Sheybani Fereshte, Sarvghad MohammadReza, Naderi HamidReza, Gharib Masoumeh
Departments of Infectious Diseases and Pathology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Obstet Gynecol. 2015 Apr;125(4):801-807. doi: 10.1097/AOG.0000000000000734.
To describe the clinical and paraclinical characteristics of idiopathic granulomatous mastitis, the management of our patients, and review the literature on this topic.
Patients referred to our clinic with a presumptive diagnosis of infectious mastitis were only included in the study if they had histopathologic confirmation of granulomatous mastitis. A systemic or infectious etiology was excluded by the testing of tissues and fluids by staining, culture, and polymerase chain reaction methods. Those patients with no reported etiology were categorized as idiopathic granulomatous mastitis and treated with antiinflammatory drugs. All were monitored for signs of recurrence.
All 22 patients with a final diagnosis of idiopathic granulomatous mastitis were women with a mean age (± standard deviation) of 32.8 ± 6.2 years. Initial treatment with a prednisone regimen was given in 15 (68.2%) patients, prednisone plus methotrexate (MTX) in six (27.3%), and MTX alone in one (4.5%). Among the total of 22 patients with idiopathic granulomatous mastitis, 12 (54.5%) received MTX either as an initial treatment or as an alternative regimen. Of the 22 patients, three (13.6%) had disease recurrence and four (18.2%) experienced adverse drug reactions. Sixteen (72.7%) patients discontinued the initial treatment regimen with acceptable control of disease activity and without recurrence or adverse drug reactions during the follow-up period.
Idiopathic granulomatous mastitis is a distinct benign breast condition of unknown etiology but several triggers are suspected, including inflammatory, infectious, and hormonal factors. Corticosteroids and MTX, with or without surgery, are the treatment of choice in these patients.
描述特发性肉芽肿性乳腺炎的临床和辅助检查特征、我们对患者的治疗方法，并回顾关于该主题的文献。
只有那些经组织病理学确诊为肉芽肿性乳腺炎的、被转诊至我们诊所且初步诊断为感染性乳腺炎的患者才被纳入研究。通过染色、培养和聚合酶链反应方法对组织和体液进行检测，排除系统性或感染性病因。那些未报告病因的患者被归类为特发性肉芽肿性乳腺炎，并接受抗炎药物治疗。所有患者均监测复发迹象。
最终诊断为特发性肉芽肿性乳腺炎的所有22例患者均为女性，平均年龄（±标准差）为32.8±6.2岁。15例（68.2%）患者初始采用泼尼松方案治疗，6例（27.3%）采用泼尼松加甲氨蝶呤（MTX）治疗，1例（4.5%）仅采用MTX治疗。在总共22例特发性肉芽肿性乳腺炎患者中，12例（54.5%）在初始治疗或替代方案中接受了MTX治疗。22例患者中，3例（13.6%）疾病复发，4例（18.2%）出现药物不良反应。16例（72.7%）患者在随访期间停用了初始治疗方案，疾病活动得到了可接受的控制，且无复发或药物不良反应。
特发性肉芽肿性乳腺炎是一种病因不明的独特的良性乳腺疾病，但怀疑有多种触发因素，包括炎症、感染和激素因素。皮质类固醇和MTX，无论是否联合手术，都是这些患者的首选治疗方法。
