Department of Breast, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Breastfeed Med. 2021 Sep;16(9):759-764. doi: 10.1089/bfm.2021.0023. Epub 2021 Apr 19.
We have already known that idiopathic granulomatous mastitis (IGM) is a rare benign chronic inflammatory disorder that can clinically mimic breast carcinoma, especially affects parous women of childbearing age, but there is little literature to report about pregnancy associated granulomatous mastitis (PAGM). The aim of our study is to report and describe the clinical signs, managements, clinical course, and clinical outcomes after treatment of PAGM in our hospital. We retrospectively analyzed 15 pregnant patients who were diagnosed as PAGM in our hospital collected from December 2018 to December 2020 by reviewing medical records and questionnaire survey, including the patients' characteristics, clinical presentations, microbiological workups, tissue pathology, treatment modalities, outcomes, and follow-up data. The mean age of these patients at diagnosis was 30.5 (range 24-35) years. All patients had one birth before, and had at least two gravida times, 6 of them (40%) had three gravida times, and only one of them had four gravida times at diagnosis. The mean weeks of gestational age were 23.7 (range 4-37) weeks. Two patients' BMI were greater than 30, which were considered obese. The mean time to presentation since last delivery was 38.4 (range 19-78) months. All patients had a history of breastfeeding; the average breastfeeding time was 12.97 months. Just 2 of them were diagnosed with lactational mastitis before. One patient smoked before, 1 patient had oral contraceptive pills before, 4 patients had breast trauma recently, 5 patients had positive bacterial culture of pyogenic fluids, 3 patients had nipple retraction, 6 patients had abnormal humoral immunity, shown as elevated C3 or C4, and 2 patients had elevated serum prolactin. All patients presented as a breast mass with pain; two of them had erythema nodosum and oligoarthritis. Nearly all patients had unilateral lesion. The mean follow-up was 11 (range 1-24) months. Thirteen patients gave birth to a healthy baby, and all babies had a healthy growth and development. Almost all patients chose observation during pregnancy. Nine patients demonstrated complete remission, five of them underwent surgery after steroids and/or antibiotics, one patient had observation alone, two chose postpartum steroids alone, and the last one chose postpartum antibiotics alone. The average time to complete remission was 11.2 (range 7-18) months. In general, PAGM is a much rare disorder which has onset during pregnancy, and mainly happens in the second trimester and the third trimester. PAGM patients were all parous women and generally within 5 years of their last pregnancy, also with uncertain etiology and pathogenesis. Observational therapy during pregnancy for PAGM is reliable and feasible.
我们已经知道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，临床上可模拟乳腺癌，尤其影响处于生育年龄的经产妇，但关于妊娠相关性肉芽肿性乳腺炎（PAGM）的文献报道较少。我们的研究目的是报告和描述我院收治的 PAGM 患者的临床特征、治疗方法、临床病程和治疗后结果。我们通过回顾病历和问卷调查，对 2018 年 12 月至 2020 年 12 月期间在我院确诊为 PAGM 的 15 例妊娠患者进行了回顾性分析，包括患者的特征、临床表现、微生物学检查、组织病理学、治疗方式、结果和随访数据。这些患者的诊断时平均年龄为 30.5 岁（24-35 岁）。所有患者均有一次分娩史，至少有两次妊娠史，其中 6 例（40%）有三次妊娠史，仅 1 例在诊断时已有四次妊娠史。平均孕龄为 23.7 周（4-37 周）。两名患者的 BMI 大于 30，被认为是肥胖。从上次分娩到就诊的平均时间为 38.4 个月（19-78 个月）。所有患者均有母乳喂养史，平均母乳喂养时间为 12.97 个月。仅有 2 例患者在就诊前曾被诊断为哺乳期乳腺炎。1 例患者有吸烟史，1 例患者有口服避孕药史，4 例患者近期有乳房外伤史，5 例患者有脓性液体的细菌培养阳性，3 例患者有乳头回缩，6 例患者有体液免疫异常，表现为 C3 或 C4 升高，2 例患者有血清催乳素升高。所有患者均表现为乳房肿块伴疼痛；其中 2 例有结节性红斑和寡关节炎。几乎所有患者均为单侧病变。平均随访时间为 11 个月（1-24 个月）。13 例患者分娩出健康婴儿，所有婴儿均健康生长发育。几乎所有患者在妊娠期间均选择观察。9 例患者完全缓解，其中 5 例在使用类固醇和/或抗生素后接受了手术，1 例仅观察，2 例仅在产后使用类固醇，最后 1 例仅在产后使用抗生素。完全缓解的平均时间为 11.2 个月（7-18 个月）。总的来说，PAGM 是一种罕见的疾病，在妊娠期间发病，主要发生在妊娠中期和晚期。PAGM 患者均为经产妇，且一般在最后一次妊娠后 5 年内，病因和发病机制尚不确定。妊娠期间对 PAGM 进行观察治疗是可靠且可行的。
