Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
J Breast Cancer. 2012 Mar;15(1):111-8. doi: 10.4048/jbc.2012.15.1.111. Epub 2012 Mar 28.
Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory disease of unknown etiology. The diagnosis of IGM requires that other granulomatous lesions in the breast be excluded. Tuberculous mastitis (TM) is also an uncommon disease that is often difficult to differentiate from IGM. The purpose of this study is to develop a new algorithm for the differential diagnosis and treatment of IGM and TM.
Medical records of 68 patients (58 with IGM and 10 with TM) between July 1999 and February 2009 were retrospectively reviewed.
The mean age of the patients was 33.5 (IGM) and 40 (TM) years (p=0.018). The median follow-up was 84 months. Of the total 10 patients with TM, 5 patients had a history of pulmonary tuberculosis. The most common symptoms of the diseases were breast lump and pain. However, axillary lymphadenopathy was more seen in TM (50%) compared to IGM (20.6%) (p=0.048). TM showed more cancer-mimicking findings on radiologic study (p=0.028). In IGM, 48 patients (82.7%) underwent surgical wide excision and 21 patients (36.2%) were managed with corticosteroid therapy and antibiotics. All of the TM patients received anti-tuberculosis medications and 9 patients (90%) underwent wide excision. The mean treatment duration was 2.8 months in IGM and 8.4 months in TM. Recurrence developed in 5 patients (8.6%) in IGM and 1 patient (10%) in TM.
This study shows different characteristics between IGM and TM. The IGM patients were younger and had more mastalgia symptoms than the TM patients. Axillary lymphadenopathy was seen more often in TM patients. Half of the TM patients had pulmonary tuberculosis or tuberculosis lymphadenitis. Surgical wide excision might be both therapeutic and useful for providing an exact diagnosis.
特发性肉芽肿性乳腺炎（IGM）是一种病因不明的罕见慢性炎症性疾病。IGM 的诊断需要排除其他乳房肉芽肿性病变。结核性乳腺炎（TM）也是一种不常见的疾病，常难以与 IGM 相鉴别。本研究旨在制定一种新的 IGM 和 TM 鉴别诊断和治疗的算法。
回顾性分析 1999 年 7 月至 2009 年 2 月间 68 例患者（58 例 IGM 和 10 例 TM）的病历。
患者平均年龄为 33.5（IGM）和 40（TM）岁（p=0.018）。中位随访时间为 84 个月。10 例 TM 患者中，5 例有肺结核病史。两种疾病最常见的症状是乳房肿块和疼痛。然而，TM 患者中更常见腋窝淋巴结肿大（50%），而 IGM 患者中为 20.6%（p=0.048）。TM 在影像学研究中更具癌样表现（p=0.028）。在 IGM 中，48 例（82.7%）患者行外科广泛切除术，21 例（36.2%）患者接受皮质类固醇治疗和抗生素治疗。所有 TM 患者均接受抗结核药物治疗，9 例（90%）患者行广泛切除术。IGM 的平均治疗时间为 2.8 个月，TM 为 8.4 个月。IGM 中有 5 例（8.6%）和 TM 中有 1 例（10%）患者复发。
本研究显示 IGM 和 TM 之间存在不同的特征。IGM 患者较年轻，且乳房疼痛症状多于 TM 患者。TM 患者中更常出现腋窝淋巴结肿大。TM 患者中有一半患有肺结核或结核性淋巴结炎。外科广泛切除术既是治疗方法，又可提供明确诊断。
