the number of publications has steadily increased, with Turkey being the leading contributor in terms of publications and citations. The University of Health Sciences, Istanbul University, and Istanbul University Cerrahpasa were the most influential institutions. The Breast Journal, Breast Care, and Journal of Investigative Surgery were the journals that published the most on this topic. The research primarily focused on the cause, differential diagnosis, treatment, and comprehensive management of GLM. Issues related to recurrence, hyperprolactinemia, and Corynebacterium emerged as current research hotspots. Conclusion Our bibliometric study outlines the historical development of the GLM field and identifies recent research focuses and trends, which may aid researchers in identifying research hotspots and directions, thereby advancing the study of GLM.
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Affiliation(s)
- Mengdi Zhang
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan City, People's Republic of China
| | - Dongqing Pu
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan City, People's Republic of China
| | - Dandan Feng
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan City, People's Republic of China
| | - Guangxi Shi
- Department of Thyroid and Breast Diagnosis and Treatment Center, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan City, People's Republic of China
| | - Jingwei Li
- Department of Thyroid and Breast Diagnosis and Treatment Center, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan City, People's Republic of China
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Shojaeian F, Haghighat S, Abbasvandi F, Houshdar Tehrani A, Najar Najafi N, Zandi A, Olfatbakhsh A, Sharifi M, Hashemi E, Nafissi N, Najafi S. Refractory and Recurrent Idiopathic Granulomatous Mastitis Treatment: Adaptive, Randomized Clinical Trial. J Am Coll Surg 2024; 238:1153-1165. [PMID: 38372343 DOI: 10.1097/xcs.0000000000001046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) is mostly described as an autoimmune disease with higher prevalence among Middle Eastern childbearing-age women. This study aimed to evaluate the best treatment of choice in patients with resistant or recurrent IGM. STUDY DESIGN Patients with established recurrent or resistant IGM who were referred to the Breast Cancer Research Center from 2017 to 2020 were randomly assigned to either one of the following treatment groups: A (best supportive care), B (corticosteroids: prednisolone), and C (methotrexate and low-dose corticosteroids). This adaptive clinical trial evaluated radiological and clinical responses, as well as the potential side effects, on a regular basis in each group, with patients followed up for a minimum of 2 years. RESULTS A total of 318 participants, with a mean age of 33.52 ± 6.77 years, were divided into groups A (10 patients), B (78 patients), and C (230 patients). In group A, no therapeutic response was observed; group B exhibited a mixed response, with 14.1% experiencing complete or partial responses, 7.7% maintaining stability, and 78.2% experiencing disease progression. Accordingly, groups A and B were terminated due to inadequate response. In group C, 94.3% achieved complete response, 3% showed partial remission, and 2.7% had no response to therapy. Among the entire patient cohort, 11.6% tested positive for antinuclear antibodies, 3.5% for angiotensin-converting enzyme, and 12.3% for erythema nodosum. Notably, hypothyroidism was a prevalent condition among the patients, affecting 7.2% of the cohort. The incidence of common side effects was consistent across all groups. CONCLUSIONS The most effective treatment option for patients with recurrent or resistant IGM is a combination therapy involving steroids and disease-modifying antirheumatic drugs such as methotrexate.
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Affiliation(s)
- Fatemeh Shojaeian
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Shojaeian)
| | - Shahpar Haghighat
- Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran (Haghighat, Olfatbakhsh, Hashemi, Najafi)
| | - Fereshteh Abbasvandi
- ATMP Department, Breast Cancer Research Centre, Motamed Cancer Institute, Tehran, Iran (Abbasvandi)
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Abbasvandi)
| | - Alireza Houshdar Tehrani
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Houshdar Tehrani)
| | - Niki Najar Najafi
- Cellular Molecular Biology, Faculty of life sciences and Biotechnology, Shahid Beheshti University, Tehran, Iran (Najar Najafi)
| | - Ashkan Zandi
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA (Zandi)
| | - Asiie Olfatbakhsh
- Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran (Haghighat, Olfatbakhsh, Hashemi, Najafi)
| | - Maryam Sharifi
- Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran (Sharifi)
| | - Esmat Hashemi
- Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran (Haghighat, Olfatbakhsh, Hashemi, Najafi)
| | - Nahid Nafissi
- Department of General Surgery, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), Iran University of Medical Sciences, Tehran, Iran (Nafissi)
| | - Safa Najafi
- Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran (Haghighat, Olfatbakhsh, Hashemi, Najafi)
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Ong SS, Ho PJ, Liow JJK, Tan QT, Goh SSN, Li J, Hartman M. A meta-analysis of idiopathic granulomatous mastitis treatments for remission and recurrence prevention. Front Med (Lausanne) 2024; 11:1346790. [PMID: 38873201 PMCID: PMC11170159 DOI: 10.3389/fmed.2024.1346790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/10/2024] [Indexed: 06/15/2024] Open
Abstract
Purpose The major aim of our meta-analysis was to review the effectiveness of various treatment modalities for achieving successful remission and preventing recurrence for women with idiopathic granulomatous mastitis (IGM). This knowledge is instrumental in developing evidence-based guidelines for clinicians to improve management strategies and outcomes for patients with IGM. Methods A systematic literature search was performed on MEDLINE (Ovid), Embase (Elsevier), PubMed, Cochrane Library, Web of Science, and Google Scholar; studies published to 19 January 2022 were included. A meta-analysis of 57 observational studies was performed. The results of two randomized controlled trials were also examined. Results There were 3,035 IGM patients across the observational and randomised studies. Overall recurrence and remission rates across all treatment strategies in 59 studies are 87.9% (2,667/3035) and 13.5% (359/2667), respectively. The studies reported 19 different treatment strategies, comprising observation, medical monotherapies, surgery, and combinations involving medical therapies, with and without surgery. Among monotherapy treatment, surgical management had the highest pooled remission rate (0.99 [95% confidence interval (CI) = 0.97-1.00]); among combination therapy, this was steroids and surgery (0.99 [0.94-1.00]). Antibiotic monotherapy had the lowest remission rate (0.72 [0.37-0.96]). The highest recurrence rates belonged to treatments that combined antibiotics and surgery (0.54 [0.02-1.00]), and antibiotics, steroids, and surgery (0.57 [0.00-1.00]). Most successful for preventing recurrence were observation (0.03 [0.00-0.10]), methotrexate (0.08 [0.00-0.24]), and steroids and surgery (0.05 [0.01-0.12]). There is a significant association between longer follow-up duration and recurrence rate reported, p = 0.002. Conclusion Combination therapies, especially those incorporating antibiotics, steroids, and surgery, have demonstrated higher remission rates, challenging the use of antibiotic monotherapy. There is an increased emphasis on the need for personalised, multi-pronged approach for preventing IGM recurrence, with longer follow-up care. More prospective future work in IGM research, with standardised diagnostic criteria, treatment protocols, and reporting guidelines will be important for developing treatment protocols and guidelines clinicians can adhere to in the clinical management of IGM patients.Systematic review registration: PROSPERO (CRD42022301386).
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Affiliation(s)
- Seeu Si Ong
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Peh Joo Ho
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jonathan Jun Kit Liow
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Qing Ting Tan
- KK Breast Department, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Serene Si Ning Goh
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Jingmei Li
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mikael Hartman
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
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Sarmadian R, Safi F, Sarmadian H, Shokrpour M, Almasi-Hashiani A. Treatment modalities for granulomatous mastitis, seeking the most appropriate treatment with the least recurrence rate: a systematic review and meta-analysis. Eur J Med Res 2024; 29:164. [PMID: 38475841 PMCID: PMC10929103 DOI: 10.1186/s40001-024-01761-3] [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: 05/31/2023] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Granulomatous mastitis (GM) is a rare, benign, inflammatory breast disease with an unknown etiology that predominantly affects women of reproductive age. The definitive treatment of GM is currently controversial; an appropriate therapeutic strategy has yet to be identified, and the disease's high recurrence rate remains. This study aims to determine the recurrence rate for each GM treatment strategy to identify the most appropriate treatment modality. METHODS The search for relevant articles was undertaken using three international databases, including Medline, Scopus, and Web of Science. Articles published in English until the end of 2021 evaluating the recurrence rate of GM were included. Using Stata 13.0, the pooled incidence and 95% confidence interval (CI) for the recurrence rate were determined. RESULTS Sixty-five eligible studies were included in our study. The recurrence rates of systemic steroid use, topical steroid use, antibiotic use, methotrexate use, observation, drainage, excision, antibiotic use and surgery, steroid use and surgery, antibiotic and steroid use, methotrexate and steroid use were 24% (95% CI: 21-27%), 11% (95% CI: 6-21%), 18% (95% CI: 14-22%), 13% (95% CI: 7-22%), 11% (95% CI: 7-17%), 65% (95% CI: 50-78%), 13% (95% CI: 10-16%), 23% (95% CI: 14-36%), 7% (95% CI: 5-11%), 11% (95% CI: 6-18%), and 4% (95% CI: 2-8%), respectively. Drainage had the highest recurrence rate, while combined methotrexate and steroid treatment had the lowest rate. CONCLUSION The optimal treatment strategy for GM depends on the disease's severity, consequences, and the patient's features. The study results indicate that combination therapy is preferable for minimizing the risk of relapse and reducing treatment complications.
