ObjectiveTo summarize the clinical characteristics of idiopathic granulomatous mastitis (IGM) and its experiences of diagnosis and treatment. MethodThe clinical data of 33 patients with IGM from January 2005 to December 2014 were analyzed retrospectively. ResultsThe mean age of the patients was 33 years. The pathological examination showed that 28 patients (85%) were typical granuloma, and 5 patients (15%) were immature granuloma, whom were confirmed after exclusion of other pathogens. Twenty-nine patients were received drugs treatment, among which 21 patients were cured by taking prednisone orally, 6 patients were cured by the combination of prednisone and methotrexate, 2 patients failed to be cured, and 13 patients relapsed after stopping taking medicine. Four patients with abscess ulceration were received surgical treatment, and 2 patients relapsed after the surgery. Fifteen recurrent patients all were took prednisone and methotrexate orally, among which 1 patient stopped taking medicine because of liver function damage, 1 patient was not fully relieved, and other 13 patients were cured again. ConclusionsThe clinical manifestations of IGM have no specificities. The diagnosis mainly relies on pathological examination. In the early phase of this disease, the treatment method of steroid or combined immunosuppressant has good effects. In case of ulceration and protracted course, surgical treatment should be considered as early as possible.
Granulomatous lobular mastitis (GLM) is a rare mastitis disease, which mainly occurs in childbearing period. The etiology, diagnosis and treatment of GLM are still disputed. In recent years, the role of Corynebacterium infection in the pathogenesis of GLM has attracted more and more attention. Cystic neutrophilic granulomatous mastitis (CNGM) has been proposed, and more and more studies have targeted CNGM as a unique subtype of GLM. This article summarizes the published literature on CNGM so far to discuss the research progress in clinicopathological features, microbiological findings, clinical diagnosis and treatment of CNGM.
ObjectiveTo construct a prediction model for the postoperative recurrence risk of granulomatous lobular mastitis (GLM) based on multiple systemic inflammatory indicators and clinicopathologic characteristics, with the aim of guiding clinical treatment. MethodsThe GLM patients who underwent lesion resection at Sichuan Provincial Maternal and Child Health Hospital from January 2017 to March 2024 were retrospectively collected. The univariate and multivariate logistic regression analyses were used to screen the risk factors for recurrence after GLM lesion resection, and a nomogram prediction model was constructed based on the risk factors. The test level was set at α=0.05. ResultsA total of 533 patients with GLM were included in this study, and 118 cases (22.1%) developed postoperative recurrence. The results of multivariate analysis showed that the no taking oral bromocriptine, having microabscess formation in postoperative pathological examination results, systemic immune inflammation index (SII) >789.0×109/L, and immunoglobulin E (IgE) >64.4 U/mL were the independent risk factors for recurrence after GML. Based on this, the nomogram predicting recurrence risk was constructed. The area under the receiver operating characteristic curve (95%CI) was 0.913 (0.895, 0.932), and its sensitivity and specificity were 90.5% and 88.9%, respectively. The calibration curve showed that the probability of recurrence after GML predicted by using the nomogram was highly consistent with the actual occurrence probability. The decision curve analysis showed that the nomogram had a good clinical net benefit. ConclusionsThe results of this study suggest that no taking bromocriptine orally, having microabscess formation in postoperative pathological examination results, SII, and IgE are risk factors for recurrence in GLM patients undergoing lesion resection. The nomogram model for predicting postoperative recurrence of GLM constructed based on these risks has good efficacy and provides a reference for the early treatment and management of GLM.