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. 2015 Oct;47(3):165-73.
doi: 10.5152/eurasianjmed.2015.118.

Granulomatous Mastitis: A Ten-Year Experience at a University Hospital

Ercan Korkut  1 , Mufide Nuran Akcay  1 , Erdem Karadeniz  1 , Irmak Durur Subasi  2 , Nesrin Gursan  3
Affiliations

Granulomatous Mastitis: A Ten-Year Experience at a University Hospital

Ercan Korkut et al. Eurasian J Med. 2015 Oct.

Abstract
in English, Turkish

Objective: In this study we aimed to define clinical, radiologic and pathological specialties of patients who applied to General Surgery Department of Atatürk University Medical Faculty with granulomatous mastitis and show medical and surgical treatment results. With the help of this study we will be able to make our own clinical algorithm for diagnosis and treatment.

Materials and methods: We searched retrospectively addresses, phone numbers and clinical files of 93 patients whom diagnosed granulomatous mastitis between a decade of January 2001 - December 2010. We noted demographic specialties, ages, gender, medical family history, main complaints, physical findings, radiological and laboratory findings, medical treatments, postoperative complications and surgical procedures if they were operated; morbidity, recurrence and success ratios, complications after treatment for patients discussed above.

Results: In this study we evaluated 93 patients, 91 females and 2 males, with granulomatous mastitis retrospectively who applied to General Surgery Department of Atatürk University Medical Faculty between January 2001 and December 2010. Mean age was 34.4 years. The diagnosis was confirmed by histopathologic examination of the lesions. Seventy three patients had idiopathic granulomatous lobular mastitis and 20 patients had specific granulomatous mastitis IGM (18 tuberculosis mastitis, 1 alveolar echinococcosis and 1 silk reaction). All the patients had surgical debridement or antibiotic, and anti-inflammatory treatment with results bad clinical response before applied our clinic.

Conclusion: Empiric antibiotic therapy and drainage of the breast lesions are not enough for complete remission of idiopathic granulomatous mastitis. The lesion must be excised completely. In selected patients, corticosteroid therapy can be useful. In the patients with tuberculous mastitis, abscess drainage and antituberculous therapy can be useful, but wide excision must be chosen for the patients with recurrent disease.

Amaç: Atatürk Üniversitesi Tıp Fakültesi genel cerrahi kliniğine başvuran ve granülomatöz mastit tanısı alan hastaların klinik, patolojik ve radyolojik özelliklerini belirlemek ve bu hastaların medikal ve cerrahi tedavi sonuçlarını bildirmektir. Bu sayede tanı yöntemleri ve tedavi algoritması üzerinde kliniğimiz deneyimine göre hareket etmek mümkün olacaktır.

Gereç ve yöntem: Ocak 2001 - Aralık 2010 arasındaki 10 yıllık dönemde histopatolojik olarak granülomatöz mastit tanısı alan 93 olgunun hastane dosyalarına, adres ve telefon kayıtlarına ulaşıldı, dosyaları retrospektif olarak incelendi. Olguların demografik özellikleri yaşları, cinsiyeti, aile hikayesi, şikayetleri, fizik muayene bulguları, radyolojik ve laboratuvar bulguları, medikal tedavisi, ameliyat edilmiş ise ameliyatın şekli, ameliyat sonrası komplikasyonlar, tedavi sonrası morbidite ve nüks oranları not edildi, başarı oranları ve komplikasyonları çıkarıldı.

Bulgular: Çalışma yaşları 20 ile 73 arasında değişmekte olan toplam 93 olgu üzerinde yapıldı. Hastaların 91’i kadın 2’si erkekti. Ortalama yaş 34,4 idi. Hastaların tanısı histopatolojik inceleme ile kondu. İdiopatik granülomatöz mastit tanısı alan 73, tüberküloz mastit tanısı alan 18, Ekinokokus Alveolaris tanısı alan 1 ve yabancı cisim reaksiyonu olan 1 hasta çalışmaya alındı. Tüm olguların ilk müracaatlarında antibiyotik, antiinflamatuar tedavi veya apse drenajı sonucu tedaviye cevap alınamadığı saptandı. Çoğu hasta dış merkezli apse drenajı sonrası nüks şikayeti ile kliniğimize sevk edilmişti.

Sonuç: İdiopatik granülomatöz mastitin tedavisinde apse drenajı ve antibiyotik tedavisi tek başına yeterli değildir. Hastalığın kesin tedavisi için lezyonun geniş olarak veya total eksizyonu gerekmektedir. Seçilmiş hastalarda kortikosteroid tedavisi etkili olmakla birlikte apse, cilde fistül, inatçı yara enfeksiyonlarında cerrahi tedavi yine ilk seçenek olarak düşünülmelidir. Tüberküloz mastit tanısı konan hastalara apse drenajı ve antitüberküloz tedavisi etkili olmakla birlikte nüks eden ve kronikleşen vakalarda cerrahi olarak total eksisyon seçilmelidir.

Keywords: Mastitis; granulomatous mastitis; tuberculosis mastitis.

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Figures

Figure 1.
Figure 1.
Clinical appearance of a patient with IGM including skin ulcerations, abscesses and fistulae.
Figure 2.
Figure 2.
An ill-defined, hypoechoic, heterogeneous 6 cm lesion is seen in the upper-inner quadrant of the left breast on ultrasonography in a patient with TM.
Figure 3.
Figure 3.
A hypoechoic, heterogeneous mass is seen in the left breast on ultrasonography in a patient with IGM.
Figure 4.
Figure 4.
Mediolateral oblique mammographic (Mammomat Inspiration, Siemens, Erlangen, Germany) views showing a 3×4 cm heterogeneous mass with spiculations in a patient with IGM.
Figure 5.
Figure 5.
Craniocaudal mammographic views showing a 3×3 cm ill-defined increased radio opacity within the inferior-medial quadrant of the left breast in a patient with IGM.
Figure 6.
Figure 6.
An ill-defined mass with Type III contrast line on MRI (Magnetom, Skyra; Siemens, Erlangen, Germany) in a patient with IGM.
Figure 7.
Figure 7.
The histopathological examination of the specimen revealed granulomas with central caseation necrosis, epithelioid histiocytes, Langhans’ giant cells and intense lymphocytic infiltration at the periphery of the granulomas in a patient with TM (H&E, ×40).
Figure 8.
Figure 8.
The histopathological examination of the specimen revealed granulomas with histiocytes, Langhans’ giant cells, plasma cells lymphocytes in a patient with IGM (H&E, ×40).
See this image and copyright information in PMC

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