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Affiliation(s)
- Roham Sarmadian
- Student Research Committee, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Safi
- Department of Radiology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Hossein Sarmadian
- Department of Infectious Diseases, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Maryam Shokrpour
- Department of Gynecology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Basij Square, Arak, Iran.
- Traditional and Complementary Medicine Research Center (TCMRC), Arak University of Medical Sciences, Arak, Iran.
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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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Kaya MN, Tekgöz E, Çolak S, Kılıç Ö, Çınar M, Yılmaz S. Drug-free remission is an achievable target with immunosuppressive treatment in idiopathic granulomatous mastitis. Ir J Med Sci 2023; 192:2815-2819. [PMID: 36928595 DOI: 10.1007/s11845-023-03338-1] [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: 01/23/2023] [Accepted: 03/03/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) is a rare inflammatory breast disease, in which there is no clear established treatment algorithm. Several physicians keep away from using immunosuppressive (IS) treatments in routine clinical practice. AIMS This study aimed to evaluate the rates of drug-free remission of the patients with IGM in a period of 3-year follow-up. METHODS This retrospective study conducted with 55 biopsy-proven IGM patients, who were followed up between February, 2011, and November, 2021, in rheumatology outpatient clinic of Gulhane Training and Research Hospital. The demographic and clinical characteristics of the patients were obtained from patients' files. The 3-year follow-up data were assessed for long-term outcome analyses. RESULTS There were 55 female patients with a mean age of 36.8 ± 6.3 years. Fifty-four (98.1%) patients were in drug-free remission at the end of 3 years. The median duration of drug-free remission in patients receiving methotrexate (MTX), only corticosteroid (CS), and azathioprine was 19.7, 32.9, and 14.7 months, respectively. The drug-free remission duration for the patient who received cyclosporine A as IS was 28.3 months. The median duration of IS treatment was 15.8 months, and the median duration of treatment with CS and other IS combination was 6.7 months. Recurrence was observed in 4 (80%) patients without IS therapy after surgery, of whom MTX was used in 3 (75%) patients and achieved remission. CONCLUSIONS IS agents provide high rate of prolonged drug-free remission and should be considered a part of routine medical care of the patients with IGM.
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Affiliation(s)
- Mehmet Nur Kaya
- Rheumatology Department, Gulhane Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey.
| | - Emre Tekgöz
- Rheumatology Department, Gulhane Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Seda Çolak
- Rheumatology Department, Gulhane Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Özlem Kılıç
- Rheumatology Department, Gulhane Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Muhammet Çınar
- Rheumatology Department, Gulhane Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Sedat Yılmaz
- Rheumatology Department, Gulhane Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
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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: 6] [Impact Index Per Article: 6.0] [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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Lermi N, Ekin A, Ocak T, Bozkurt ZY, Ötegeçeli MA, Yağız B, Coşkun BN, Pehlivan Y, Dalkılıç E. What predicts the recurrence in ıdiopathic granulomatous mastitis? Clin Rheumatol 2023; 42:2491-2500. [PMID: 37301771 DOI: 10.1007/s10067-023-06651-3] [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: 02/28/2023] [Revised: 05/06/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Idiopathic granulomatous mastitis (IGM) is a rarely seen chronic and benign disease of the breast. IGM usually emerges in women between 30 and 45 years of age and within the first 5 years after lactation. There is no consensus on the treatment of the disease. Steroids, immunosuppressive agents such as methotrexate and azathioprine, antibiotics, and surgical and conservative treatments can be preferred. In the present study, it was aimed to demonstrate the treatment options and follow-up data of the patients with IGM and to investigate the effective factors on recurrence if developed in the follow-up period. MATERIALS AND METHOD The data of 120 patients diagnosed with idiopathic granulomatous mastitis were evaluated for this cross-sectional retrospective study. The demographic, clinical, treatment, and follow-up features of the patients were obtained from the file records. RESULTS The median age value of the 120 female patients included in the study was 35 (24-67) years. Of the patients, 45%, 79.2%, 49.2%, and 15% had a past history of surgical intervention, steroid use, methotrexate use, and azathioprine use, respectively. Recurrent lesion developed after the treatment in 57 (47.5%) patients. The recurrence rate was 66.1% in the patients who underwent surgical intervention in the initial treatment. There was a statistically significant difference between the patients with and without recurrence regarding the presence of abscess, the presence of recurrent abscess, and having surgical intervention as the initial treatment in the past history. The rate of having surgery was statistically significantly higher compared with the administration of steroid therapy alone and the combination of steroid and immunosuppressive therapy in the initial treatment of the patients who developed recurrence. The rate of having surgery together with the administration of steroid and immunosuppressive therapy was statistically significantly higher than the administration of steroid and immunosuppressive therapies. DISCUSSION Our study showed that surgical intervention and the presence of abscess increased recurrence in the treatment of IGM. Key Points • This study has shown that surgical intervention and the presence of abscess increase recurrence. • A multidisciplinary approach to the treatment of IGM and management of the disease by the rheumatologists may be critical.
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Affiliation(s)
- Nihal Lermi
- Division of Rheumatology, Uludag University Faculty of Medicine, Görükle Kampüsü, 16059, Nilüfer, Bursa, Turkey.
| | - Ali Ekin
- Division of Rheumatology, Uludag University Faculty of Medicine, Görükle Kampüsü, 16059, Nilüfer, Bursa, Turkey
| | - Tuğba Ocak
- Division of Rheumatology, Uludag University Faculty of Medicine, Görükle Kampüsü, 16059, Nilüfer, Bursa, Turkey
| | - Zeynep Yılmaz Bozkurt
- Division of Rheumatology, Uludag University Faculty of Medicine, Görükle Kampüsü, 16059, Nilüfer, Bursa, Turkey
| | - Mehmet Akif Ötegeçeli
- Department of Internal Medicine, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Burcu Yağız
- Division of Rheumatology, Uludag University Faculty of Medicine, Görükle Kampüsü, 16059, Nilüfer, Bursa, Turkey
| | - Belkıs Nihan Coşkun
- Division of Rheumatology, Uludag University Faculty of Medicine, Görükle Kampüsü, 16059, Nilüfer, Bursa, Turkey
| | - Yavuz Pehlivan
- Division of Rheumatology, Uludag University Faculty of Medicine, Görükle Kampüsü, 16059, Nilüfer, Bursa, Turkey
| | - Ediz Dalkılıç
- Division of Rheumatology, Uludag University Faculty of Medicine, Görükle Kampüsü, 16059, Nilüfer, Bursa, Turkey
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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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Idiopathic Granulomatous Mastitis (IGM): Clinical Features and Non-Surgical Management. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2023. [DOI: 10.5812/ijcm-119945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Background: Idiopathic Granulomatous Mastitis (IGM) is a benign disease; it can clinically and radiologically mimic the symptoms of breast cancer. Objectives: Due to the rare and limited number of studies in Iran, this study was designed and conducted to evaluate patients' clinical characteristics and treatment management with IGM. Methods: In this cross-sectional and retrospective descriptive-analytic study, we studied the medical records of 293 patients with IGM, such as demographic information, characteristics of breast lesions, type of treatment, complications, and their outcome, which were recorded in the Cancer Research Centers of Shahid Beheshti University of Medical Sciences (SBMU) from 2010 to 2019. The patients were contacted by telephone to visit clinically or collect additional information. Data were analyzed by SPSS software version 24. Results: The mean age of patients was 39.21 (ST = 8.29) years. Breast involvement in 236 cases (80.5%) was unilateral, and in 50 cases (17.1%), the involvement was Pere pri-Areola. The most common type of treatment was conservative therapy (analgesia + drainage) (178 cases, 60.8%), which was the primary treatment in our study; 66 patients (22.5%) received antibiotic therapy + analgesia + drainage, and 41(14%) cases received corticosteroid in addition to this treatment. Totally, 132 cases (79.5%) were completely cured with the performed treatments, 17 cases (5.8%) had a recurrence of symptoms, and 14.7% of the patients were still receiving treatment. Recurrence after 1 year in patients who had a longer duration of disease (more than 12 months) was higher than in those who had a shorter period (less than 12 months) (15.3% vs. 5.1%, P = 0.004). Also, the highest recurrence rate was in the group receiving corticosteroids compared to the group receiving the usual treatment and usual treatment plus antibiotics. This relationship was statistically significant (22.0% vs. 9 % and 6.1%, respectively, P = 0.032). Complications (scar or breast skin color change) were significantly higher in patients without a pregnancy history than in patients who had pregnancy (50.0% vs. 22.8%, P = 0.030). Also, these complications were significantly higher in patients who had a longer duration of disease (more than 12 months) than in shorter periods of disease (less than 12 months) (31.4% vs. 17.3%, P = 0.005). Conclusions: The results of our study and its comparison with the results of other studies still emphasize the uncertainty of the etiology of IGM disease and its treatment, but to some extent, our study has shown that conservative treatment (drainage with analgesic drugs) is one of the best treatment options. Also, corticosteroid therapy is associated with a higher recurrence rate, but in some cases is necessary and recommended in many studies.
