Clinical Characteristics Of 71 Cases Of Granulomatous Mastitis

BackgroundGranulomatous mastitis(GM)is a rare chronic inflammatory disease with the incidence increased year by year.GM can affect females in all age groups,especially women of childbearing age.The onset of GM can be acute or slow,and symptoms are not typical,sometimes only palpable breast lumps but no obvious signs of inflammation.The common clinical manifestations are retraction,breast lumps,nipple discharge and breast abscesses.Some patients only take breast mass as the first diagnostic manifestation.After treatment,the patient’s condition is prone to recurrence.Because of similar clinical and imaging features,sometimes it is difficult to identify GM with breast cancer,leading to misdiagnosis and mistreatment.This makes more than 50% of reportedcases initially misdiagnosed as breast cancer,which may lead to unnecessary mastectomy.This kind of disease can be manifested as irregular hypoechoic or mixed-echoic masses on imaging,which is difficult to differentiate from breast cancer.Percutaneous biopsy is the main diagnostic method.Granulomatous mastitis has no effective specific treatment.At present,the main treatment methods are: antibiotics,glucocorticoids,immunosuppressive agents,surgery and so on.Combination therapy is often needed to achieve good results.The etiology of the disease is still unclear,which may be related to smoking,oral estrogen and progesterone,hyperprolactinemia,autoimmune-related diseases,but no specific pathogenic antigen has been found.This article elaborates the clinical and pathological characteristics and treatment strategies of granulomatous mastitis to give an initial discussion about the issue mentioned above.ObjectiveThe purpose of this study was to analyze the clinical characteristics and risk factors of granulomatous mastitis(GM)by a case-control study.Thecorrelatio-n between the age of onset,the location of the first onset,the level of C-reactive protein,nipple inversion and the history of galactostasis was discussed.Sec-ondly,by describing the clinical characteristics of granulomatous mastitis,inclu-ding examination,treatment methods,etc.So as to provide reference informatio-n for the diagnosis and treatment of patients with granulomatous mastitis.MethodsA total of 71 patients who undergo puncture or surgical pathology confirmed GM were selected from March 2013 to March 2018 at the Department of Breast Surgery,Taian Central Hospital.Inclusion criteria:Clear pathological diagnosis;Female patients;Informed consent of patients.Exclusion criteria:Male patients;Patients with major organ or system dysfunction;Patients with other types of breast diseases;Pathological diagnosis is not clear;Participants refused to participate in this study.In the control group,70 patients with fibroadenoma or breast disease confirmed by pathology were randomly selected as the control group.Specific criteria for grouping and exclusion are listed below.The clinical features,pathological features,examination,treatment and prognosis of71 patients in the case group were analyzed retrospectively.ResultsThe average onset age was 33.10 years in GM group,Most of the chronic mastitis patients were 30 to 39 years old.The first onset site was unilateral.The incidence of right breast was 42.3%(30/71),left breast was 54.9%(39/71),and bilateral breast was 2.8%.In the case group,71.8%(51/71)of the cases were complicated with inverted nipples.In the control group,3 cases were congenital inverted nipples,accounting for 4.3%(3/70)of the control group.GM patients have a higher incidence of congenital inverted nipples.In the GM group,42.3%(30/71)patients had a history of galactostasis,which was significantly different from the control group.In the case group,CRP of 27 patients was higher than the normal value,accounting for 38.0%(27/71).The main clinical manifestations of granulomatous mastitis include nipple discharge,nipple inversion,breast mass,breast pain,local redness,abscess,and fistula formation.Ultrasonography often indicates hypoechoic,mixed or patchy hypoechoic masses,which are sometimes difficult to differentiate from breast cancer.Pathological diagnosis is the golden standard for the diagnosis of the disease.We collected specimens from 18 patients for bacterial culture.The results showed that 4 patients had Gram-positive bacteria,including 3 Corynebacterium and 1 Listeria Grignardii.The bacterial cultures of 5cases were Gram-positive cocci,2 cases were Staphylococcus aureus and the other 2 cases were Staphylococcus epidermidis.Treatment methods include antibiotics,glucocorticoids,immunosuppressive agents,surgery and so on.Combination therapy is often needed toachieve good results.ConclusionsGranulomatous mastitis is a rare breast disease,and its etiological mechanism is still unclear.The clinical characteristics of granulomatous mastitis differ from other breast diseases in domestic women,which are predilection of left breast,inverted nipple,history of galactostasis and elevated C-reactive protein level.The clinical manifestations are accompanied by breast mass and local skin swelling and pain.The possibility of this disease should be considered.Ultrasound,mammography and mammography can be used as auxiliary examinations for the diagnosis of the disease,but pathological diagnosis is stillneeded.Current treatment options include antimicrobial and/or immunomodulatory(steroidal)models and surgical treatment of granulomatous breast disease.The treatment plan should consider the patient’s clinical manifestation,tolerance and personal will,and make individual choice.