İdiopatik granulomatöz mastit: Zor tanı ve yönetim

Amaç: İdiopatik granulomatöz mastit (İGM) nadir bir enflamatuar hastalıktır. Etyolojisi müphem olduğundan tanısı ve tedavisi zordur. İGM yönetimi kapsamlı bir değerlendirmeyi gerektirir; tedavi yöntemini standardize etmek ve optimal olanı belirlemek de zordur. Bu çalışmada İGM nedeniyle tedavi edilen hastalarda klinik ve radyolojik bulgular, tedavi yaklaşımı, klinik seyir ve nüks oranının irdelenmesi amaçlanmıştır. Yöntemler: Çalışmamızda Temmuz 2003 ile Aralık 2015 arasında histopatolojik İGM tanısı konulan hastalarda tıbbi raporlar, ultrasonografi (USG) ve mamografi (MMG) bulguları, klinik seyir ve nüks oranları tıbbi kayıtlardan retrospektif elde edildi. Bulgular: Tüm hastalarda ağrılı, sert ve düzensiz kitle ortak bulgu idi. Parenkim heterojenitesi, apse ve kitle görünümü USG bulguları iken; asimetrik yoğunluk MMG'nin ana bulgusu idi. Yirmiüç (%63,8) hastada geniş lokal eksizyon yapılırken 13 (%36) hastada insizyonel biyopsi ve apse drenajı yapılmış idi. Sonuç: Granulomatöz mastitte fizik muayene bulguları meme karsinomu ile örtüşmektedir. USG parankim heterojenitesi ve apse oluşumu ile birlikte özellikle büyümüş aksiller lenf nodülünün bulunması enflamatuar sürecin varlığını destekler. Ancak bu bulgular karsinomu ekarte etmez. Bu nedenle maligniteyi gözden kaçırmamak için histopatolojik tanı çalışması kaçınılmazdır. İGM tedavisinde genişletilmiş eksizyon rol oynayabilir.

İdiopathic granulomatous mastitis: A Hard Disease to Diagnose and Manage

Objective: Idiopathic granulomatous mastitis (IGM) is an infrequent chronic inflammatory condition of breast. It is hard to diagnose and treat due to its unusual aetiology and pathogenesis. The goal of this study is to assess the clinical and radiological findings, type of treatment approaches, clinical outcome, and recurence in patients treated with IGM. Methods: We included the patients diagnosed with IGM histopathologically between July 2003 and October 2015. Ultrasonography (US) and mammography (MMG) results, follow-up and recurrence data, and medical outcome data were gained from patients' records. Results: The symptom that is common in all patients was an irregular, firm, and painful mass. Main USG findings were abscess and mass formation, and parenchymal heterogeneity, while main MMG finding was an increase in asymmetric density. As surgical technique, wide local excision was performed in 23 (63.8%) patients, and incisional biopsy with abscess drainage in 13(36%) patients. Conclusions: IGM often poses a diagnostic dilemma by mimicking malignancy. While USG finding of parenchymal heterogeneity, abscess formation with axillary lymphadenomegaly support the diagnosis of inflammation, these findings do not necessarily exclude carcinoma. Hence, histopathologic verification is obligatory to provide a certain diagnosis. Extensive surgery may play a role in treatment of IGM.

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