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Autoimmune rheumatic diseases associated with granulomatous mastitis. Rheumatol Int 2023; 43:399-407. [PMID: 36418558 DOI: 10.1007/s00296-022-05251-9] [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: 09/13/2022] [Accepted: 11/14/2022] [Indexed: 11/25/2022]
Abstract
Granulomatous mastitis (GM) is a benign, inflammatory condition of the breast that mainly affects women of reproductive age. Although its pathogenesis remains unknown, previous studies revealed an association between autoimmune rheumatic diseases (ARDs) and GM in a subset of patients implicating immune-mediated mechanisms. The aim of this narrative review was to identify and describe the ARDs associated with GM to shed further light on disease pathogenesis. We conducted a comprehensive literature search of patients presenting with GM and coexisting ARDs using electronic databases. An association between GM and various ARDs has been reported, including sarcoidosis, systematic lupus erythematosus, granulomatosis with polyangiitis, psoriasis/psoriatic arthritis, familial Mediterranean fever, ankylosing spondylitis, Sjogren's syndrome, rheumatoid arthritis, and erythema nodosum, with the most common being granulomatous mastitis-erythema nodosum-arthritis syndrome (GMENA), granulomatosis with polyangiitis (Wegener's) and sarcoidosis. In addition, clinical characteristics, diagnostic and therapeutic approaches were recorded. Further research is warranted to better understand the association between GM and ARDs and raise awareness amongst rheumatologists.
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Al Awfi MM, Al Rahbi SK. Idiopathic Granulomatous Mastitis: Six years of experience and the current evidence in literature. Sultan Qaboos Univ Med J 2023; 23:36-41. [PMID: 36865415 PMCID: PMC9974032 DOI: 10.18295/squmj.4.2022.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/27/2022] [Accepted: 03/23/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives This study aimed to retrospectively describe the clinicopathological pattern and management experience of idiopathic granulomatous mastitis in women receiving care at the Royal Hospital, a tertiary care centre in Oman. The study then compared the researchers' experience with the current literature trends. Methods The data of patients from January 2012 to December 2017 were reviewed retrospectively, after receiving ethical approval from the Centre of Studies and Research. Results This retrospective study included 64 patients were confirmed to have idiopathic granulomatous mastitis. All patients were in the premenopausal phase, with only one being nulliparous. Mastitis was the most common clinical diagnosis; furthermore, half of the patients had a palpable mass. Most patients had received antibiotics during the span of their treatment. Drainage procedure was done in 73% of the patients, whereas excisional procedure was done for 38.7%. Only 52.4% of patients were able to achieve complete clinical resolution within six months of follow-up. Conclusion There is no standardised management algorithm due to the paucity of high-level evidence comparing different modalities. However, steroids, methotrexate and surgery are all considered to be effective and acceptable treatments. Moreover, current literature tends towards multimodality treatments planned tailored case-to-case based on the clinical context and patients' preference.
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Affiliation(s)
- Mahmood M. Al Awfi
- Department of General Surgery, Oman Medical Specialty Board, Muscat, Oman,Corresponding Author’s e-mail:
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Altıntaş T. The role of lower dose steroid therapy with vitamin D replacement in patients with idiopathic granulomatous mastitis. Turk J Surg 2022; 38:250-254. [PMID: 36846061 PMCID: PMC9948657 DOI: 10.47717/turkjsurg.2022.5576] [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: 11/09/2021] [Accepted: 06/08/2022] [Indexed: 03/01/2023]
Abstract
Objectives Low-dose steroid therapy has been recommended in idiopathic granulomatous mastitis (IGM) in various studies in the literature, but the therapeutic minimum dose has not been determined yet. Furthermore, vitamin D deficiency, the effect of which is accepted in autoimmune diseases, has not been previously examined in IGM. The aim of our study was to evaluate the efficacy of lower dose steroid theraphy with adjustment of vitamin D replacement doses with measuring serum 25-hydroxyvitamin D levels in patients with idiopathic granulomatous mastitis (IGM). Material and Methods Vitamin D levels were evaluated in 30 IGM patients who applied to our clinic between 2017-2019. Vitamin D replacement was performed in patients with serum 25-hydroxyvitamin D level below 30 ng/mL and prednisolone was given to all patients at a dose of 0.05-0.1 mg/kg/ day. Clinical recovery times of the patients were compared with the literature. Results Vitamin D replacement was given to 22 (73.33%) patients. Recovery time was shorter in patients receiving vitamin D replacement (7.62 ± 2.38; 9.00 ± 3.38; p= 0.680). Average recovery time was 8.00 ± 2.68 weeks. Conclusion Treatment of IGM can be carried out with lower dose steroid therapy, leading to less complications and lower costs. Measuring serum 25-hydroxyvitamin D level and treating it with the appropriate dose may contribute to the healing process.
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Affiliation(s)
- Tansu Altıntaş
- Clinic of General Surgery, İstanbul Health Science University Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Türkiye
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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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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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Godazandeh G, Shojaee L, Alizadeh-Navaei R, Hessami A. Corticosteroids in idiopathic granulomatous mastitis: a systematic review and meta-analysis. Surg Today 2021; 51:1897-1905. [PMID: 33590327 DOI: 10.1007/s00595-021-02234-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/16/2020] [Indexed: 02/05/2023]
Abstract
Idiopathic granulomatous mastitis (IGM) is an inflammatory disease of the breasts with an unknown etiology. Corticosteroids are one the primary options for treating this disease, but the results of previous studies concerning their efficacy have been controversial. We, therefore, decided to assess the effectiveness of corticosteroids on IGM using a systematic review and meta-analysis. We conducted a systematic search using MeSH terms and all relevant keywords in PubMed, EMBASE, Cochrane Library and Web of Science until May 21, 2019. Data were analyzed using the Comprehensive Meta-Analysis (CMA) V.2 software program and presented as the event rate, risk ratio (RR) and risk difference (RD). Twelve studies including 559 IGM patients were entered into the meta-analysis. Our analysis showed that the RR and RD of recurrence in the steroid-only group compared with the surgery-only group were 2.99 (95% confidence interval [CI] 0.28-31.33) and 0.14 (95% CI - 0.01-0.30), respectively, showing no statistical significance. The meta-analysis of the steroid-only group and steroid + surgery group showed that the RR of recurrence was 6.13 (95% CI 0.41-81.62) with no significance. However, the meta-analysis of the RD showed that the risk of recurrence in the steroid group was significantly higher than that in the steroids + surgery group (RD: 0.28, 95% CI 0.11-0.44). This meta-analysis showed that managing IGM with only steroids may be less effective than the combination of steroids and surgery. This combination approach may result in a lower rate of recurrence and side effects in these patients.
