Mastite granulomatosa
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Resumo
A mastite granulomatosa é uma doença rara, de etiologia desconhecida e de diagnóstico de exclusão logo de descartar outras causas de mastite, como as associadas a infecções bacterianas e a germens atípicos como fungos e tuberculose. A incidência há sido difícil de determinar, mas varia de 0.3% a 1.8%. Mais frequente em mulheres em idade reprodutiva, a apresentação clínica mais comum deste tipo de mastite é uma massa mamária de consistência dura, unilateral, associada a dor, eritema, calor e inchaço, sem febre. Tende a formar abscessos únicos ou múltiplos com fistulização, o que faz confundir com carcinoma inflamatório ou localmente avançado. Além disso, tende a ser recorrente. O diagnóstico só se pode confirmar por histopatologia, na qual se evidenciam granulomas não caseificantes concentrados em lóbulos mamários, com infiltrado linfocitário crônico, necrose e, com frequência, extasia ductal. O tratamento é controvertido, com opções que vão desde a observação, antibióticoterapia, terapia com corticosteroides, medicamentos imunossupressores como o metotrexato, à cirurgia com incisão local ampla.
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Referências
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