Chirappapha Prakasit, Thaweepworadej Panya, Supsamutchai Chairat, Biadul Namsiri, Lertsithichai Panuwat
Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Department of Surgery, Bangkok Metropolitan Administration General Hospital, Bangkok, Thailand.
Ann Med Surg (Lond). 2018 Nov 9;36:162-167. doi: 10.1016/j.amsu.2018.11.001. eCollection 2018 Dec.
Idiopathic granulomatous mastitis (IGM) is an uncommon benign chronic inflammatory disease which can clinically and radiographically mimic abscess or breast cancer. Definitive diagnosis was made by histopathology and exclusion of an identifying etiology. Optimal treatment has not been yet established. The aim of this study was to report and describe the clinical signs, radiological findings, managements, clinical course, and clinical outcomes after treatment of IGM.
We retrospectively studied IGM medical records of 44 patients in our institute collected from March 1990 to October 2016. The patient characteristics, clinical presentations, radiological findings, microbiological workups, tissue pathology, treatment modalities, outcomes, and follow-up data were reviewed and analyzed. The success rate, recurrence rate and time-to-healing were compared focusing on the treatment modalities to find the proper treatments for IGM patient.
Forty-four patients were diagnosed as IGM. The median follow-up time was 20.73 months ranging from 1.26 to 118.8 months while the median time of the diagnosis was 21 days ranging from 2 to 246 days. Due to the follow-up period, only thirty-nine patient data were used for the analysis. In the first setting, 30 patients were treated by surgery, 6 patients were treated by using steroid while other 3 patients were treated by other different treatments. Only 25 from 39 patients (64.10%) were cured by the first modality. The overall median time-to-healing was 84 days while the medians of time-to-healing treated by surgery, steroid and the rest were 75, 114.5, and 238 days respectively. The surgical treatment had the shortest time-to-healing but not statistically significant (p = 0.23). Thirteen patients out of twenty-five (52%) had wound complications after performing an excision. Lastly, five patients out of thirty-nine (12.82%) had recurrence.
IGM is an uncommon benign disease which is hardly distinguished from malignancy. There is not a significant difference among treatment modalities in term of time-to-healing and recurrence of disease. The result shows that surgery is outperformed by the shortest healing time. However, the surgical treatment must be chosen with careful due to high rate of wound complications. Multimodality treatment is recommended as the proper treatments for IGM patient.
特发性肉芽肿性乳腺炎（IGM）是一种罕见的良性慢性炎症性疾病，在临床和影像学上可类似脓肿或乳腺癌。通过组织病理学检查并排除明确病因来做出明确诊断。目前尚未确定最佳治疗方法。本研究的目的是报告并描述IGM的临床体征、影像学表现、治疗方法、临床病程及治疗后的临床结局。
我们回顾性研究了我院1990年3月至2016年10月收集的44例IGM患者的病历。对患者的特征、临床表现、影像学表现、微生物学检查、组织病理学、治疗方式、结局及随访数据进行了回顾和分析。比较不同治疗方式的成功率、复发率和愈合时间，以寻找适合IGM患者的治疗方法。
44例患者被诊断为IGM。中位随访时间为20.73个月，范围为1.26至118.8个月，而诊断的中位时间为21天，范围为2至246天。由于随访期的原因，仅39例患者的数据用于分析。初次治疗时，30例患者接受手术治疗，6例患者使用类固醇治疗，另外3例患者接受其他不同治疗。39例患者中仅25例（64.10%）通过初次治疗方式治愈。总体中位愈合时间为84天，而手术、类固醇及其他治疗方式的愈合时间中位数分别为75天、114.5天和238天。手术治疗的愈合时间最短，但无统计学意义（p = 0.23）。25例患者中有13例（52%）在切除术后出现伤口并发症。最后，39例患者中有5例（12.82%）复发。
IGM是一种罕见的良性疾病，很难与恶性肿瘤区分开来。在愈合时间和疾病复发方面，不同治疗方式之间没有显著差异。结果表明手术治疗的愈合时间最短。然而，由于伤口并发症发生率高，必须谨慎选择手术治疗。建议采用多模式治疗作为IGM患者的合适治疗方法。