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Affiliation(s)
- Gholamali Godazandeh
- Department of Surgery, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Leyla Shojaee
- Department of Surgery, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Reza Alizadeh-Navaei
- Gastrointestinal Cancer Research Center, Non-Communicable Disease Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Amirhossein Hessami
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
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Zhu Q, Wang L, Wang P. The Identification of Gene Expression Profiles Associated with Granulomatous Mastitis. Breast Care (Basel) 2021; 16:319-327. [PMID: 34602937 DOI: 10.1159/000507474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 03/24/2020] [Indexed: 12/13/2022] Open
Abstract
Background Granulomatous mastitis (GM) is a rare chronic inflammatory disease of the breast. The current therapeutic effects of the antibiotic therapy and surgical or immunomodulatory (steroid) treatment are normally poor due to the unclear etiology. Method This study aimed to identify the differentially expressed mRNAs in GM tissues using RNA sequencing and further explored the functions of differentially expressed mRNAs resulting in GM. Moreover, we revealed the relationship between GM and breast cancer by shared highly expressed genes in GM tissues and breast cancer tissues. Results A total of 12,115 mRNAs were analyzed in the whole expression profile, and 207 mRNAs (136 upregulated and 71 downregulated mRNAs) were differently expressed between the GM tissues and normal tissues. The enrichment analysis showed that the differentially expressed mRNAs were enriched in the biological processes and played a significant role in the immune system. Besides, the genes expressed significantly highly in breast cancer tissues are found to be enriched with GM genes, which may explain the similar clinical features between breast cancer and GM. We also found that the HSD11B1 gene which was differentially expressed in GM was used as drug target of prednisone, which is a common treatment for GM. Conclusion This study is the first to use sequencing technology to elucidate the genetic mechanisms of GM. The finding of this study may have potential value in GM diagnosis and also provides potential drug targets for GM treatment.
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Affiliation(s)
- Qiang Zhu
- Department of Breast Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lin Wang
- Department of Breast Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Pilin Wang
- Department of Breast Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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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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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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Toktas O, Toprak N. Treatment Results of Intralesional Steroid Injection and Topical Steroid Administration in Pregnant Women with Idiopathic Granulomatous Mastitis. Eur J Breast Health 2021; 17:283-287. [PMID: 34263157 DOI: 10.4274/ejbh.galenos.2021.2021-2-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/20/2021] [Indexed: 12/01/2022]
Abstract
Objective Idiopathic granulomatous mastitis (IGM) is an inflammatory and chronic benign breast disease that has proven difficult to diagnose and treat. Since most treatment modalities cannot be used in pregnant patients, the choice of treatment is more difficult and the need for surgery is more pressing. In this first and innovative study, we assess the results of local corticosteroid therapy of IGM in pregnant women. Materials and Methods Pregnant women with IGM were evaluated between June 2017 and May 2019. The six pregnant women were treated using intralesional steroid injections and topical steroid administration. The treatment response was evaluated, both clinically and radiologically, at the end of 2 weeks and once more at the end of 1 month. Results The median patient age was 26 years. The mean duration of complaints was 4.3 months. The median number of children was 2, and the mean breastfeeding time was 41 months. The predominant complaints at onset were a breast mass or local pain and inflammation in four (66.7%) patients and a breast mass with pain and without signs of local skin inflammation in two (33.3%) patients. Diagnosis was made using a tru-cut biopsy in two patients, and with an incisional biopsy in four patients who had abscess drainage and fistulation to the skin. Five (83.3%) patients achieved a complete response, and one (16.7%) patient responded only partially after the first course of treatment. A second course of treatment was given to the patient with partial response. All patients achieved complete response at the end of the second course of treatment. The mean follow-up time was 19.5 months. During the follow-up period, one patient experienced a recurrence at 4 months after giving birth, and she then received a third course of treatment. Topical and systemic side effects of the corticosteroids were not observed in any patient. Conclusion While the state of pregnancy generally precludes the use of most drugs, the use of local corticosteroid in the treatment of IGM is effective in terms of treatment response, treatment duration, need for surgery, and reduced recurrence and side effects.
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Affiliation(s)
- Osman Toktas
- Department of Surgery, Van Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
| | - Nurşen Toprak
- Department of Radiology, Van Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
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Luo W, Xu B, Wang L, Xiang L, Lai M, Zhang X, Liu X. Clinical characteristics and predictive factors of erythema nodosum in granulomatous lobular mastitis. Australas J Dermatol 2021; 62:342-346. [PMID: 34106462 DOI: 10.1111/ajd.13640] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 05/06/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND/OBJECTIVES In recent years, there is a growing incidence of granulomatous lobular mastitis (GLM), but studies about the coexistence of erythema nodosum (EN) and GLM are rare. In this study, we assess the clinical characteristics and predictive factors of EN in GLM. METHODS A total of 303 patients diagnosed with GLM were enrolled from January 2012 to October 2018 at the second affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, including 78 patients with EN. Follow-up data included: lesion site, lesion size, therapy approaches, course of GLM, course of EN, the recurrence of disease, possible causes. All patients had pathologic confirmation of GLM based on core needle biopsy (CNB) or surgical excision. RESULT Fever in the EN group was significantly more common compared to the non-EN group (44.87% vs 12.89%, P < 0.001). The proportion of lesion range >2 quadrants in the EN group was significantly higher than that in the non-EN group (42.31% vs 16.00%, P < 0.001). The course of the disease was longer in the EN group compared to the non-EN group (10.32 moths vs 8.74 moths, P < 0.001). Patients with EN had a trend towards a higher risk of recurrence (5.13% vs 1.33%, P = 0.055). CONCLUSION EN is more likely to be found in GLM patients with breast lesion range >2 quadrants. The presence of EN in GLM indicates that the condition becomes more severe and the course of GLM also becomes longer.
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Affiliation(s)
- Wei Luo
- Department of Mammary Disease, The Second affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Biao Xu
- Department of Mammary Disease, The Second affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Lei Wang
- Department of Mammary Disease, The Second affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Lifang Xiang
- Department of Mammary Disease, The Second affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Milin Lai
- Department of Mammary Disease, The Second affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xu Zhang
- Department of Mammary Disease, The Second affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xiaoyan Liu
- Department of Mammary Disease, The Second affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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Papila Kundaktepe B, Velidedeoğlu M, Mete B. The effect of methotrexate monotherapy on treatment-resistant idiopathic granulomatous mastitis patients. Surgeon 2021; 20:e13-e19. [PMID: 33836950 DOI: 10.1016/j.surge.2021.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/16/2021] [Accepted: 03/09/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) is a disease of unknown etiology, involving a chronic inflammatory process, characterized by noncaseating granuloma formation. IGM can mimic a tumor clinically and radiologically. Since we are a tertiary referral center, most of our patients (n = 56, 87.5%) are secondary admissions who have previously had antibiotics and steroid treatments; therefore, we accept these patients as resistant cases. Here, we aim to present our single-center series of 64 patients with resistant IGM who underwent methotrexate monotherapy. To the best of our knowledge, our study includes the highest number of patients described in the literature with IGM who have undergone this treatment. METHODS This study included 64 patients, 56 of which were resistant cases, diagnosed with IGM between January 2013 and January 2020 at Istanbul University Cerrahpasa, Cerrahpasa Medical Faculty, General Surgery Breast Outpatient Clinic that were followed-up at least once. These patients were administered oral methotrexate monotherapy 15 mg/week for 24 weeks, and in relapsed cases, the treatment was up to 20 mg/week for 1 year. Folic acid 10 mg/week was given as a supplement to all patients. RESULTS Complete recovery was observed in 52 (81.25%) of the 64 patients. Follow-up was discontinued by 4 patients. The dose was increased and the duration of treatment was extended up to 1 year when relapse was observed in 8 patients and complete response was then obtained in these cases. Only 3 patients (4.69%) experienced side effects and were switched to subcutaneous treatment due to nausea. CONCLUSION Considering the high patient compliance, low recurrence, minimal side effects, and overall success of the treatment, we believe that methotrexate monotherapy may be used in treatment-resistant IGM patients and may also be the first choice for first-line treatment in the future.
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Affiliation(s)
- Berrin Papila Kundaktepe
- Istanbul University-Cerrahpasa, Cerrahpaşa Faculty of Medicine, Department of General Surgery, Turkey.
| | - Mehmet Velidedeoğlu
- Istanbul University-Cerrahpasa, Cerrahpaşa Faculty of Medicine, Department of General Surgery, Turkey.
| | - Bilgül Mete
- Istanbul University-Cerrahpasa, Cerrahpaşa Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Turkey.
