Department of Internal Medicine, Centre Hospitalo-Universitaire Hôtel-Dieu, Nantes, France.
QJM. 2013 May;106(5):433-41. doi: 10.1093/qjmed/hct040. Epub 2013 Feb 13.
To investigate the presentation, disease course and long-term outcome of a western cohort of idiopathic granulomatous mastitis (IGM) and to analyse the impact of different therapeutic strategies.
Multicentre retrospective study of 23 women followed over an extended period. Patients were recruited in nine French internal medicine departments.
The median follow-up was 6 years. IGM presented commonly as a single inflammatory unilateral extra-areolar lump of varying size. Clinical course was heterogeneous and frequently remitting/relapsing. Most patients had at least one recurrence (18/23, 78%). The mean number of recurrences was 1.3 ± 1.5. Seven women had a bilateral evolution. Twelve women received steroids (corticosteroids). Only two of these did not respond to corticosteroids, whereas six relapsed when dose was tapered off. Nine patients received colchicine and/or hydroxychloroquine. First-line treatment consisted of excisional surgery in eight cases. At the date of last interview, 91% of the patients declared to be healed, 15 being free of treatment. However, 12/21 (57%) reported significant sequelae (unsightly scars: eight and/or lasting pain: six). Unsightly scars were not more prevalent in patients who had received steroids whereas they tended to be more frequent after breast excisional surgery. In addition, we found that excisional surgery did not prevent recurrences more successfully than a conservative approach.
Despite its retrospective nature, this Caucasian series provides novel information regarding long-term outcomes in IGM and argues in favour of conservative approaches. The value of immunomodulatory drugs such as colchicine or hydroxychloroquine deserves further investigation.
研究西方特发性肉芽肿性乳腺炎（IGM）患者的临床表现、病程和长期预后，并分析不同治疗策略的影响。
对 9 个法国内科部门收治的 23 名女性患者进行了长期回顾性多中心研究。
中位随访时间为 6 年。IGM 常表现为单侧、不同大小的孤立性炎性乳晕外肿块。临床过程多样，常呈缓解/复发。大多数患者至少有一次复发（18/23，78%）。平均复发次数为 1.3±1.5。7 名患者出现双侧病变。12 名患者接受了皮质类固醇治疗。这 12 名患者中，仅 2 名对皮质类固醇无反应，6 名患者在减药时复发。9 名患者接受了秋水仙碱和/或羟氯喹治疗。8 例患者接受了切除术作为一线治疗。在最后一次随访时，91%的患者报告已治愈，15 例患者已停止治疗。然而，12/21（57%）患者报告存在显著后遗症（外观难看的疤痕：8 例；持续疼痛：6 例）。接受皮质类固醇治疗的患者中，外观难看的疤痕并不比接受乳房切除术的患者更常见，但前者更容易发生。此外，我们发现切除术并不比保守治疗更能成功预防复发。
尽管本研究为回顾性研究，但仍为 IGM 的长期预后提供了新的信息，并支持采用保守治疗方法。秋水仙碱或羟氯喹等免疫调节药物的价值值得进一步研究。
