Bouton Marcia E, Winton Lisa M, Gandhi Sonal G, Jayaram Lakshmi, Patel Prahladbhai N, O' Neill Patrick J, Komenaka Ian K
Maricopa Medical Center, Phoenix, AZ, USA.
New Horizon's Women's Care, Phoenix, AZ, USA.
Int J Surg Case Rep. 2015;10:8-11. doi: 10.1016/j.ijscr.2015.02.051. Epub 2015 Mar 4.
Idiopathic granulomatous mastitis (IGM) is becoming more commonly recognized and reported more often. Currently, many recommend corticosteroids in its management.
A 34-year-old G3P2 Hispanic female, 28 weeks pregnant, presented with a 19cm right breast mass. She had a known prolactinoma treated with bromocriptine which was discontinued during her pregnancy. Ultrasound guided core biopsy procedure revealed granulomatous mastitis. The patient was told that the mass would resolve with observation. The patient seen at another institution by an infectious disease specialist who started treatment with amphotericin for presumptive disseminated coccidioidomycosis. Repeated titers were negative for coccidioides antibody. Repeat cultures were negative as well. Due to the persistence of the infectious disease specialist, tissue cultures were performed on fresh tissue specimens, which did not grow bacterial, fungal, nor acid fast organisms. The amphotericin regimen resulted in no improvement of her breast mass after 10 weeks. Within two weeks of stopping the antifungal therapy, however, the mass diminished to 6cm. The patient delivered at 39 weeks. Bromocriptine was restarted, and within 4 weeks, the lesion was no longer palpable. She had not shown signs of recurrence for 32 months.
Treatment recommendations for IGM vary widely but antibiotics and antifungal medications are not recommended. Corticosteroid treatment is most commonly recommended, however, outcomes may not be different from management with observation. Prolactin may be involved in the pathophysiology of the process.
IGM is becoming recognized more frequently. Observation and patience with natural history can be an effective management.
特发性肉芽肿性乳腺炎（IGM）越来越多地被认识和报道。目前，许多人推荐在其治疗中使用皮质类固醇。
一名34岁、孕3产2的西班牙裔女性，怀孕28周，出现一个19厘米的右乳肿块。她已知患有泌乳素瘤，曾用溴隐亭治疗，孕期停药。超声引导下的粗针活检显示为肉芽肿性乳腺炎。患者被告知肿块可通过观察自行消退。该患者在另一家机构由一名传染病专家诊治，专家因怀疑播散性球孢子菌病开始用两性霉素治疗。球孢子菌抗体的重复滴度为阴性。重复培养也为阴性。由于传染病专家坚持，对新鲜组织标本进行了组织培养，未培养出细菌、真菌或抗酸菌。两性霉素治疗方案10周后，她的乳房肿块没有改善。然而，在停止抗真菌治疗两周内，肿块缩小至6厘米。患者在39周时分娩。溴隐亭重新开始使用，4周内，病变不再可触及。32个月来她没有复发迹象。
IGM的治疗建议差异很大，但不推荐使用抗生素和抗真菌药物。最常推荐使用皮质类固醇治疗，然而，其结果可能与观察管理没有差异。泌乳素可能参与了该过程的病理生理。
IGM越来越多地被认识。观察并耐心等待其自然病程可能是一种有效的管理方法。