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Ringsted S, Friedman M. A rheumatologic approach to granulomatous mastitis: A case series and review of the literature. Int J Rheum Dis 2021; 24:526-532. [PMID: 33523600 PMCID: PMC8152827 DOI: 10.1111/1756-185x.14065] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/01/2021] [Accepted: 01/04/2021] [Indexed: 12/01/2022]
Abstract
AIM Idiopathic granulomatous mastitis (IGM) is an enigmatic inflammatory breast disorder. IGM responds to immunomodulatory treatment and may be associated with systemic manifestations such as arthritis and erythema nodosum. These patients are increasingly referred to rheumatologists for management, but IGM is rarely discussed in the rheumatology literature. The objective of this report is to familiarize rheumatologists with the treatment and systemic manifestations of IGM. We report here a case series of IGM at our institution, and a literature review of IGM treated with methotrexate (MTX). METHOD Patients with IGM at our institution were identified and described using a retrospective chart review. A literature review of PubMed and Google Scholar identified studies of IGM patients treated with MTX. RESULTS We identified 28 IGM patients at our institution. Inflammatory arthritis/arthralgia were present in four patients (14%), and five patients (18%) had erythema nodosum. Patients treated with MTX had the highest rates of relapse-free remission; relapse-free remission occurred in four of the five (80%) MTX-treated patients, compared with 5 of 12 (42%) patients treated with steroids alone, and two or three (66%) patients treated with steroids and surgery. In the literature review, 116 patients treated with MTX were identified, and the rate of relapse-free remission ranged from 58% to 100%. Arthritis/arthralgia and erythema nodosum were more common at our institution than reported in the literature. CONCLUSION Methotrexate is a promising treatment for IGM. Arthritis/arthralgias and erythema nodosum may be under-recognized when IGM patients are managed outside rheumatology. Prospective studies are needed to characterize clinical features and optimum treatment of IGM.
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Affiliation(s)
- Sarah Ringsted
- Department of Medicine, Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland, OR 9723
| | - Marcia Friedman
- Department of Medicine, Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland, OR 9723
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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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Effectiveness of Methotrexate in Idiopathic Granulomatous Mastitis Treatment. Am J Med Sci 2020; 360:560-565. [DOI: 10.1016/j.amjms.2020.05.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/08/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023]
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Hu T, Li S, Huang H, Huang H, Tan L, Chen Y, Deng H, Wu J, Zhu L, Zhang J, Su F, Chen K. Multicentre, randomised, open-label, non-inferiority trial comparing the effectiveness and safety of ductal lavage versus oral corticosteroids for idiopathic granulomatous mastitis: a study protocol. BMJ Open 2020; 10:e036643. [PMID: 33039992 PMCID: PMC7552910 DOI: 10.1136/bmjopen-2019-036643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION The ideal treatment for idiopathic granulomatous mastitis (IGM) remains unclear. In a prospective, single-centre, pilot study, we reported that ductal lavage treatment for non-lactational mastitis patients had a 1-year clinical complete response (cCR) rate of >90%, without any significant adverse events. Thus, in this multicentre, randomised, open-label, non-inferiority trial, we will aim to compare the effectiveness and safety of ductal lavage vs oral corticosteroids as the first-line treatment for patients with IGM. METHODS AND ANALYSIS The trial will be conducted at the Breast Tumor Center of Sun Yat-sen Memorial Hospital in China and at least at one participating regional centre. We plan to recruit 140 eligible IGM patients who will be randomised into the ductal lavage group or oral corticosteroid group with a 1:1 ratio. The patients in the oral corticosteroid group will receive meprednisone or prednisone for 6 months. The patients in the ductal lavage group will receive ductal lavage and breast massage, as previously reported. All the participants will be followed up at the clinic for 1 year post randomisation. The primary endpoint of this trial will be the 1-year cCR rate, and the secondary endpoints will include the time to cCR, treatment failure rate, relapse rate and protocol compliance rate. The trial was designed to determine whether ductal lavage is non-inferior to oral corticosteroids (1-year cCR rate assumed to be 90%), with a non-inferiority margin of 15%. ETHICS AND DISSEMINATION The ethics committee of Sun Yat-sen Memorial Hospital at Sun Yat-sen University approved the study (2018-Lun-Shen-Yan-No. 30). The results of the trial will be communicated to the participating primary care practices, published in international journals and presented at international clinical and scientific conferences. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03724903); Pre-results.
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Affiliation(s)
- Tingting Hu
- Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shunrong Li
- Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Heng Huang
- Department of Mammary Surgery, Lianjiang People's Hospital, Zhanjiang, Guangdong, China
| | - Hui Huang
- Department of Mammary Surgery, Maternity and Child Health Care Hospital of Jiangmen, Jiangmen, Guangdong, China
| | - Luyuan Tan
- Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yanbo Chen
- Department of orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Heran Deng
- Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jiannan Wu
- Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Liling Zhu
- Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jian Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Fengxi Su
- Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Kai Chen
- Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
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Çetin K, Sıkar HE, Göret NE, Rona G, Barışık NÖ, Küçük HF, Gulluoglu BM. Comparison of Topical, Systemic, and Combined Therapy with Steroids on Idiopathic Granulomatous Mastitis: A Prospective Randomized Study. World J Surg 2020; 43:2865-2873. [PMID: 31297582 DOI: 10.1007/s00268-019-05084-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) is a benign disorder of the breast, for which the optimal treatment modality remains missing. METHODS A total of 124 patients with a histopathologically proven diagnosis of IGM were enrolled in a prospective, randomized parallel arm study. Patients were treated with topical steroids in Group T (n: 42), systemic steroids (0.8 mg/kg/day peroral) in Group S (n: 42), and combined steroids (0.4 mg/kg/day peroral + topical) in Group C (n: 40). Compliance with the therapy, response to the therapy, the duration of therapy, side effects and the recurrence rates were compared. RESULTS Sixteen patients did not comply with the treatment, and the highest ratio of compliance with therapy was seen in Group T (p < 0.05). Complete clinical regression (CCR) was observed in 90 (83.3%) patients. Response to the treatment (RT) was evaluated radiologically and observed in 89.8% of the patients. There was no statistically significant difference between groups regarding CCR, RT and the recurrence rate. The longest duration of therapy was observed in Group T (22 ± 9.1-week), whereas the shortest was observed in Group S (11.7 ± 5.5-week) (p < 0.001). The systemic side effects were significantly lower in Group T in comparison with Groups S and C (2.4% vs. 38.2% and 30.3%, respectively) (p < 0.001). CONCLUSIONS The efficiency of the treatment was similar for all groups, both clinically and radiologically. Although the duration of therapy was longer in Group T, the lack of systemic side effects increased the compliance of the patients with the therapy. Therefore, topical steroids would be among first-line treatment options of IGM.
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Affiliation(s)
- Kenan Çetin
- Department of General Surgery, University of Health Sciences, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey.
| | - Hasan E Sıkar
- Department of General Surgery, University of Health Sciences, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Nuri E Göret
- Department of General Surgery, University of Health Sciences, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Günay Rona
- Department of Radiology, University of Health Sciences, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Nagehan Ö Barışık
- Department of Pathology, University of Health Sciences, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Hasan F Küçük
- Department of General Surgery, University of Health Sciences, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Bahadır M Gulluoglu
- Breast and Endocrine Surgery Unit, Department of General Surgery, Marmara University School of Medicine, 34899, Pendik, Istanbul, Turkey
- Department of Breast Surgery, SENATURK (Turkish Academy of Breast Sciences), 34710, Kadikoy, Istanbul, Turkey
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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: 13] [Impact Index Per Article: 3.3] [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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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: 21] [Impact Index Per Article: 5.3] [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: 17] [Impact Index Per Article: 3.4] [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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Zhou F, Liu L, Liu L, Yu L, Wang F, Xiang Y, Zheng C, Huang S, Cai H, Yu Z. Comparison of Conservative versus Surgical Treatment Protocols in Treating Idiopathic Granulomatous Mastitis: A Meta-Analysis. Breast Care (Basel) 2019; 15:415-420. [PMID: 32982653 DOI: 10.1159/000503602] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 09/23/2019] [Indexed: 12/12/2022] Open
Abstract
Background Idiopathic granulomatous mastitis (IGM) is a rare, benign breast disease without any definitive therapeutic strategy. It is controversial whether to use conservative or surgical treatment of IGM and high-level evidence-based medicine data are lacking. The purpose of this study was to systemically evaluate the clinical effectiveness of the conservative versus surgical treatment for IGM. Methods In this meta-analysis, we searched PubMed, EMbase, ScienceDirect, and Web of Science for comparative studies about the conservative versus surgical treatment of IGM. Two researchers independently identified reports and extracted data. We used Stata 11 for data analysis. A meta-analysis was performed to investigate the differences in the recurrence rate of conservative and surgical treatment using a random effects model. Results A total of 10 studies involving 1,101 patients were included. The results demonstrated that there was no significant difference in the recurrence rate among patients who were treated by nonsurgical therapy and surgical treatment. No publication bias was detected. Conclusion This meta-analysis demonstrates that both the conservative and surgical treatment approaches have appropriate efficacy in IGM treatment and relapse. Further randomized controlled trials with longer follow-up periods are required to confirm the advantages of each approach.
