İdiyopatik Granülomatöz Mastitte Radyolojik Görüntüleme
Özet
İdiyopatik granülomatöz mastit (İGM), memenin benign kronik inflamatuar bir hastalığı olup klinik ve radyolojik olarak sıklıkla meme kanserini taklit eder. Tanı ve ayırıcı tanısında ultrasonografi (US), mamografi, elastosonografi ve manyetik rezonans görüntüleme (MRG) gibi multimodallik yöntemler kullanılır. Genç kadınlarda radyasyon içermeyen US ilk tercih olmalı; hipoekoik kitleler, parankimal heterojenite ve fistül traktları araştırılmalıdır. Kırk yaş üstünde daha yararlı olan mamografide fokal asimetri ve düzensiz kitleler en sık izlenen bulgulardır. MRG ise hastalığın yaygınlığını ve segmental kontrastlanmaları en duyarlı şekilde gösteren tamamlayıcı bir araçtır. İGM; inflamatuar meme kanseri, invaziv lobüler kanser, enfektif ve tüberküloz mastit ile diyabetik mastopati gibi patolojilerle karışabilir. Özellikle agresif seyirli inflamatuar meme kanseriyle ayırıcı tanısında hasta yaşının küçüklüğü, abselerin varlığı ve tutulum özellikleri dikkate alınır. BT'nin tanısal değeri düşükken tomosentez sürece dahil edilebilir. Radyolojik bulgular nonspesifik olduğundan kesin tanı için vasküler alandan yapılan kor biyopsi ilk seçenek olmalı ve histopatolojik olarak süreç desteklenmelidir. Radyoloğun rolü lezyon lokalizasyonunu, boyutunu, nüksleri ve tedavi yanıtını izlemektir.
Idiopathic granulomatous mastitis (IGM) is a benign chronic inflammatory breast disease that clinically and radiologically mimics breast cancer. Multimodality imaging including ultrasonography (US), mammography, elastosonography, and magnetic resonance imaging (MRI) is utilized for its diagnosis and differential diagnosis. In young women, radiation-free US should be the first choice to investigate hypoechoic masses, parenchymal heterogeneity, and fistula tracts. In patients over forty, mammography is more useful, where focal asymmetry and irregular masses are the most common findings. MRI is a complementary tool providing high sensitivity for disease extent and segmental non-mass enhancements. IGM can be confused with inflammatory breast cancer, invasive lobular cancer, infective and tuberculous mastitis, and diabetic mastopathy. In the differential diagnosis from aggressive inflammatory breast cancer, younger patient age, presence of abscesses, and involvement characteristics are considered. While CT has low diagnostic value, tomosynthesis can be included in the evaluation. Because radiological findings are non-specific, core biopsy from the vascular part must be the first choice for histopathological confirmation. The radiologist's role is to monitor lesion localization, size, recurrences, and treatment response.
Referanslar
Tse GM, Poon CS, Ramachandram K, et al. Granulomatous mastitis: a clinicopathological review of 26 cases. Pathology. 2004 Jun;36(3):254-257. doi: 10.1080/00313020410001692602
Zhou F, Yu LX, Ma ZB, et al. Granulomatous lobular mastitis. Chronic Diseases and Translational Medicine. 2016 Apr 22;2(1):17-21. doi: 10.1016/j.cdtm.2016.02.004.
Pluguez-Turull CW, nanyes JE, Quintero CJ, et al. Idiopathic Granulomatous Mastitis: Manifestations at Multimodality Imaging and Pitfalls. Radiographics. 2018;38(2):330-356.
Kessler E, Wolloch Y. Granulomatous mastitis: a lesion clinically simulating carcinoma. The American Journal of Pathology. 1972 Dec;58(6):642-646. doi: 10.1093/ajcp/58.6.642.
Korkut E, Akcay MN, Karadeniz E, et al. Granulomatous Mastitis: A Ten-Year Experience at a University Hospital. Eurasian Journal of Medicine. 2015 Oct;47(3):165-173. doi: 10.5152/eurasianjmed.2015.118.
Oztekin PS, Durhan G, Nercis Kosar P, et al. Imaging Findings in Patients with Granulomatous Mastitis. Iranian Journal of Radiology . 2016 May 31;13(3):e33900.
Grover H, Grover SB, Goyal P, et al. Clinical and imaging features of idiopathic granulomatous mastitis - The diagnostic challenges and a brief review. Clinical imaging. 2021 Jan;69:126-132. doi: 10.1016/j.clinimag.2020.06.022.
