Evaluation of follow-up strategies for corticosteroid therapy of idiopathic granulomatous mastitis

Introduction: Idiopathic granulomatous mastitis is a rare benign breast disease. Initial reports from hospitals in Egypt from Departments of Pathology at Cancer Institutes of Cairo, Tanta and Mansoura Universities; indicate that the disease is not as rare as that in the developed countries. It often mimics breast carcinoma both clinically and radiologically. Histological examination is the gold standard for diagnosis. Management of Idiopathic granulomatous mastitis is still debatable. In our study, we aimed to evaluate the addition of corticosteroid therapy to surgical excision in management of idiopathic granulomatous mastitis. Patients and Methods: This is a comparative study was conducted at Ain-Shams University Hospital’s breast clinic on patients with idiopathic granulomatous mastitis from to August 2015 till September 2018. Thirty patients were divided into 2 groups. Group (A) includes patients who underwent surgical management only. Group (B) includes patients who received corticosteroid therapy according to the severity of the cases then surgical Excision was done for the residual lesion. Follow up of all cases up to 1-2 years was done to document the recurrence rate and compare the cosmetic outcome of both groups. Informed consent was obtained from all patients included in the study. Results: The mean age of the affected women was 38.80 and 33.13 in group (A) and group (B), respectively and it wasn’t statistically different (p value = 0.099). The most common presenting symptom was a palpable mass in the breast (66.7% and 93.3%) in group (A) and group (B) respectively. Recurrence rate was higher in group (A) (40%) with no recurrence documented in group (B) however 2 cases were omitted from the study due to steroid noncompliance and complications. Cosmetic outcome was excellent in 76.9% of group (B) and good in 53.3% of group (A). Conclusion: Systemic steroid therapy with surgical resection is the recommended as first-line treatment strategy for IGM as it shows less recurrence rate and surgical scarring. Increased awareness of IGM will increase their understanding and improve their management.

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Combined Treatment Method Comparison Of Medical And Surgical Treatment In Idiopathic Granulomatous Mastitis

International Journal Of Medical Science And Clinical Invention ◽

10.18535/ijmsci/v5i4.05 ◽

2018 ◽

Vol 5 (4) ◽

pp. 3737-3742

Author(s):

Ebubekir Gündeş ◽

Mehmet Aykut Yildirim ◽

Tevfik Küçükkartallar ◽

Faruk Aksoy ◽

Ahmet Tekin ◽

...

Keyword(s):

Surgical Treatment ◽

Combined Treatment ◽

Granulomatous Mastitis ◽

Selective Treatment ◽

Idiopathic Granulomatous Mastitis ◽

Therapy Algorithm ◽

Group I ◽

Significant Difference ◽

The Mean

Aim: Our aim in conducting this study was to ascertain the clinical, pathological, and radiological characteristics of patients diagnosed with idiopathic granulomatous mastitis in our clinic and to contribute to related literature by creating a therapy algorithm for granulomatous mastitis. Method: A total of 62 patients diagnosed with granulomatous mastitis in our clinic were classified into three groups as per the mode of treatment they received. Among these, 20 patients who had only been administered corticosteroids were allocated to Group I, while 18 patients who had received surgical treatment in addition to corticosteroid treatment were allocated to Group II, and 24 patients who had only received surgery were allocated to Group III. Results: All the cases were female patients. The mean age of the patients was 33.67 ± 6.35 (21-48). No statistically significant difference was found among the groups as per the mean age figures, pregnancy, breastfeeding, oral contraceptive administration, smoking and alcohol use, and family history (p>0.05). 49 (77.4%) patients were diagnosed with granulomatous mastitis by thick-needle biopsy, 7 (11.2%) by incisional biopsy, 4 (6.4%) by excisional biopsy, and 3 (4.8%) by fine-needle aspiration biopsy (FNAB) before the onset of treatment. The median value for the follow-up of the patients was 40 (6-81) months and there was no statistically significant difference among follow-up periods (p: 0.51). 15 (24.1%) patients among all the cases had recurrence. There was a statistically significant difference among the groups with regards to recurrence (p: 0.015). Conclusion: Granulomatous mastitis may simulate breast cancer both clinically and radiologically. Recurrence is observed in patients who only received corticosteroid or surgical treatment. The combination of corticosteroid and surgical treatment significantly reduces the rate of recurrence. Therefore, this combination can be recommended as selective treatment.