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Affiliation(s)
- Fei Zhou
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, China.,Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
| | - Lu Liu
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China.,Department of Breast Surgery, Qingdao Municipal Hospital Group, Qingdao, China
| | - Liyuan Liu
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, China.,Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
| | - Lixiang Yu
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, China.,Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
| | - Fei Wang
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, China.,Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
| | - Yujuan Xiang
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, China.,Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
| | - Chao Zheng
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, China.,Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
| | - Shuya Huang
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, China.,Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
| | - Han Cai
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, China.,Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
| | - Zhigang Yu
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, China.,Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
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Zhang Q, Ding B, Qian L, Wu W, Wen Y, Gong N. The Effect of Western Medicine Therapies on Granulomatous Mastitis: a Meta-analysis. Indian J Surg 2019. [DOI: 10.1007/s12262-019-01883-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Alrayes A, Almarzooq R, Abdulla HA. Surgical treatment of granulomatous mastitis: Our experience in Bahrain. Breast J 2019; 25:958-962. [DOI: 10.1111/tbj.13378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/08/2019] [Accepted: 02/11/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Amal Alrayes
- Department of Surgery Salmaniya Medical Complex Manama Bahrain
| | - Raed Almarzooq
- Department of Surgery Salmaniya Medical Complex Manama Bahrain
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McLean NR, Chummun S, Youssef MK, Bristow G. Delayed breast reconstruction in idiopathic granulomatous mastitis. EUROPEAN JOURNAL OF PLASTIC SURGERY 2019. [DOI: 10.1007/s00238-018-1474-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Chen K, Zhu L, Hu T, Tan C, Zhang J, Zeng M, Li S, Song E. Ductal Lavage for Patients With Nonlactational Mastitis: A Single-Arm, Proof-of-Concept Trial. J Surg Res 2019; 235:440-446. [PMID: 30691827 DOI: 10.1016/j.jss.2018.10.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/09/2018] [Accepted: 10/17/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Surgery, steroids, and/or observations alone have been proposed for patients with nonlactational mastitis (NLM), but most of these studies were retrospective. The optimal treatment for these patients remains unclear. This prospective, single-arm, proof-of-concept trial aimed to evaluate the feasibility and safety of ductal lavage as a novel treatment for patients with NLM. METHODS Eligible patients with NLM received an intraductal infusion of corticosteroids and antimicrobial agents and returned the next day for a breast massage. This cycle was repeated for 2 wk, and we followed up these patients for 1 y. Patients did not receive surgery or steroids after ductal lavage. The primary endpoint was the time to complete response (CR). RESULTS This trial included 32 patients with a median (range) age of 32 (20-53). Skin erythema and tenderness were the major symptoms. The median (range) visual analog score was 5 (0-9). There were 21 (65.6%), 4 (12.5%), and 7 (21.9%) patients diagnosed as idiopathic granulomatous mastitis, periductal mastitis, and unspecific NLM, respectively. During the ductal lavage, the median (range) number of cannulated ducts at first attempt was 5 (3-8). Ductal lavage significantly reduced the visual analog score and mastitis score (M-score) (P < 0.01). Within a median follow-up of 15.6 mo, 93.8% (30/32) of patients achieved CR. The median (range) time to CR was 6 (0.5-21) mo. Three patients (10.0%) relapsed. No adverse events associated with ductal lavage were observed. CONCLUSIONS Ductal lavage for patients with NLM is feasible and safe, and a definitive randomized controlled trial for further investigation is warranted. TRIAL REGISTRATION ClinicalTrials.gov, NCT02794688.
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Affiliation(s)
- Kai Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, PR China.
| | - Liling Zhu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Tingting Hu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Cui Tan
- Department of pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Jian Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Minhua Zeng
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Shunrong Li
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, PR China.
| | - Erwei Song
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, PR China.
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Maione C, Palumbo VD, Maffongelli A, Damiano G, Buscemi S, Spinelli G, Fazzotta S, Gulotta E, Buscemi G, Lo Monte AI. Diagnostic techniques and multidisciplinary approach in idiopathic granulomatous mastitis: a revision of the literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:11-15. [PMID: 30889150 PMCID: PMC6502167 DOI: 10.23750/abm.v90i1.6607] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 04/10/2018] [Indexed: 12/23/2022]
Abstract
Idiopathic granulomatous mastitis (IGM) is a chronic benign inflammatory disease of the breast that may mimic breast cancer. It is most common in parous young fertile women, although it can occur in nulliparous women and in men. IGM is an idiopathic disease due to the influence of some environmental factors in genetically predisposed subjects. Several pathogenic hypothesis have been proposed in the last years (autoimmune, hormonal, infective genesis). IGM presents as a painful palpable mass located in one of the two udders. The skin is usually normal but could present signs of inflammation with or without lymph nodes involvement. Ultrasonography, mammography, magnetic resonance can be diagnosed an IGM, but pathognomonic radiological signs has not yet reported in literature. Biopsy findings show granulomatous lesion centered on the breast lobule, as in granulomatous mastitis induced by tuberculosis or sarcoidosis. The aim of this review of literature is to verify the development of new advanced diagnostic techniques and multidisciplinary approach for this condition. In the last years innovative approaches have modified IGM diagnosis and therapy, avoiding surgery in most of cases, introducing a more conservative medical approach based on recent etiopathological hypothesis. (www.actabiomedica.it)
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Chirappapha P, Thaweepworadej P, Supsamutchai C, Biadul N, Lertsithichai P. Idiopathic granulomatous mastitis: A retrospective cohort study between 44 patients with different treatment modalities. Ann Med Surg (Lond) 2018; 36:162-167. [PMID: 30479764 PMCID: PMC6240599 DOI: 10.1016/j.amsu.2018.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/29/2018] [Accepted: 11/01/2018] [Indexed: 12/29/2022] Open
Abstract
Background Idiopathic granulomatous mastitis (IGM) is an uncommon benign chronic inflammatory disease which can clinically and radiographically mimic abscess or breast cancer. Definitive diagnosis was made by histopathology and exclusion of an identifying etiology. Optimal treatment has not been yet established. The aim of this study was to report and describe the clinical signs, radiological findings, managements, clinical course, and clinical outcomes after treatment of IGM. Method We retrospectively studied IGM medical records of 44 patients in our institute collected from March 1990 to October 2016. The patient characteristics, clinical presentations, radiological findings, microbiological workups, tissue pathology, treatment modalities, outcomes, and follow-up data were reviewed and analyzed. The success rate, recurrence rate and time-to-healing were compared focusing on the treatment modalities to find the proper treatments for IGM patient. Results Forty-four patients were diagnosed as IGM. The median follow-up time was 20.73 months ranging from 1.26 to 118.8 months while the median time of the diagnosis was 21 days ranging from 2 to 246 days. Due to the follow-up period, only thirty-nine patient data were used for the analysis. In the first setting, 30 patients were treated by surgery, 6 patients were treated by using steroid while other 3 patients were treated by other different treatments. Only 25 from 39 patients (64.10%) were cured by the first modality. The overall median time-to-healing was 84 days while the medians of time-to-healing treated by surgery, steroid and the rest were 75, 114.5, and 238 days respectively. The surgical treatment had the shortest time-to-healing but not statistically significant (p = 0.23). Thirteen patients out of twenty-five (52%) had wound complications after performing an excision. Lastly, five patients out of thirty-nine (12.82%) had recurrence. Conclusion IGM is an uncommon benign disease which is hardly distinguished from malignancy. There is not a significant difference among treatment modalities in term of time-to-healing and recurrence of disease. The result shows that surgery is outperformed by the shortest healing time. However, the surgical treatment must be chosen with careful due to high rate of wound complications. Multimodality treatment is recommended as the proper treatments for IGM patient. No difference between each treatment modalities for IGM in term of time-to-healing and recurrence of disease. The success rate by wide local excision alone was 65.22% and had the shortest healing time. But wound complication rate from surgery was quite high (52%) even in the case performing mastectomy. Multimodality treatment is required in one-third of the patients.