Aghajanzadeh M, Hassanzadeh R, Alizadeh Sefat S, et al. Granulomatous mastitis: Presentations, diagnosis, treatment and outcome in 206 patients from the north of Iran. The Breast; 2015;24(4):456-460. doi: 10.1016/j.breast.2015.04.003.
Yildiz S, Aralasmak A, Kadioglu H, et al. Radiologic findings of idiopathic granulomatous mastitis. Medical ultrasonography.2015;17(1):39–44.
Martinez-Ramos D, Simon-Monterde L, Suelves-Piqueres C, et al. Idiopathic granulomatous mastitis: A systematic review of 3060 patients. The breast journal. 2019;25(6):1245-1250. doi: 10.1111/tbj.13446.
Patel RA, Strickland P, Sankara IR, et al. Idiopathic granulomatous mastitis: case reports and review of literature. Journal of general internal medicine. 2010;25(3):270-273. doi: 10.1007/s11606-009-1207-2
Dinç Elibol F, Elibol C, Tekin L, et al. A very rare cause of male breast lump: Idiopathic granulomatous mastitis. The breast journal. 2020 Apr;26(4):778-779. doi: 10.1111/tbj.13571
Fazzio RT, Shah SS, Sandhu NP, et al. Idiopathic granulomatous mastitis: imaging update and review. Insights Imaging. 2016 Aug;7(4):531-539. doi: 10.1007/s13244-016-0499-0.
Hovanessian Larsen LJ, Peyvandi B, Klipfel N, et al. Granulomatous lobular mastitis: imaging, diagnosis, and treatment. AJR. American journal of roentgenology. 2009;193(2):574–581. doi: 10.2214/AJR.08.1528.
Bani-Hani KE, Yaghan RJ, Matalka II, et al. Idiopathic granulomatous mastitis: time to avoid unnecessary mastectomies. The breast journal. 2004 Jul-Aug;10(4):318-322. doi: 10.1111/j.1075-122X.2004.21336.x.
Going JJ, Anderson TJ, Wilkinson S, et al. Granulomatous lobular mastitis. Journal of clinical pathology. 1987;40:535–540. doi: 10.1136/jcp.40.5.535.
Lin CH, Hsu CW, Tsao TY, et al. Idiopathic granulomatous mastitis associated with risperidone-induced hyperprolactinemia. Diagnostic pathology. 2012 Jan 5;7:2. doi: 10.1186/1746-1596-7-2
Gautier N, Lalonde L, Tran-Thanh D, et al. Chronic granulomatous mastitis: imaging, pathology and management. European journal of radiology. 2013;82:e165–175. doi: 10.1016/j.ejrad.2012.11.010.
Poyraz N, Emlik GD, Batur A, et al. Magnetic resonance imaging features of idiopathic granulomatous mastitis: a retrospective analysis. Iranian journal of radiology.2016;13(3):e20873. doi: 10.5812/iranjradiol.20873.
Lee JH, Oh KK, Kim EK, et al. Radiologic and clinical features of idiopathic granulomatous lobular mastitis mimicking advanced breast cancer. Yonsei medical journal.2006;47(1):78–84. doi: 10.3349/ymj.2006.47.1.78.
Al-Khawari HA, Al-Manfouhi HA, Madda JP, et al. Radiologic features of granulomatous mastitis. The breast journal. 2011;17(6):645–650.
Dursun M , Yılmaz S, Yahyayev A, et al. Multimodality imaging features of idiopathic granulomatous mastitis: outcome of 12 years of experience. La Radiologia medica. 2012;117(4):529–538. doi: 10.1007/s11547-011-0733-2.
Boufettal H, Essodegui F, Noun M, et al. Idiopathic granulomatous mastitis: a report of twenty cases. Diagnostic and interventional imaging.2012;93:586–596. doi: 10.1016/j.diii.2012.04.028
Han BK, Choe YH, Park JM, et al. Granulomatous mastitis: mammographic and sonographic appearances. AJR. American journal of roentgenology. 1999;173:317–320. doi: 10.2214/ajr.173.2.10430126.
Kocaoglu M, Somuncu I, Ors F, et al. Imaging findings in idiopathic granulomatous mastitis. Journal of computer assisted tomography.2004;28:635–641. doi: 10.1097/01.rct.0000131927.82761.40.
Ozturk M, Mavili E, Kahriman G, et al. Granulomatous mastitis: radiological findings. Acta Radiologica.2007;48:150–155. doi: 10.1080/02841850601128975.
