Staged operation in the surgical treatment of granulomatous lobular mastitis
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PROVIDER: S-EPMC10915423 | biostudies-literature | 2024 Feb
REPOSITORIES: biostudies-literature
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Project description:Background:The etiology and pathogenesis of granulomatous lobular mastitis (GLM) remain unknown, with no unified evaluation criteria or standard treatments. This study aimed to assess the etiology and features of GLM, as well as the effects of surgery (lesion excision + stage I breast reconstruction; LE + BR) for GLM. Methods:This study evaluated 178 female GLM patients retrospectively in 2006-2015. The surgery and non-surgery groups included 164 and 14 patients, respectively. All patients received conservative therapy (traditional Chinese medicine combined with regional wet compress and pus drainage). In addition, the surgery group (n=164) underwent LE + BR. Clinical data, including disease course, causes, lesion size, marital status, and treatment approaches, were assessed. Results:Follow-up was 13-117 months. Seventy-five of the 178 patients had no overt causes (42.1%); meanwhile, 63 (35.4%) and 16 (9.0%) had congenital nipple retraction and a history of psychotropic drugs for >1 year, respectively. The surgery group showed lesions significantly shrunk (?1 quadrant) with acute inflammation fully controlled; 8 showed recurrence, indicating a cure rate of 95.1% (156/164). In the non-surgery group, 4 cases showed relapse after 6-14 months (cure rate =71.4%; 10/14). Therefore, surgical treatment was significantly more efficient than non-surgical treatment (P=0.001). Kaplan-Meier survival curves for the two treatment types showed a significant difference in recurrence (log rank =11.84, P<0.001). Conclusions:In GLM patients, LE + BR is safe and effective with respect to cosmetic results, recovery time, and recurrence. Successful surgery should be performed for patients whose lesions ?1 quadrant, aim to achieve optimal GLM treatment.
| S-EPMC6989911 | biostudies-literature
Project description:Background and Objective Non-puerperal mastitis (NPM) is a breast disease with poor clinical manifestations, which seriously affects women’s health and quality of life. Due to the low incidence rate of the disease and the paucity of related research, there is much misdiagnosis and mis-management of periductal mastitis (PDM) and granulomatous lobular mastitis (GLM). Therefore, understanding the differences between PDM and GLM, in terms of etiology and clinical manifestations, is crucial for patient treatment and prognosis. At the same time, choosing different treatment methods may not achieve the best treatment effect, so the appropriate treatment method can often reduce the patient’s pain and reduce the recurrence of the patient’s disease. Methods The PubMed database was searched for articles published from 1 January 1990 to 16 June 2022 using the following search terms: “non-puerperal mastitis”, “periductal mastitis”, “granulomatous lobular mastitis”, “mammary duct ectasia”, “idiopathic granulomatous mastitis”, “plasma cell mastitis”, and “identification”. The key findings of the related literatures were analyzed and summarized. Key Content and Findings We systematically described the key points in the differential diagnosis, treatment, and prognosis of PDM and GLM. The use of different animal models for research and novel drugs to treat the disease were also described in this paper. Conclusions The key points in the differentiation of the two diseases are clearly explained, and the respective treatment options and prognosis are summarized.
| S-EPMC9951018 | biostudies-literature
Project description:Granulomatous lobular mastitis (GLM) is a chronic inflammatory breast condition that is characterized by granulomatous inflammation. GLM remains a refractory disease due to its failure to respond to routine anti-inflammatory therapies and its high recurrence rate. Thus, the present study aimed to investigate the application of local heat therapy in GLM as a potential therapeutic strategy. The results revealed that the application of local heat therapy was associated with a shortened remission time for GLM, while the remission and recurrence rates were similar to those of existing therapies. The median first remission time following local heat therapy was significantly decreased compared with that following corticosteroid therapy (5.30 months vs. 11.27 months; P<0.05). The remission rates were not significantly different between the local heat therapy (76.9%), extensive excision (90.4%) and the corticosteroid therapy (85.7%) groups (P>0.05). In addition, the recurrence rates were not statistically different between the groups (local heat therapy, 8.3%; extensive excision, 10%; and corticosteroid therapy, 10%; P>0.05). The local heat therapy showed mild adverse effects and shortened healing times compared to the other therapies; however, further confirmation is required.
| S-EPMC8393844 | biostudies-literature
Project description:This study describes a rare case of male granulomatous lobular mastitis (GLM) with recurrence in different sites on the ipsilateral side. A 48-year-old male patient presented with no previous history of breast-related disease, and physical examination suggested a mass in the right breast. Ultrasonography revealed a cyst and infection in the right breast. No obvious abnormality was found in laboratory analysis, and a core needle biopsy revealed GLM. Incision and drainage were applied to the right lesion, and symptoms resolved within a few weeks. At 2 years following this initial presentation, the patient reported that the right breast mass reappeared in different locations after the consumption of alcohol. Relevant examination and a core needle biopsy again suggested GLM of the right breast. The patient declined hormone therapy and was subsequently lost to follow-up. After reviewing this case, the course of the disease in this patient, and the connection between gynecomastia and GLM, along with ipsilateral recurrence, are under investigation.