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Affiliation(s)
- Prakasit Chirappapha
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Panya Thaweepworadej
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Department of Surgery, Bangkok Metropolitan Administration General Hospital, Bangkok, Thailand
| | - Chairat Supsamutchai
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Namsiri Biadul
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Panuwat Lertsithichai
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Liu L, Zhou F, Zhang X, Liu S, Liu L, Xiang Y, Guo M, Yu L, Wang F, Ma Z, Li L, Gao D, Zhang Q, Fu Q, Yu Z. Granulomatous Lobular Mastitis: Antituberculous Treatment and Outcome in 22 Patients. Breast Care (Basel) 2018; 13:359-363. [PMID: 30498422 DOI: 10.1159/000487935] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Granulomatous lobular mastitis (GLM) is a rare chronic inflammatory condition of the breast. The purpose of this study was to describe antituberculous treatment of GLM and the long-term follow-up outcome. Methods This retrospective study included 22 patients who had been histopathologically diagnosed with GLM at the Second Hospital of Shandong University from January 2011 to March 2015. Clinical characteristics, ultrasonography and mammography findings, laboratory tests, treatment regimens, follow-up information, and recurrences were recorded. Results All patients were female with a median age of 29 (range 23-44) years. The most common symptom was a breast mass with or without pain. Large irregular hypoechoic masses could be found in the breast ultrasounds of 13 patients. All patients received triple antituberculous therapy. During a median follow-up period of 40 months, 3 patients were lost to follow-up; of the remaining 19 patients, 18 achieved clinical complete remission and no recurrences were observed. Conclusion GLM is an unusual benign breast condition that mimics breast carcinoma in its clinical and imaging presentation. Antituberculous therapy seems to be an effective alternative option in the treatment of GLM.
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Affiliation(s)
- Lu Liu
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China.,Department of Breast Surgery, Qingdao Municipal Hospital Group, Qingdao, Shandong, China
| | - Fei Zhou
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China.,Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, China
| | - Xiaoxia Zhang
- Department of Thyroid and Breast Surgery, Linyi People's Hospital, Linyi, Shandong, China
| | - Shuchen Liu
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China.,Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, China
| | - Liyuan Liu
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China.,Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, China
| | - Yujuan Xiang
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China.,Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, China
| | - Mingming Guo
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China.,Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, China
| | - Lixiang Yu
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China.,Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, China
| | - Fei Wang
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China.,Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, China
| | - Zhongbing Ma
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China.,Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, China
| | - Liang Li
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China.,Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, China
| | - Dezong Gao
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China.,Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, China
| | - Qiang Zhang
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China.,Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, China
| | - Qinye Fu
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China.,Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, China
| | - Zhigang Yu
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China.,Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, China
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Barreto DS, Sedgwick EL, Nagi CS, Benveniste AP. Granulomatous mastitis: etiology, imaging, pathology, treatment, and clinical findings. Breast Cancer Res Treat 2018; 171:527-534. [PMID: 29971624 DOI: 10.1007/s10549-018-4870-3] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 06/26/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To outline the demographics, clinical presentation, imaging features, and treatment modalities observed among a series of patients diagnosed with biopsy-proven granulomatous mastitis (GM). METHOD Following approval by institutional review board, retrospective chart review was performed on patients with biopsy-proven granulomatous mastitis at our institution in the period from January 2013 until October 2017. RESULTS A total of 90 patients were identified: 87 women and 3 men. The mean age was 35 years, mostly women in their reproductive age. In our study, patients with GM were more likely to be Hispanic compared to the general population. Sixty-three percent of patients were within 5 years of previous pregnancy. Painful palpable mass-like lesion was the most common physical finding. Breast ultrasound (US) was performed in all patients, and most commonly showed a hypoechoic irregular-shaped mass. Mammography (MG) showed asymmetry or irregular mass as the main finding. Definitive diagnosis was obtained by imaging-guided core needle biopsies in 94.4%. Conservative management was preferred, and only one patient underwent surgery. CONCLUSION Although clinical and radiological findings of patients with GM may mimic those of breast carcinoma, our study showed that women of childbearing age, especially among Hispanic ethnicity with a recent history of pregnancy or high prolactin level and newly tender mass-like lesion, in addition to new focal asymmetry on mammogram and heterogeneous hypoechoic irregular-shaped mass on ultrasound exam, should raise concern for GM. Non-invasive approach and clinical follow-up were the preferred treatment method.
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Affiliation(s)
- David S Barreto
- Department of Breast Radiology, Baylor College of Medicine, One Baylor Plaza, MS: BCM360, Houston, TX, 77030, USA.
| | - Emily L Sedgwick
- Department of Breast Radiology, Baylor College of Medicine, One Baylor Plaza, MS: BCM360, Houston, TX, 77030, USA
| | - Chandandeep S Nagi
- Department of Pathology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Ana P Benveniste
- Department of Breast Radiology, Baylor College of Medicine, One Baylor Plaza, MS: BCM360, Houston, TX, 77030, USA
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41
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Severs FJ, Guevara L, Sam KQ, Roark A, Benveniste AP, Ebuoma L. Granulomatous Mastitis of the Breast: A Malicious Mimic. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2018. [DOI: 10.1177/8756479317750107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Granulomatous mastitis (GM) is a rare and benign condition of the breast. The condition most commonly affects women of childbearing age and is commonly associated with pregnancy, breastfeeding, and oral contraceptive use. The symptoms and imaging characteristics of GM often mimic those of breast carcinomas. Imaging findings tend to be less pronounced by mammography, and GM can be mammographically occult, making sonography important in identifying the condition. Proper identification of this entity is important to prevent misdiagnosis and/or delayed treatment. The diagnosis is commonly made by tissue sampling under ultrasound guidance.
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Affiliation(s)
- Frederick J. Severs
- Department of Diagnostic and Interventional Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Lindsey Guevara
- Department of Diagnostic and Interventional Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Kenny Q. Sam
- Department of Diagnostic and Interventional Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Ashley Roark
- Department of Diagnostic and Interventional Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Ana Paula Benveniste
- Department of Diagnostic and Interventional Radiology, Baylor College of Medicine, Houston, TX, USA
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Pluguez-Turull CW, Nanyes JE, Quintero CJ, Alizai H, Mais DD, Kist KA, Dornbluth NC. Idiopathic Granulomatous Mastitis: Manifestations at Multimodality Imaging and Pitfalls. Radiographics 2018. [DOI: 10.1148/rg.2018170095] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Cedric W. Pluguez-Turull
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Jennifer E. Nanyes
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Cristina J. Quintero
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Hamza Alizai
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Daniel D. Mais
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Kenneth A. Kist
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Nella C. Dornbluth
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
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Moris D, Damaskos C, Davakis S, Vailas M, Garmpis N, Spartalis E, Kontos M, Kontzoglou K. Is idiopathic granulomatous mastitis a surgical disease? The jury is still out. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:309. [PMID: 28856149 DOI: 10.21037/atm.2017.05.24] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Idiopathic granulomatous mastitis (IGM), is a rare entity of chronic inflammatory disorder of the breast of unknown etiology. Very few cases have been described so far, almost exclusively in women. Here we describe a case of IGM in a 53-year-old man presented with a right breast mass, progressively enlarging during the last 6 months. Due to the findings of clinical examination and CT-scan, the suspicion for a potentially malignant lesion was given and the decision for surgical resection was made. Microscopic analysis of the specimen showed non-caseating granulomas around mammary lobules, findings compatible with IGM. The patient is recurrence-free at 18-month follow-up. IGM is a rare benign inflammatory breast disease, usually seen in females of reproductive age. Establishing a diagnosis can be challenging for a surgeon and requires a high index of suspicion as most patients are initially misdiagnosed by their primary care physicians. Steroids and immunosuppressive drugs are considered as fundamental treatment modalities but they are correlated with increased rates of disease response and recurrence. On the contrary, surgical resection demonstrated significantly superior results compared to steroid-alone treatment in terms of recurrence and post-treatment recovery.
