Aghajanzadeh Manouchehr, Hassanzadeh Rasool, Alizadeh Sefat Soheila, Alavi Ali, Hemmati Hossein, Esmaeili Delshad Mohammad Sadegh, Emir Alavi Cyrus, Rimaz Siamak, Geranmayeh Siamak, Najafi Ashtiani Mohammad, Habibzadeh Seyed Mahmoud, Rasam Khosheh, Massahniya Sara
Department of Surgery, Guilan University of Medical Sciences, Rasht, Iran.
Student Research Committee, Guilan University of Medical Sciences, Rasht, Iran.
Breast. 2015 Aug;24(4):456-60. doi: 10.1016/j.breast.2015.04.003. Epub 2015 Apr 29.
The aim of this study is to review the clinical presentations, diagnostic methods, treatment options and outcome of patients with Granulomatous Mastitis (GM).
In a retrospective study, we indentified 206 women who met the required histological criteria of (GM).
Thirty eight (18%) of these women had taken antibiotics before their diagnosis of GM. The most common symptoms in remaining 168 symptomatic women were breast mass. The most common ultrasonographic and mammographic finding was large irregular hypo echoic masses and an irregular mass, respectively. As a diagnostic tool, fine needle aspiration (FNA) was performed in 33 (19.5%) and core needle biopsy with or without ultrasound was done in 92 (55%) of patients while successful rate was 13 (39%) and 87 (94.5%), respectively. The remaining 43 (25.5%) of women underwent surgical excisions. Only 6 (3%) patients improved with antibiotics and 200 (97%) of women who did not respond to antibiotics, were treated with steroid and among them 144 (72%) improved. Treatment with combination of methotrexate and steroid was done in 56 (28%) patients and was effective in 40 (71%) of them. Sixteen (8%) patients were treated with a combination of steroid and bromocriptine which was effective in 5 (31%) patients. A wide surgical excision was performed in 11 (5.5%) patients who were nonresponsive to steroid and methotrexate and bromocriptine therapy.
Our findings indicate that clinical and imaging findings of (GM) have overlapped with malignancy. The best diagnostic method is core needle biopsy. Corticosteroids are in the first line of treatment with a good therapeutic response.
本研究旨在回顾肉芽肿性乳腺炎（GM）患者的临床表现、诊断方法、治疗选择及预后。
在一项回顾性研究中，我们确定了206名符合肉芽肿性乳腺炎所需组织学标准的女性。
这些女性中有38名（18%）在诊断为肉芽肿性乳腺炎之前使用过抗生素。其余168名有症状的女性中最常见的症状是乳房肿块。最常见的超声和乳腺X线摄影表现分别是大的不规则低回声肿块和不规则肿块。作为诊断工具，33名患者（19.5%）进行了细针穿刺抽吸（FNA），92名患者（55%）进行了有或无超声引导的粗针活检，成功率分别为13名（39%）和87名（94.5%）。其余43名女性（25.5%）接受了手术切除。仅6名患者（3%）使用抗生素后病情改善，200名对抗生素无反应的女性接受了类固醇治疗，其中144名（72%）病情改善。56名患者（28%）接受了甲氨蝶呤和类固醇联合治疗，其中40名（71%）有效。16名患者（8%）接受了类固醇和溴隐亭联合治疗，其中5名（31%）有效。11名对类固醇、甲氨蝶呤和溴隐亭治疗无反应的患者（5.5%）进行了广泛的手术切除。
我们的研究结果表明，肉芽肿性乳腺炎的临床和影像学表现与恶性肿瘤有重叠。最佳诊断方法是粗针活检。皮质类固醇是一线治疗药物，治疗反应良好。
