RESEARCH ARTICLE/ARAŞTIRMA YAZISI 203 The Journal of Breast Health 2011 Vol: 7 • No: 4 Meme Sağlığı Dergisi 2011 Cilt: 7 • Sayı: 4 IDIOPATHIC GRANULOMATOUS MASTITIS Can Atalay 1 , Gamze Kızıltan 1 , Cihangir Özaslan 1 , Işın Pak 2 1 Department of General Surgery, Ankara Oncology Hospital, Ankara, Turkey 2 Department of Pathology, Ankara Oncology Hospital, Ankara, Turkey ABSTRACT Purpose: Idiopathic granulomatous mastitis is a rare, benign breast disease of unknown etiology characterized by chronic inflammation. Distinguishing it from either breast carcinoma or infections both clinically and radiologically can be difficult. The purpose of this study is to review the characteristics of idiopathic granulomatous mastitis in a large series of patients and to evaluate the effectiveness of the treatment methods during a long follow up period. Patients and Methods: Patients treated with the diagnosis of idiopathic granulomatous mastitis between 2005 and 2009 were included in the study. Patients’ clinical, radiological, and histopathological findings were retrospec- tively obtained from the files. Results: Fifty-one female patients with a median age of 33 were included. All pa- tients had a history of childbirth and breastfeeding. Forty-five patients (88.2%) were premenopausal. The main clinical feature was a mass in the breast in all patients and clinical findings suggesting an infection accompanied the mass in seven patients (13.7%). Surgery was the definitive procedure in all patients. Wide local excision was the treatment of choice in 50 patients (98%) whereas modified radical mastectomy was performed in one patient. Median follow- up time was 38 months and three patients (5.9%) presented with recurrence. One patient recurred twice and total mastectomy with reconstruction was per- formed. Two other patients were treated with further wide local excisions. Conclusion: Surgeons, radiologists, and pathologists should be familiar with idiopathic granulomatous mastitis and multiple assessments including clini- cal, radiological, and histopathological examinations are required for an accu- rate diagnosis. Long-term follow-up preferably by the same doctors is neces- sary for the management of such a difficult disease. Key words: breast, granulomatous mastitis, surgery Gönderilme Tarihi: 11 Nisan 2011 „ Revizyon Tarihi: 11 Mayıs 2011 „ Kabul Tarihi: 10 Haziran 2011 İDİYOPATİK GRANULOMATÖZ MASTİT ÖZET Amaç: İdiyopatik granulomatöz mastit, kronik inflamasyonla seyreden, et- yolojisi bilinmeyen, nadir görülen, benign bir meme hastalığıdır. Klinik ve radyolojik olarak hem meme kanserinden hem de meme enfeksiyonlarından ayırt etmek zor olabilir. Bu çalışmanın amacı, idiyopatik granulomatöz mas- titin özelliklerini geniş bir hasta serisinde gözden geçirmek ve uzun bir takip süresinde tedavi yöntemlerinin etkinliğini değerlendirmektir. Hastalar ve Yöntem: İdiyopatik granulomatöz mastit tanısıyla 2005 – 2009 yıl- ları arasında tedavi edilen hastalar çalışmaya alındı. Hastaların klinik, radyo- lojik ve histopatolojik özellikleri retrospektif olarak dosyalarından elde edildi. Bulgular: Ortanca yaşı 33 olan 51 hasta çalışmaya alındı. Hastaların tümünde doğum ve emzirme öyküsü mevcuttu ve 45 hasta (%88.2) premenopozaldi. Hastaların tümündeki ana klinik bulgu memede mevcut kitleydi ve enfeksi- yonu düşündüren klinik bulgular 7 hastada (%13.7) kitleye eşlik etmektey- di. Hastaların tamamına cerrahi uygulandı. Geniş lokal eksizyon 50 hastada (%98) tercih edilen tedavi yöntemiyken modifiye radikal mastektomi bir hastada uygulandı. Ortanca takip süresi 38 aydı ve üç hastada (%5.9) nüks saptandı. Bu hastalardan birisi iki kez nüksetti ve total mastektomi ve rekons- trüksiyon uygulandı. Diğer iki hasta ise yeniden geniş lokal eksizyonla tedavi edildi. Sonuç: Cerrahlar, radyologlar ve patologlar, idiyopatik granulomatöz mastiti daha yakından tanımalıdır ve doğru tanı için klinik, radyolojik ve histopato- lojik olarak tekrarlayan değerlendirmeler gereklidir. Tercihan aynı hekimler tarafından yapılan uzun süreli takip bu zor hastalığın tedavisi için gereklidir. Anahtar sözcükler: meme, granulomatöz mastit, cerrahi Introduction Idiopathic granulomatous mastitis (IGM) is a rare, benign breast disease of unknown etiology characterized by chronic inflamma- tion. Kessler and Wolloch described IGM for the first time in 1972 (1). Until today, around 300 cases have been reported with only a few small series of patients (2). Almost all of the previously report- ed patient series included less than 25 patients (3-9). Similarly, patients with IGM were reported from national cancer centres (10). The main reason for the rarity of this disease could possibly be the difficulty in distinguishing IGM from either breast carci- noma or infections both clinically and radiologically. Reported pretreatment diagnosis of malignancy is 51% in IGM (2). Even after histopathological evaluation, IGM may be underdiagnosed due to its resemblance to carcinoma in some cases. In addition, Sunulduğu Kongre: X. Ulusal Meme Hastalıkları Kongresi, 30 Eylül-4 Ekim 2009, Çeşme, İzmir.