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Affiliation(s)
- Demetrios Moris
- Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Damaskos
- Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Davakis
- Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Michail Vailas
- Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Garmpis
- Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftherios Spartalis
- Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Kontos
- Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Kontzoglou
- Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Lei X, Chen K, Zhu L, Song E, Su F, Li S. Treatments for Idiopathic Granulomatous Mastitis: Systematic Review and Meta-Analysis. Breastfeed Med 2017; 12:415-421. [PMID: 28731822 DOI: 10.1089/bfm.2017.0030] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Idiopathic granulomatous mastitis (IGM) is a benign breast disease with no ideal treatment regimen so far. This study aimed to evaluate the complete remission/resolution (CR) rate and recurrence rate of different treatment options. METHODS We systematically searched and identified eligible studies from January 1, 2010, to December 31, 2015, in PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Medline databases. We included original studies reporting the CR and/or recurrence rate of each treatment used. The pooled incidence and 95% confidence interval (95% CI) for CR and recurrence rate were calculated using Stata 13.0. RESULTS Fifteen eligible studies were included in our study. Six, nine, and five studies with 138, 358, and 106 patients were analyzed for surgical managements, oral steroids, and oral steroids+surgical managements, respectively. The pooled estimates for CR rate of them were 90.6% (95% CI 83.8%, 95.7%), 71.8% (95% CI 67.1%, 76.3%), and 94.5% (95% CI 88.9%, 98.3%). The pooled estimates for recurrence rate were 6.8% (95% CI 3.3%, 11.5%), 20.9% (95% CI 9.2%, 16.1%), and 4.0% (95% CI 1.5%, 8.4%), respectively. Other interventions analyzed were topical steroids, observation, oral steroids+MTX, and steroids+prolactin lowering agent, with varied pooled estimates for CR and recurrence rate. CONCLUSION Surgical managements had high CR rate with relatively low recurrence rate, with or without steroids. Thus, it was suitable for patients requiring rapid remission. However, for patients with concerns about surgical scarring, oral steroids could be an acceptable option. Further investigations are still needed to better understand the managements of IGM.
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Affiliation(s)
- Xin Lei
- 1 Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou, People's Republic of China .,2 Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou, China
| | - Kai Chen
- 1 Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou, People's Republic of China .,2 Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou, China
| | - Liling Zhu
- 1 Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou, People's Republic of China .,2 Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou, China
| | - Erwei Song
- 1 Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou, People's Republic of China .,2 Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou, China
| | - Fengxi Su
- 1 Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou, People's Republic of China .,2 Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou, China
| | - Shunrong Li
- 1 Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou, People's Republic of China .,2 Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou, China
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Shin YD, Park SS, Song YJ, Son SM, Choi YJ. Is surgical excision necessary for the treatment of Granulomatous lobular mastitis? BMC WOMENS HEALTH 2017; 17:49. [PMID: 28738795 PMCID: PMC5525244 DOI: 10.1186/s12905-017-0412-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 07/19/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND We aimed to investigate the role of surgical excision in treating granulomatous lobular mastitis. METHODS We performed a retrospective chart review of patients with granulomatous lobular mastitis treated from March 2008 to March 2014. We analyzed clinical features and therapeutic modalities and compared the patient outcomes based on treatment. RESULTS During the study period, a total of 34 patients were diagnosed with granulomatous lobular mastitis and treated. Initial treatments included wide excision (18), oral steroids after incision and drainage (14), and antibiotic therapy (2). The patients receiving only antibiotic therapy showed no improvement after 1 month and wide excision was then performed. Wide excision resulted in nine case of delayed wound healing with fistula. These patients were treated with oral steroids for 1.5-5 months, with subsequent improvement. Overall, 11 out of 20 patients who had underwent wide excision showed improvement without additional treatment. Fourteen patients who had initially received oral steroids for 1 to 6 months (average, 2.8 months) after incision and drainage showed complete remission. During the median follow-up period with 45.5 months (range, 22-98 months), six patients (17.6%) experienced recurrence. Wide excision group experienced recurrence in five (25%) and steroid and drainage group experienced recurrence in one (7.1%). All six recurrences responded to additional steroid therapy for average 3.5 months. Most wide excision group left extensive breast scarring with deformation that was not in steroid and drainage group. CONCLUSIONS Wide excision resulted high recurrence than steroid and drainage group and left extensive scarring. Steroid therapy with or without abscess drainage may be the first choice of treatment for majority cases with granulomatous lobular mastitis.
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Affiliation(s)
- Young Duck Shin
- Department of Anesthesiology, Chungbuk National University Hospital, Chungbuk National University School of Medicine, 410 Sungbong-ro, Heungdeok-gu, Cheongju, 28644, Chungcheongbuk-do, South Korea
| | - Sung Su Park
- Department of Surgery, Chungbuk National University Hospital, Chungbuk National University School of Medicine, 410 Sungbong-ro, Heungdeok-gu, Cheongju, 28644, Chungcheongbuk-do, South Korea
| | - Young Jin Song
- Department of Surgery, Chungbuk National University Hospital, Chungbuk National University School of Medicine, 410 Sungbong-ro, Heungdeok-gu, Cheongju, 28644, Chungcheongbuk-do, South Korea
| | - Seung-Myoung Son
- Department of Pathology, Chungbuk National University Hospital, Chungbuk National University School of Medicine, 410 Sungbong-ro, Heungdeok-gu, Cheongju, Chungcheongbuk-do, 28644, South Korea
| | - Young Jin Choi
- Department of Surgery, Chungbuk National University Hospital, Chungbuk National University School of Medicine, 410 Sungbong-ro, Heungdeok-gu, Cheongju, 28644, Chungcheongbuk-do, South Korea.
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Sam KQ, Severs FJ, Ebuoma LO, Chandandeep NS, Sedgwick EL. Granulomatous Mastitis in a Transgender Patient. J Radiol Case Rep 2017; 11:16-22. [PMID: 28580069 DOI: 10.3941/jrcr.v11i2.2934] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Granulomatous mastitis is a rare and benign inflammatory condition of the breast most commonly affecting women of child-bearing age as well as patients on oral contraceptives. This condition is important to identify due to its diagnostic mimicry of malicious entities such as breast carcinoma. Clinical and radiological findings are nonspecific and may overlap with breast carcinomas, thus pathologic confirmation is often necessary for definitive diagnosis. Although cases of granulomatous mastitis have been described in cisgender females, there have been no reported cases in the transgender patient, a growing patient population with few imaging guidelines. Transgender patients are at risk of developing this breast entity due to the use of long-term hormone treatments or presence of residual breast tissue. A trial of antibiotics or steroids may be administered. However, surgical treatment is often necessary in recurrent or refractory cases.
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Affiliation(s)
- Kenny Q Sam
- Department of Diagnostic and Interventional Radiology, Baylor College of Medicine, Houston, USA
| | - Frederick J Severs
- Department of Diagnostic and Interventional Radiology, Baylor College of Medicine, Houston, USA
| | - Lilian O Ebuoma
- Department of Diagnostic and Interventional Radiology, Baylor College of Medicine, Houston, USA
| | - Nagi S Chandandeep
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, USA
| | - Emily L Sedgwick
- Department of Diagnostic and Interventional Radiology, Baylor College of Medicine, Houston, USA
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Ahmed YS, Abd El Maksoud W. Evaluation of therapeutic mammoplasty techniques in the surgical management of female patients with idiopathic granulomatous mastitis with mild to moderate inflammatory symptoms in terms of recurrence and patients' satisfaction. Breast Dis 2016; 36:37-45. [PMID: 27177342 DOI: 10.3233/bd-150198] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Although idiopathic granulomatous mastitis (IGM) affects young females, its surgical management usually leads to disfigurement of the breasts. OBJECTIVES To assess the use of therapeutic mammoplasty techniques for management of IGM in terms of recurrence and postoperative patients' satisfaction. METHODS This prospective clinical study included thirteen patients who were diagnosed histologically as IGM. Patients with moderate to large breasts, who had a breast mass between 20-50% of the breast size with failed medical treatment or intolerability to steroids were subjected to therapeutic mammoplasty techniques. Only patients with large breasts were offered contra-lateral reduction mammoplasty to resume symmetry and achieve better aesthetic results. RESULTS Early postoperative bleeding that was encountered in one patient (7.7%) was the only serious postoperative complication. Patient was re-operated and the bleeder was secured. Recurrence occurred in 2 patients (15.4%) at 16 and 24 months after the operation. Kyungpook National University Hospital (KNUH) breast reconstruction satisfaction questionnaire used to assess patients' satisfaction 6 months after the operation and revealed that 10 patients (76.9%) were satisfied after the operation. CONCLUSION Using therapeutic mammoplasty techniques in surgical management of IGM in moderate to large breasts seems justifiable with good results regarding recurrence and postoperative patients' satisfaction.
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Affiliation(s)
- Yasser S Ahmed
- Medical Research Institute, University of Alexandria, Egypt
| | - Walid Abd El Maksoud
- Department of General Surgery, Faculty of Medicine, University of Alexandria, Egypt
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