Breast Department, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
Department of Histopathology and Cytology, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
World J Surg. 2019 Jul;43(7):1737-1745. doi: 10.1007/s00268-019-05014-x.
Granulomatous mastitis (GM) is an inflammatory breast disease of unknown aetiology. It poses diagnostic and therapeutic challenges with myriad forms of clinical presentation, varying results to treatments and propensity to recur. This study aims to look at clinical and treatment factors that predispose to recurrence of GM.
We performed a retrospective review of 113 patients in our unit with histologically proven GM from 2006 to 2016. Demographic, clinical, treatment and outcomes data were collected and analysed.
Eighty-nine patients were treated with antibiotics (78.8%), 79 (69.9%) with steroids and 23 (20.4%) patients underwent surgery. Twenty (17.7%) patients had recurrence. Patients who presented with inflammatory signs and symptoms had increased odds of having subsequent recurrence: skin changes (1.50), pain (2.00), fistula (4.39) and antibiotic treatment (6.65). Four patients (20%) with recurrence had positive bacterial cultures. All 4 grew Corynebacterium. Patients with Corynebacterium infection had a 2.64 times higher risk of recurrence. Surgery did not preclude recurrence. There was a 70% (7/10) penicillin resistance rate in our patients with positive cultures for Corynebacterium.
Initial presentation with inflammatory signs and symptoms may confer increased risk of recurrence, warranting closer monitoring. Corynebacterium infection may play a part as a causative factor and risk factor for recurrence. Non-penicillin antibiotics should be considered as first-line antibiotics for patients presenting with inflammatory changes. Further prospective studies with larger patient populations might reveal information on the aetiology of GM and result in the development of a more standardized and effective treatment regimen.
肉芽肿性乳腺炎（GM）是一种病因不明的炎症性乳腺疾病。它具有多种临床表现形式，治疗效果各异，易复发，给诊断和治疗带来了挑战。本研究旨在探讨导致 GM 复发的临床和治疗因素。
我们对 2006 年至 2016 年在我院经组织学证实为 GM 的 113 例患者进行了回顾性分析。收集并分析了人口统计学、临床、治疗和结局数据。
89 例患者接受抗生素治疗（78.8%），79 例（69.9%）接受类固醇治疗，23 例（20.4%）患者接受手术治疗。20 例（17.7%）患者复发。出现炎症迹象和症状的患者复发的可能性增加：皮肤变化（1.50）、疼痛（2.00）、瘘管（4.39）和抗生素治疗（6.65）。4 例（20%）复发患者的细菌培养阳性。所有 4 例均培养出棒状杆菌。感染棒状杆菌的患者复发风险增加 2.64 倍。手术并不能排除复发。我们的患者中，阳性棒状杆菌培养物对青霉素的耐药率为 70%（7/10）。
最初出现炎症迹象和症状可能会增加复发的风险，需要密切监测。棒状杆菌感染可能是导致复发的一个致病和危险因素。对于出现炎症改变的患者，应考虑使用非青霉素类抗生素作为一线抗生素。进一步的前瞻性研究，纳入更多的患者人群，可能会揭示 GM 的病因学信息，并导致制定出更标准化和有效的治疗方案。