| S-EPMC10392419 | biostudies-literature
Project description:Granulomatous lobular mastitis (GLM) is a rare and chronic benign inflammatory disease of the breast. Difficulties exist in the management of GLM for many front-line surgeons and medical specialists who care for patients with inflammatory disorders of the breast. This consensus is summarized to establish evidence-based recommendations for the management of GLM. Literature was reviewed using PubMed from January 1, 1971 to July 31, 2020. Sixty-six international experienced multidisciplinary experts from 11 countries or regions were invited to review the evidence. Levels of evidence were determined using the American College of Physicians grading system, and recommendations were discussed until consensus. Experts discussed and concluded 30 recommendations on historical definitions, etiology and predisposing factors, diagnosis criteria, treatment, clinical stages, relapse and recurrence of GLM. GLM was recommended as a widely accepted definition. In addition, this consensus introduced a new clinical stages and management algorithm for GLM to provide individual treatment strategies. In conclusion, diagnosis of GLM depends on a combination of history, clinical manifestations, imaging examinations, laboratory examinations and pathology. The approach to treatment of GLM should be applied according to the different clinical stage of GLM. This evidence-based consensus would be valuable to assist front-line surgeons and medical specialists in the optimal management of GLM.
| S-EPMC9040252 | biostudies-literature
Project description:Purpose:analysing the differential expression of miRNAs in tissue between GLM patients and healthy controls, provide a comprehensive differential expression profile of miRNAs, screen out possible biomarkers, and elucidate post-transcriptional regulation from the whole level.Methods: The expression profile of miRNAs was measured here by high-throughput sequencing in tissue of GLM patients and healthy controls. Significantly differentially expressed miRNAs were screened by threshold setting and cluster analysis, and their target genes were analysed by gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes(KEGG) enrichment.Results: a total of 31,077 miRNAs were predicted by high-throughput sequencing.Under the condition of threshold ∣log2 fold change (log2FC)|>2.5, qvalue<0.001, 13 miRNAs that were expected to be GLM biomarkers were sreened out. The expression of 13 miRNAs in the GLM group were higher than in the control group, as follows: hsa-miR-106a-5p, hsa-miR-155-5p, hsa-miR-20b-5p, hsa-miR-223-5p, hsa-miR-3916, hsa-miR-4433a-3p, hsa-miR-4433b-5p, hsa-miR-451a, hsa-miR-4659a-3p, hsa-miR-4802-3p, hsa-miR-5571-3p, hsa-miR-624-5p, and hsa-miR-942-3p. Cell and biological process were the most significantly enriched GO term and KEGG pathway.Conclusions: This is the first report detailing genome-wide miRNA profiling of GLM, and the possible targets and pathways of GLM were analysed from bioinformatic analysis. This study finds that 13 significantly differential expressed miRNAs may have important theoretical significance and potential application value and need subsequent large-sample clinical trials for further validation.
2025-02-19 | GSE197083 | GEO
Project description:ObjectiveThis network meta-analysis aims to evaluate the recurrence rates of various treatment options for granulomatous lobular mastitis.MethodsWe systematically searched and identified eligible studies in PubMed, EMBASE, Cochrane Library, and Web of Science databases until September 30, 2023. Original studies reporting the recurrence rates of various treatments were included. Subsequently, literature screening, data extraction, and network meta-analysis were conducted. This study was registered with PROSPERO (registration number CRD 42023434773).ResultsNineteen articles involving 1,095 patients were included in this study. The network meta-analysis revealed that several treatment combinations reduced the recurrence rate compared to observation: Surgery + Local steroid injection + Systemic steroids therapy (OR: 0.23, 95% CI 0.01 to 4.53), Local steroid injection (OR: 0.34, 95% CI 0.02 to 6.81), Surgery + Systemic steroids therapy (OR: 0.36, 95% CI 0.02 to 5.29), Surgery + Traditional Chinese Medicine (OR: 0.33, 95% CI 0.01 to 9.11), Systemic steroids therapy + MTX (OR: 0.62, 95% CI 0.01 to 34.59), and Systemic steroids therapy + drainage (OR: 0.76, 95% CI 0.05 to 10.67). Among these, Surgery + Local steroid injection + Systemic steroids therapy demonstrated superior efficacy. The surface under cumulative ranking curve (SUCRA) values were highest for Surgery + Local steroid injection + Systemic steroids therapy (0.85), followed by Local steroid injection (0.78) and Surgery + Systemic steroids therapy (0.77).ConclusionsSteroid-based combination therapy may be the first choice for IGM patients, with a comprehensive strategy of local and systemic steroids combined with surgery having the best effect on IGM.
