İdiyopatik Granülomatöz Mastit
Özet
İdiyopatik granülomatöz mastit (IGM), sıklıkla mikroapselerin eşlik ettiği nonkazeifiye granülomlarla karakterize, meme kanserini taklit eden nadir ve benign inflamatuar bir meme hastalığıdır. Genellikle doğurganlık çağındaki ve yakın zamanda doğum/emzirme öyküsü olan kadınlarda görülür. Etiyolojisi tam olarak bilinmemekle birlikte hormonal dengesizlikler, otoimmünite, mikrobiyal ajanlar ve sigara kullanımı gibi faktörlerin rol oynadığı düşünülmektedir. En sık klinik bulgusu ağrılı, palpe edilebilen kitle ve eritamatöz cilt değişiklikleridir. Tanı aşamasında ultrasonografi, mamografi ve MRG gibi radyolojik yöntemlerden yararlanılsa da kesin tanı için altın standart, invaziv meme kanserini ekarte etmeyi sağlayan tru-cut biyopsisidir. Ayırıcı tanıda tüberküloz mastit ve duktus ektazisi gibi hastalıklar elenmelidir. IGM'nin optimal tedavisi hakkında fikir birliği olmasa da tedavi yaklaşımları arasında yakın takip, kortikosteroidler, immünosupresif ajanlar (metotreksat, azatiyoprin), sınırlı antibiyoterapi ve seçilmiş vakalarda komplet cerrahi eksizyon yer almaktadır. Hastalığın yönetiminde nüks riskini ve komplikasyonları azaltmak adına multidisipliner bir yaklaşım benimsenmelidir.
Idiopathic granulomatous mastitis (IGM) is a rare, benign inflammatory breast disease characterized by non-caseating granulomas often accompanied by microabscesses, mimicking breast carcinoma. It typically occurs in childbearing-aged women with a recent history of childbirth and breastfeeding. Although its etiology remains unknown, factors such as hormonal imbalances, autoimmunity, microbial agents, and smoking are thought to play a role. The most common clinical findings are a painful, palpable mass and erythematous skin changes. While radiological methods like ultrasonography, mammography, and MRI are utilized during the diagnosis phase, the gold standard for definitive diagnosis is tru-cut biopsy, which allows for the exclusion of invasive breast cancer. In differential diagnosis, conditions like tuberculous mastitis and duct ectasia must be ruled out. There is no consensus on the optimal treatment of IGM; however, therapeutic approaches include close observation, corticosteroids, immunosuppressive agents (methotrexate, azathioprine), limited antibiotic therapy, and complete surgical excision in selected cases. A multidisciplinary approach must be adopted in the management of the disease to reduce the risk of recurrence and complications.
Referanslar
Alsaleh N. Assertive clinical practice in managing patients with idiopathic granulomatous mastitis: Review of literature. Ann Med Surg (Lond). 2021;70:102792. Published 2021 Sep 11. doi:10.1016/j.amsu.2021.102792
Centers for Disease Control and Prevention (CDC). Idiopathic granulomatous mastitis in Hispanic women - Indiana, 2006-2008. MMWR Morb Mortal Wkly Rep. 2009;58(47):1317-1321.
Kessler E, Wolloch Y. Granulomatous mastitis: a lesion clinically simulating carcinoma. Am J Clin Pathol. 1972;58(6):642-646. doi:10.1093/ajcp/58.6.642
Altintoprak F, Kivilcim T, Ozkan OV. Aetiology of idiopathic granulomatous mastitis. World J Clin Cases. 2014;2(12):852-858. doi:10.12998/wjcc.v2.i12.852
Koksal H. Human leukocyte antigens class I and II in patients with idiopathic granulomatous mastitis. Am J Surg. 2019;218(3):605-608. doi:10.1016/j.amjsurg.2019.01.038
Schelfout K, Tjalma WA, Cooremans ID, Coeman DC, Colpaert CG, Buytaert PM. Observations of an idiopathic granulomatous mastitis. Eur J Obstet Gynecol Reprod Biol. 2001;97(2):260-262. doi:10.1016/s0301-2115(00)00546-7
Gautier N, Lalonde L, Tran-Thanh D, et al. Chronic granulomatous mastitis: Imaging, pathology and management. Eur J Radiol. 2013;82(4):e165-e175. doi:10.1016/j.ejrad.2012.11.010
Maione C, Palumbo VD, Maffongelli A, et al. Diagnostic techniques and multidisciplinary approach in idiopathic granulomatous mastitis: a revision of the literature. Acta Biomed. 2019;90(1):11-15. Published 2019 Jan 23. doi:10.23750/abm.v90i1.6607
Hovanessian Larsen LJ, Peyvandi B, Klipfel N, Grant E, Iyengar G. Granulomatous lobular mastitis: imaging, diagnosis, and treatment. AJR Am J Roentgenol. 2009;193(2):574-581. doi:10.2214/AJR.08.1528
Al-Khawari HA, Al-Manfouhi HA, Madda JP, Kovacs A, Sheikh M, Roberts O. Radiologic features of granulomatous mastitis. Breast J. 2011;17(6):645-650. doi:10.1111/j.1524-4741.2011.01154.x
Benson JR, Dumitru D. Idiopathic granulomatous mastitis: presentation, investigation and management. Future Oncol. 2016;12(11):1381-1394. doi:10.2217/fon-2015-0038
Wolfrum A, Kümmel S, Theuerkauf I, Pelz E, Reinisch M. Granulomatous Mastitis: A Therapeutic and Diagnostic Challenge. Breast Care (Basel). 2018;13(6):413-418. doi:10.1159/000495146
Zhou F, Yu LX, Ma ZB, Yu ZG. Granulomatous lobular mastitis. Chronic Dis Transl Med. 2016;2(1):17-21. Published 2016 Apr 22. doi:10.1016/j.cdtm.2016.02.004
Baslaim, M.M., Khayat, H.A. & Al-Amoudi, S.A. Idiopathic Granulomatous Mastitis: A Heterogeneous Disease with Variable Clinical Presentation. World J Surg 31, 1677–1681 (2007). https://doi.org/10.1007/s00268-007-9116-1
Asoglu O, Ozmen V, Karanlik H, et al. Feasibility of surgical management in patients with granulomatous mastitis. Breast J. 2005;11(2):108-114. doi:10.1111/j.1075-122X.2005.21576.x
Tse GM, Poon CS, Ramachandram K, et al. Granulomatous mastitis: a clinicopathological review of 26 cases. Pathology. 2004;36(3):254-257. doi:10.1080/00313020410001692602
Ocal K, Dag A, Turkmenoglu O, Kara T, Seyit H, Konca K. Granulomatous mastitis: clinical, pathological features, and management. Breast J. 2010;16(2):176-182. doi:10.1111/j.1524-4741.2009.00879.x
Lacambra M, Thai TA, Lam CC, et al. Granulomatous mastitis: the histological differentials. J Clin Pathol. 2011;64(5):405-411. doi:10.1136/jcp.2011.089565
Pereira FA, Mudgil AV, Macias ES, Karsif K. Idiopathic granulomatous lobular mastitis. Int J Dermatol. 2012;51(2):142-151. doi:10.1111/j.1365-4632.2011.05168.x
Ammari FF, Yaghan RJ, Omari AK. Periductal mastitis. Clinical characteristics and outcome. Saudi Med J. 2002;23(7):819-822.
DeHertogh DA, Rossof AH, Harris AA, Economou SG. Prednisone management of granulomatous mastitis. N Engl J Med. 1980;303(14):799-800. doi:10.1056/NEJM198010023031406
