Department of Surgery, Medical Research Institute, Alexandria University, Alexandria, Egypt.
Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Breast Dis. 2022;41(1):413-420. doi: 10.3233/BD-220047.
IGM has a diagnostic and treatment dilemma. The etiology of IGM is unknown but some conditions have been discussed as predisposing factors including Oral Contraceptive Pills, pregnancy, breast feeding, reproductive age, hyperprolactinemia, infectious and autoimmune diseases. The current study aimed to determine possible risk factors for IGM and to evaluate our experience in its management.
The study included forty patients with IGM and forty females with normal breasts as a control group. CST treatment was initiated for all patients; patients who responded completely were followed up without surgical intervention. Failure to respond to medical therapy or incidence of corticosteroid-related complications were considered indications for surgical treatment. All patients were followed up for 6 months to detect recurrence.
IGM had a significant higher incidence rate in young females within 5 years from the last lactation, smokers, those with hypperprolactinaemia, who had a history of breast feeding and those who received OCP (P = <0.001, <0.001, 0.006, 0.001, 0.023 and 0.027 respectively). The central part of the breast was more affected (9 cases (22.5%)). Multicenteric disease affected 8 cases (20%). Breast Mass was the most common presenting sign. After CST; the mass disappeared in 5 cases (12.5%), mass size reduced in 26 cases (65%) and mass size not affected in 9 cases (22.5%). Surgery was done in whom the mass size was reduced or not affected (35 cases (87.5%)). Disease recurrence was reported in 2 cases (5.7%).
IGM usually affects females in their childbearing period with multiple risk factors mainly parity, smoking, OCP and breast feeding with wide variation regarding the presenting manifestations. We should start with CST as there is always a chance to avoid unnecessary surgery and combination of both modalities can reduce the incidence of recurrence.
IGM 具有诊断和治疗上的困境。IGM 的病因尚不清楚，但一些情况已被讨论为其诱发因素，包括口服避孕药、怀孕、哺乳、育龄期、高泌乳素血症、感染和自身免疫性疾病。本研究旨在确定 IGM 的可能危险因素，并评估我们在其治疗中的经验。
该研究包括 40 例 IGM 患者和 40 名乳房正常的女性作为对照组。所有患者均开始接受 CST 治疗；完全缓解的患者无需手术干预即可随访。对药物治疗无反应或出现皮质类固醇相关并发症被认为是手术治疗的指征。所有患者均随访 6 个月以检测复发。
IGM 在最近一次哺乳后 5 年内的年轻女性、吸烟者、高泌乳素血症患者、有哺乳史和服用 OCP 的患者中的发病率显著更高（P<0.001、<0.001、0.006、0.001、0.023 和 0.027 分别）。乳房中央部分受影响更严重（9 例（22.5%））。多中心疾病影响 8 例（20%）。乳房肿块是最常见的表现。接受 CST 治疗后，肿块消失 5 例（12.5%），肿块缩小 26 例（65%），肿块大小无变化 9 例（22.5%）。肿块大小缩小或无变化的患者行手术治疗（35 例（87.5%））。有 2 例（5.7%）报告疾病复发。
IGM 通常影响育龄期多产、吸烟、服用 OCP 和哺乳的女性，其临床表现差异很大。我们应该首先使用 CST，因为总有机会避免不必要的手术，并且两种方法的联合可以降低复发的发生率。
