Microbiology Department, St James's Hospital, Dublin, Ireland.
Department of Histopathology, St James's Hospital, Dublin, Ireland
J Clin Pathol. 2024 Nov 19;77(12):835-841. doi: 10.1136/jcp-2023-209028.
Idiopathic granulomatous mastitis (IGM) is a rare, benign, inflammatory breast disorder of unknown aetiology usually affecting women of reproductive age. It classically presents as a unilateral painful breast mass. It is frequently mistaken for carcinoma or other inflammatory breast diseases. Diagnostic investigations include clinical examination, appropriate imaging and tissue sampling. A link between IGM and infection with the species in particular has been described.
A retrospective single-centre cohort study was conducted over a 5-year period (2017-2022); all cases of IGM were identified.
Forty-one patients were diagnosed with IGM. Breast lump was the most common presenting complaint (n=29). The average age was 45 years. Eighteen patients had samples sent for culture and sensitivity, 11 of which had positive microbiology results indicative of spp infection.An 82% resolution rate (27 of 33) was recorded in those who received either a short-antibiotic course or none at all. Eight patients reported persistent disease at 3 months, five of which had evidence of spp.
This 5-year review highlights the impact of IGM in a tertiary centre in Dublin, Ireland. Although no treatment guidelines exist, options include antibiotics, immunomodulators and surgery. Due to risk of fistulae and unfavourable cosmetic outcomes, surgery should be reserved for refractory IGM. We suspect that there may be a subset of patients where prolonged antibiotic therapy should be considered. Defining this subgroup requires further study, but likely includes those with cystic neutrophilic granulomatous mastitis, relapsing disease and in whom spp is recovered.
特发性肉芽肿性乳腺炎（IGM）是一种罕见的、良性的、病因不明的炎症性乳腺疾病，通常发生在育龄妇女中。它通常表现为单侧疼痛性乳房肿块。常被误诊为癌或其他炎症性乳腺疾病。诊断性检查包括临床检查、适当的影像学检查和组织取样。已经描述了 IGM 与 种感染之间的联系。
对一个 5 年期间（2017-2022 年）的回顾性单中心队列研究进行了回顾；所有 IGM 病例均被确定。
41 名患者被诊断为 IGM。乳房肿块是最常见的主诉症状（n=29）。平均年龄为 45 岁。18 名患者送检了样本进行培养和药敏试验，其中 11 例微生物学结果呈阳性，提示存在 种感染。在接受短期抗生素治疗或根本不接受治疗的 33 例患者中，有 82%（27 例）的患者得到了缓解。8 名患者在 3 个月时报告疾病持续存在，其中 5 例有 种的证据。
本 5 年回顾性研究强调了爱尔兰都柏林一家三级中心的 IGM 影响。尽管没有治疗指南，但治疗选择包括抗生素、免疫调节剂和手术。由于瘘管和不良美容结局的风险，手术应保留给难治性 IGM。我们怀疑可能有一部分患者需要考虑延长抗生素治疗。进一步研究需要定义这个亚组，但可能包括那些患有囊性中性粒细胞性肉芽肿性乳腺炎、复发性疾病和从中回收 种的患者。
