2011, Number 06
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Ginecol Obstet Mex 2011; 79 (06)
Idiopathic granulomatous mastitis treated with steroids and methotrexate
Peña-Santos G, Ruiz-Moreno JL
Language: Spanish
References: 13
Page: 373-376
PDF size: 317.03 Kb.
ABSTRACT
Idiopathic granulomatous mastitis is a rare inflammatory breast disease of unknown etiology. It manifests as breast mass of 6 cm on average (range 2-10 cm), often in upper outer quadrant of left breast, in another quadrant, right or bilateral breast. Clinical diagnosis by ultrasound or mammography and fine needle aspiration confuses with carcinoma; histopathology (gold standard) confirm the diagnosis after ruling out causes of granulomatous inflammation, mainly tuberculosis. Steroid treatment achieve complete remission, but adverse reactions and relapses after the descent and suspension. Methotrexate or azathioprine is added from the start to maintain remission. We report three cases of idiopathic granulomatous mastitis diagnosis and treatment based on prednisone until clinical improvement and methotrexate as maintenance therapy. Complete remission was obtained in three patients. The rheumatologist knows and handles autoimmune/ inflammatory with these drugs, therefore, is suggested the multidisciplinary treatment of this disease with oncologists and gynecologists.
REFERENCES
Aguirre-González EH, Verduzco-Rodríguez L, Palet-Guzmán J A. Mastitis granulomatosa. Informe de 16 casos. Ginecol Obstet Mex 1999;67:509-511.
Al Nazer MA. Idiopathic granulomatous lobular mastitis. A forgotten clinical diagnosis. Saudi Med J 2003;24(12):1377-1380.
Azlina AF, Ariza Z, Arni T, Hisham AN. Chronic Granulomatous Mastitis: Diagnostic and Therapeutic Considerations. World J Surg 2003;27:515-518.
Bani-Hani KE, Yaghan RJ, Matalka II, Shatnawi NJ. Idiopathic Granulomatous Mastitis: Time to Avoid Unnecessary Mastectomies. Breast J 2004;10(4):318-322.
Lester SC. Differential Diagnosis of Granulomatous Mastitis. Breast J 2005;11(6):534-535.
Kesller E, Wolloch Y. Granulomatous mastitis: a lesion clinically simulating carcinoma. Am J Clin Pathol 1972;58:642-646.
Schelfout K, Tjalma WA, Cooremas ID, Coeman DC, Colpaert CG, Buytaert PM. Observations of an idiopathic granulomatous mastitis. Eur J Obstet Gynecol Reprod Biol 2001;97:260-262.
Su FH, Liu SC, Suen JH, Chen DS, Sister Mary Ann Lou. Idiopathic Granulomatous Mastitis: A Case Successfully Treated with a Minimum Dose of a Steroid. Chang Gung Med J 2005;28(6):431-435.
Pérez PJA, Carpio PD, Gac EP. Mastitis Granulomatosa Idiopática. Rev Chilena de Cirugía 2002;54(4):392-395.
Raj N, Macmillan RD, Ellis IO, Deighton CM. Rheumatologists and breasts: immunosuppressive therapy for granulomatous mastitis. Rheumatology 2004;43(8):1056-1057.
Lai EC, Chan WC, Ma TK, Tang AP, Poon CS, Leong HT. The Role of Conservative Treatment in Idiopathic Granulomatous Mastitis. Breast J 2005;11(6):454- 456.