| S-EPMC11790104 | biostudies-literature
Project description:Granulomatous lobular mastitis (GLM) is a chronic idiopathic granulomatous mastitis of the mammary gland characterized by significant pain and a high propensity for recurrence, the incidence rate has gradually increased, and has become a serious breast disease that should not be ignored. GLM is highly suspected relative to microbial infections, especially those of Corynebacterium species; however, the mechanisms involved are unclear, and prevention and treatment are difficult. In this study, we demonstrated the pathogenicity of Corynebacterium parakroppenstedtii in GLM using Koch's postulates. Based on the drug sensitization results of C. parakroppenstedtii, and utilizing a retrospective study in conjunction with a comprehensive literature review, we suggested an efficacious, targeted antibiotic treatment strategy for GLM. Subsequently, we identified the pathogenic factor as a new type of glycolipid (named corynekropbactins) secreted by C. parakroppenstedtii. Corynekropbactins may chelate iron, cause the death of mammary cells and other mammary -gland-colonizing bacteria, and increase the levels of inflammatory cytokines. We further analyzed the prevalence of C. parakroppenstedtii infection in patients with GLM. Finally, we suggested that the lipophilicity of C. parakroppenstedtii may be associated with its infection route and proposed a possible model for the development of GLM. This research holds significant implications for the clinical diagnosis and therapeutic management of GLM, offering new insights into targeted treatment approaches.
| S-EPMC11491465 | biostudies-literature
Project description:Background:The exact etiology and pathogenesis of granulomatous lobular mastitis (GLM) are yet to be illuminated. This study aimed to investigate CD68, CD163-positive M2 macrophages, CD57-positive natural killer (NK) cells, and IgG4 in GLM lesion tissue to explore their correlation with the occurrence and clinical features of GLM. Methods:Surgical pathologic specimens of GLM were collected from patients admitted to Hunan Provincial People's Hospital between October, 2014 and October 2015. Based on the postoperative pathological diagnosis, the tissues were divided into 3 groups: the experimental group (GLM, n=36), control group 1 (plasma cell mastitis, PCM, n=17), and control group 2 (breast cystic hyperplasia, n=10). Immunohistochemical staining was carried out using Elivision super testing to detect CD68, CD163, CD57, and IgG4 expression in the pathological tissue samples. The relationship between clinical parameters, including age, reproductive condition, nipple retraction, and tumor size, and the expressions of CD68, CD163, CD57, and IgG4 was analyzed. Results:There was no obvious difference in the levels of CD68, CD163, and CD57 expression between the GLM group and the PCM group, although both groups had higher expression levels of expression than the breast cystic hyperplasia group (P<0.05). In the GLM group, the expression level of CD57 at 2 weeks-3 months was significantly higher than at ?2 weeks (P<0.05). The expression level of CD57 in PCM patients >2 years after lactation was significantly higher than in patients ?2 years after lactation (P<0.05). The level of IgG4 expression in GLM patients with nipple retraction was significantly higher than in those without nipple retraction (P<0.05). Conclusions:Inflammatory cells are closely linked to the occurrence of GLM and PCM. In our study, both the GLM and PCM groups had low expression of IgG4, but the expression level of IgG4 in GLM patients with inverted nipples was significantly higher than that in patients without inverted nipples. This suggests that there may be two different clinical subtypes of GLM. Furthermore, our research also found that NK cells can provide a basis for GLM clinical staging.
| S-EPMC7475371 | biostudies-literature
Project description:The etiology and pathogenesis of granulomatous lobular mastitis (GLM) remain largely elusive and the expression levels and regulatory roles of microRNAs (miRNAs or miRs) in GLM have remained mostly undetermined. In the present study, the miRNAs that were differentially expressed in breast biopsy samples from patients with GLM and normal tissue adjacent to fibroadenoma were analyzed, a comprehensive differential expression profile of miRNAs was provided and potential biomarkers were screened out. The expression profile of miRNAs was determined by high-throughput sequencing in the tissues of patients with GLM and healthy controls. Significantly differentially expressed miRNAs were screened by threshold setting and cluster analysis and their target genes were analyzed by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment. Finally, circulating differentially expressed miRNAs between the GLM and control groups were further analyzed by reverse transcription-quantitative PCR (RT-qPCR). A total of 31,077 miRNAs were detected by high-throughput sequencing. By using the cutoff criteria of |log2 fold change|>2.5 and q<0.001, 13 miRNAs that were indicated to be GLM biomarkers were screened out. The expression levels of these 13 miRNAs in the GLM group were higher than those in the control group. GO and KEGG enrichment analyses suggested that the occurrence and development of GLM may be associated with autoimmune inflammation, metabolism and pathogenic organisms. miR-451a and miR-5571-3p were confirmed to be significantly increased in the serum of patients with GLM compared with their levels in the serum of healthy volunteers, which suggests that they may be used as biomarkers of GLM. To the best of our knowledge, the present study was the first report detailing genome-wide miRNA profiling of patients with GLM compared with controls. The possible targets and pathways of GLM were evaluated by bioinformatics analysis. The present study identified 13 differentially expressed miRNAs with important theoretical significance and potential application. Furthermore, miR-451a and miR-5571-3p were verified by RT-qPCR as possible biomarkers of GLM.
| S-EPMC9257833 | biostudies-literature