Background: Idiopathic granulomatous mastitis (IGM) is a
benign inflammatory lesion of the mammary gland. Globally, it poses a major
diagnostic and therapeutic problem. The optimal treatment for IGM remains
unclear. As reported by previous studies, surgery, steroids, and observation
are the primary treatment strategies for IGM. To date, there is no universally
accepted treatment for this condition. Many treatment modalities have been
attempted, from conservative therapy to mastectomy, but none of them has shown
satisfactory results. Recent studies have shown promising results of corticosteroids
on idiopathic granulomatous mastitis, so steroid therapy can be an effective
treatment for idiopathic granulomatous mastitis.
Aim: The aim of the study is to provide a therapeutic
strategy in the future for idiopathic granulomatous mastitis.
Methods: This is a prospective and descriptive type of
observational study that was performed on 70 patients with idiopathic
granulomatous mastitis confirmed histologically by core needle or incisional
biopsy at the general surgery unit of Chittagong Medical College Hospital and a
few renowned private hospitals in the Chittagong Metropolitan City during
October 2016 to September 2017. After diagnosis, oral prednisolone (1mg/kg/day)
was given and the cases were observed by personal interview and through telephone
interview. The patients were on follow-up for 06 months. Age, size of the
breast lump, breast pain, nipple discharge, and skin changes were recorded in
all cases. Results were analysed using mean, percentage, and proportion as
appropriate.
Results: The mean age was 26.35±13.5 years, ranging from 19
to 40 years. Out of 70 patients, Core cut biopsy was done in 55 patients
(78.58%), and incisional biopsy with abscess drainage was performed in 15
patients (21.42%). 59 patients (84.28%) had complete recovery after a single
cycle of steroid treatment; the remaining 11 patients (15.72%) had recurrence;
among them, 6 patients were cured after the 2nd cycle of steroids, but
unfortunately, 5 patients did not respond. Though complications were found in
50 patients, all of them made good progress in the short term.
Conclusion: We recommend steroid therapy as the first-line
treatment in our study. However, prospective, randomised clinical trials are
needed to determine the treatment algorithm. Treatment of IGM with prednisolone
can be the first choice as it is a noninvasive method of treatment. However,
further studies with a greater number of patients are needed to formulate
reasonable treatment algorithms for a successful outcome. Recurrent cases can
be trialled with further cycles of prednisolone.
Author(s) Details
T. H. Khan
Chittagong Medical College Hospital, Chattogram, Bangladesh.
S. Huq
Department of Surgery, Chittagong Medical College Hospital, Chattogram,
Bangladesh.
S. M. M. H. Chowdhury
Department of Vascular Surgery, Chittagong Medical College Hospital,
Chattogram, Bangladesh.
T. Benzir
Department of Burn & Plastic Surgery, Chittagong Medical College
Hospital, Chattogram, Bangladesh.
A. A. Maruf
Department of Hepatobiliary Surgery, Chittagong Medical College Hospital,
Chattogram, Bangladesh.
F. Mostafa
Department of Surgical Oncology, Chittagong Medical College Hospital,
Chattogram, Bangladesh.
S. A. Haque
Department of Thoracic Surgery, Dhaka Medical College Hospital, Dhaka,
Bangladesh.
Please see the book here :- https://doi.org/10.9734/bpi/aodhr/v10/7089
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