Toktas Osman, Toprak Nurşen
Department of Surgery, Van Yüzüncü Yıl University Faculty of Medicine, Van, Turkey.
Department of Radiology, Van Yüzüncü Yıl University Faculty of Medicine, Van, Turkey.
Eur J Breast Health. 2021 Jun 24;17(3):283-287. doi: 10.4274/ejbh.galenos.2021.2021-2-4. eCollection 2021 Jul.
Idiopathic granulomatous mastitis (IGM) is an inflammatory and chronic benign breast disease that has proven difficult to diagnose and treat. Since most treatment modalities cannot be used in pregnant patients, the choice of treatment is more difficult and the need for surgery is more pressing. In this first and innovative study, we assess the results of local corticosteroid therapy of IGM in pregnant women.
Pregnant women with IGM were evaluated between June 2017 and May 2019. The six pregnant women were treated using intralesional steroid injections and topical steroid administration. The treatment response was evaluated, both clinically and radiologically, at the end of 2 weeks and once more at the end of 1 month.
The median patient age was 26 years. The mean duration of complaints was 4.3 months. The median number of children was 2, and the mean breastfeeding time was 41 months. The predominant complaints at onset were a breast mass or local pain and inflammation in four (66.7%) patients and a breast mass with pain and without signs of local skin inflammation in two (33.3%) patients. Diagnosis was made using a tru-cut biopsy in two patients, and with an incisional biopsy in four patients who had abscess drainage and fistulation to the skin. Five (83.3%) patients achieved a complete response, and one (16.7%) patient responded only partially after the first course of treatment. A second course of treatment was given to the patient with partial response. All patients achieved complete response at the end of the second course of treatment. The mean follow-up time was 19.5 months. During the follow-up period, one patient experienced a recurrence at 4 months after giving birth, and she then received a third course of treatment. Topical and systemic side effects of the corticosteroids were not observed in any patient.
While the state of pregnancy generally precludes the use of most drugs, the use of local corticosteroid in the treatment of IGM is effective in terms of treatment response, treatment duration, need for surgery, and reduced recurrence and side effects.
特发性肉芽肿性乳腺炎（IGM）是一种炎症性慢性良性乳腺疾病，已证实难以诊断和治疗。由于大多数治疗方式不能用于孕妇，治疗选择更加困难，手术需求更为迫切。在这项首次创新性研究中，我们评估了孕妇IGM局部皮质类固醇治疗的效果。
对2017年6月至2019年5月期间的IGM孕妇进行评估。6名孕妇接受了病灶内类固醇注射和局部类固醇给药治疗。在2周结束时以及1个月结束时再次从临床和放射学角度评估治疗反应。
患者年龄中位数为26岁。主诉平均持续时间为4.3个月。子女数中位数为2个，平均母乳喂养时间为41个月。发病时的主要主诉为乳房肿块或局部疼痛及炎症，4例（66.7%）患者为此情况；乳房肿块伴疼痛且无局部皮肤炎症体征，2例（33.3%）患者为此情况。2例患者通过粗针活检确诊，4例有脓肿引流及皮肤瘘管形成的患者通过切开活检确诊。5例（83.3%）患者获得完全缓解，1例（16.7%）患者在第一个疗程后仅部分缓解。对部分缓解的患者给予第二个疗程的治疗。所有患者在第二个疗程结束时均获得完全缓解。平均随访时间为19.5个月。随访期间，1例患者产后4个月复发，随后接受了第三个疗程的治疗。未观察到任何患者出现皮质类固醇的局部和全身副作用。
虽然怀孕状态通常排除了大多数药物的使用，但局部皮质类固醇用于治疗IGM在治疗反应、治疗持续时间、手术需求以及降低复发率和副作用方面是有效的。
