This study aimed to discuss the role of agents, such as steroids and methotrexate (MTX), in the treatment of patients with idiopathic granulomatous mastitis (IGM). Using Pubmed and Google Scholar data bases, a retrospective study was carried out on IGM cases treated with steroids and/or MTX between 1972 and 2010. Four IGM cases treated with MTX at our clinic were also summarized in this study. A total of 541 IGM cases since 1972, including ours, were retrospectively analyzed. Steroid treatment 5-85 mg was administered over 5 days-22 months to 112 patients aged 21-48 years. Recurrence occurred in 22 patients, steroid-induced diabetes mellitus in 5 patients, no response to treatment was observed in 4 patients, in 2 patients, the mass decreased in size, and static disease was observed in one. The steroid treatment was changed to MTX treatment in 4 patients who had recurrence, 5 with steroid-induced DM and in 4 who were nonrespondents. Three patients were started on steroid together with MTX as a primary treatment. Of the patients treated with MTX, a satisfactory result was obtained in 14 cases and in 2, mastectomy was performed because of recurrence despite the treatment with MTX. IGM is a troublesome condition that presents management problems due to the side effects of steroids. Our study demonstrates that the use of MTX in IGM cases has been effective in preventing complications, in resolving the inflammatory process, and in limiting side effects of corticosteroids.
Inflammatory fibroid polyps are rare, localized, non-neoplastic lesions originating in the submucosa of the gastrointestinal tract. Intussusception due to inflammatory fibroid polyps is uncommon; moreover, ileo-ileal intussusception has only rarely been reported. Here, we report an 11 × 7 cm giant inflammatory fibroid polyp of the small bowel that presented as intussusception in a 73-year-old woman. Ultrasonography demonstrated a solid, homogeneous, echogenic mass surrounded by the typical mural layers of an invaginated ileum. The immunohistopathological diagnosis after segmental ileal resection was an ileal inflammatory fibroid polyp. Although encountered rarely in adults, physicians should be aware of invagination and consider it in each case of acute abdomen because of the wide spectrum of clinical settings.
Tuberculosis should be considered in the list of differential diagnoses for thyroid abscesses and nodular lesions in people living in geographic regions with a high tuberculosis prevalence.
Tuberculosis is a systemic disease with localized manifestations; therefore, anti-TB therapy must be initiated in any patient whose pathologic specimen reveals tuberculosis.
Acute chylous ascites is a rarely seen clinical picture, therefore, examination findings are often confused with acute appendicitis. To the best of our knowledge, there is no publication to date showing the occurrence of them together. This study presents the treatment plan for a 25-year-old male patient with both acute chylous ascites and appendicitis. Surgical findings were retrocaecal appendicitis, evident lymphangiectasia in the proximal segment of jejunum, and approximately 3 lt of chylous fluid. An appendectomy was performed and drainage was applied. Low-fat total parenteral nutrition (TPN) and octreotide treatment were administered for 7 days postoperatively. We also present a general review of some studies on chylous ascites, which have been published in the English language medical literature since 1910.
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