Toprak N, Toktas O, Ince S, et al. Does ARFI elastography complement B-mode ultrasonography in the radiological diagnosis of idiopathic granulomatous mastitis and invasive ductal carcinoma? Acta Radiologica. 2022;63(1):28-34. doi: 10.1177/0284185120983568.
Teke M, Teke F, Alan B, et al. Differential diagnosis of idiopathic granulomatous mastitis and breast cancer using acoustic radiation force impulse imaging. Journal of medical ultrasonics (2001) . 2017; 44(1):109-115. doi: 10.1007/s10396-016-0749-2.
Makal GB, Güvenç İ. The Role of Shear Wave Elastography in Differentiating Idiopathic Granulomatous Mastitis From Breast Cancer. Academic radiology. 2021 Mar;28(3):339-344. doi: 10.1016/j.acra.2020.02.008.
Durur-Karakaya A, Durur-Subasi I, Akcay MN, et al. Sonoelastography findings for idiopathic granulomatous mastitis. Japanese journal of radiology.2015 Jan;33(1):33-38. doi: 10.1007/s11604-014-0378-x.
Yağcı B, Erdem Toslak I, Çekiç B, et al. Differentiation between idiopathic granulomatous mastitis and malignant breast lesions using strain ratio on ultrasonic elastography. Diagnostic and interventional imaging.2017;98(10):685-691. doi: 10.1016/j.diii.2017.06.009.
Kanao S, Kataoka M, Iima M, et al. Differentiating benign and malignant inflammatory breast lesions: Value of T2 weighted and diffusion weighted MR images. Magnetic resonance imaging. 2018;50:38-44. doi: 10.1016/j.mri.2018.03.012
Dawood S, Cristofanilli M. Inflammatory breast cancer: what progress have we made? Oncology (Williston Park). 2011 Mar;25(3):264-270, 273.
Robertson FM, Bondy M, Yang W, et al. Inflammatory breast cancer: the disease, the biology, the treatment. CA: a cancer journal for clinicians. 2010 Nov-Dec;60(6):351-375. doi: 10.3322/caac.20082.
Gurleyik G, Aktekin A, Aker F, et al. Medical and surgical treatment of idiopathic granulomatous lobular mastitis: a benign inflammatory disease mimicking invasive carcinoma. Journal of breast cancer. 2012;15(1):119-123. doi: 10.4048/jbc.2012.15.1.119.
Buğdaycı O, Arıbal ME. İdiyopatik granülomatöz mastitte radyolojik bulgular. Altıntoprak F, editör. Mastitler. 1. Baskı. Ankara: Türkiye Klinikleri; 2021. p.45-54.
Wang L, Wang D, Fei X, et al. A rim-enhanced mass with central cystic changes on MR imaging: how to distinguish breast cancer from inflammatory breast diseases? PLoS One. 2014 Mar 5;9(3):e90355. doi: 10.1371/journal.pone.0090355
Seo HR, Na KY, Yim HE, et al. Differential diagnosis in idiopathic granulomatous mastitis and tuberculous mastitis. Journal of breast cancer.2012 Mar;15(1):111-118. doi: 10.4048/jbc.2012.15.1.111.
Sabaté JM, Clotet M, Gómez A, et al. Radiologic evaluation of uncommon inflammatory and reactive breast disorders. Radiographics. 2005 Mar-Apr;25(2):411-424. doi: 10.1148/rg.252045077.
Dilaveri CA, Mac Bride MB, Sandhu NP, et al. Breast manifestations of systemic diseases. International journal of women's health. 2012;4:35-43. doi: 10.2147/IJWH.S27624.
Wong KT, Tse GM, Yang WT. Ultrasound and MR imaging of diabetic mastopathy. Clinical radiology. 2002 Aug;57(8):730-735. doi: 10.1053/crad.2002.0936.
Nicholson BT, Mills SE. Sarcoidosis of the breast: An unusual presentation of a systemic disease. The breast journal. 2007 Jan-Feb;13(1):99-100. doi: 10.1111/j.1524-4741.2006.00375.x
Oran E, Gürdal S, Yankol Y, et al. Management of idiopathic granulomatous mastitis diagnosed by core biopsy: a retrospective multicenter study. The breast journal. 2013;19(4):411-418. doi: 10.1111/tbj.12123.
Durur-Subasi I. Diagnostic and Interventional Radiology in Idiopathic Granulomatous Mastitis. The Eurasian journal of medicine.2019;51(3):293-297.
