Department of General Surgery, Kocaeli Atakent Cihan Hospital, İzmit, Kocaeli, Turkey.
Department of General Surgery, Bandırma Research and Training Hospital, Balikesir, Turkey.
Clin Exp Med. 2024 Jul 28;24(1):173. doi: 10.1007/s10238-024-01444-7.
Idiopathic granulomatous mastitis (IGM) is a benign, chronic inflammatory lesion of the breast. Immunoglobulin G4 (IgG4) associated disease is rare in the breast. In our study, we aimed to evaluate the efficacy of steroid treatment on IgG4 levels in tissue in patients diagnosed with IGM. Between 2008 and 2017, 55 patients diagnosed with IGM in our clinic were included in the study. Demographic, clinical, microbiologic and histopathologic characteristics, treatment modality and recovery time were evaluated retrospectively. Patients were divided into 3 groups according to tissue IgG4 levels: negative (Group I), infrequently and slightly positive (Group II), and highly positive (Group III). Group I patients had a complete response rate of 77.8%. In the rest of the patients (22.2%), insufficient response was detected from the beginning of the treatment. In Group II, the response rate was 91.3% and the permanent success rate after treatment was 87.0%. Although group III patients had a complete response at the beginning (95.65%), they relapsed in a short period of time (26.1%) after discontinuation of steroid treatment. At least one steroid-related side effect was observed in 47 (85.8%) patients in all groups. There is no consensus on the dose and duration of immunosuppressive treatment in IGM. In this study, responses to steroid treatment according to IgG4 concentration in pathologic breast tissue and recurrences after the end of treatment were determined. We think that high IgG4 concentration in the tissue is associated with recurrence and other immunosuppressive drugs should be added as maintenance after steroid treatment.
特发性肉芽肿性乳腺炎（IGM）是一种良性、慢性的乳腺炎症性病变。免疫球蛋白 G4（IgG4）相关疾病在乳腺中较为罕见。在本研究中，我们旨在评估类固醇治疗对组织中 IgG4 水平的疗效，这些患者被诊断为 IGM。2008 年至 2017 年期间，我们诊所共诊断了 55 例 IGM 患者，这些患者均被纳入本研究。回顾性评估了患者的人口统计学、临床、微生物学和组织病理学特征、治疗方式和康复时间。根据组织 IgG4 水平，患者被分为 3 组：阴性（第 I 组）、轻度阳性（第 II 组）和高度阳性（第 III 组）。第 I 组患者的完全缓解率为 77.8%。在其余的患者（22.2%）中，从治疗开始就发现治疗效果不足。在第 II 组中，缓解率为 91.3%，治疗后的永久成功率为 87.0%。尽管第 III 组患者在开始时（95.65%）有完全缓解，但在停止类固醇治疗后不久（26.1%）就复发了。所有组中至少有 47 例（85.8%）患者存在类固醇相关的不良反应。在 IGM 中，关于免疫抑制治疗的剂量和持续时间尚无共识。在本研究中，我们根据组织中 IgG4 浓度确定了对类固醇治疗的反应以及治疗结束后的复发情况。我们认为组织中 IgG4 浓度较高与复发有关，在类固醇治疗后应添加其他免疫抑制剂作为维持治疗。