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Idiopathic Granulomatous Mastitis: In Search of a Therapeutic Template

Journal of Surgical Sciences ◽

10.3329/jss.v20i2.43815 ◽

2019 ◽

Vol 20 (2) ◽

pp. 51-54

Author(s):

Sadia Armin Khan ◽

Abu Ahmed Ashraf Ali

Keyword(s):

Clinical Findings ◽

Clinicopathological Features ◽

Granulomatous Mastitis ◽

Idiopathic Granulomatous Mastitis ◽

College Hospital ◽

Precise Diagnosis ◽

Long Term Follow Up ◽

History Of

Background: Granulomatous mastitis also known as granulomatous inflammatory lesionsof the breast can be divided into idiopathic granulomatous mastitis and granulomatousmastitis occurring as a rare secondary complication of a great variety of other conditions.Treatment is radically different for idiopathic granulomatous mastitis and other granulomatouslesions of the breast, the precise diagnosis is therefore very important. Objectives: The purpose of this study was to find the clinicopathological features ofidiopathic granulomatous mastitis, as well as the authors' experience with surgicaltreatment of these patients. Methods and Materials: A hospital based retrospective study done with twenty diagnosedpatients of idiopathic granulomatous mastitis enrolled from department of surgery, Ad-dinwomen's.medical college hospital, Dhaka in the period between July 2012- July 2015. Results: Mean age of presentation was 38.1 years. All patients had a history of childbirthand breastfeeding. Sixteen (80%) patients were premenopausal. The main clinical featurewas a mass in the breast in all patients and clinical findings suggesting an infection accompaniedthe mass in seven patients (35%). Surgery was the definitive procedure in allpatients. Wide local excision done in all patients. None of the patients received steroids.Median follow-up time was 12 months. During follow-up, two patients (10%) presented withrecurrence. All patients with recurrence had a mass in their breasts on the same side ofprevious disease. Conclusion: Increased recognition of this disease will improve its understanding andmanagement. Long-term follow-up is necessary. Journal of Surgical Sciences (2016) Vol. 20 (2) :51-54

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Study of clinico‐pathological changes before and after corticosteroid therapy in cases of idiopathic granulomatous mastitis

The Breast Journal ◽

10.1111/tbj.14215 ◽

2021 ◽

Author(s):

Ahmed Maher Mansy ◽

Ahmed Abdellatif ◽

Mona Abdel‐Hadi ◽

Galal Abou Elnagah ◽

Mohamed El Messiry

Keyword(s):

Corticosteroid Therapy ◽

Granulomatous Mastitis ◽

Pathological Changes ◽

Idiopathic Granulomatous Mastitis ◽

Before And After

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Idiopathic granulomatous mastitis: introducing a diagnostic algorithm based on 5 years of follow-up of 152 cases from Turkey and a review of the literature

Surgery Today ◽

10.1007/s00595-021-02367-6 ◽

2021 ◽

Author(s):

Mehmet Velidedeoglu ◽

Veysel Umman ◽

Fahrettin Kilic ◽

Varol Celik ◽

Ertugrul Gazioglu ◽

...

Keyword(s):

Diagnostic Algorithm ◽

Granulomatous Mastitis ◽

Review Of The Literature ◽

Idiopathic Granulomatous Mastitis

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Idiopathic Granulomatous Mastitis- Challenges of Diagnosis and Treatment

Medicine Today ◽

10.3329/medtoday.v28i1.30963 ◽

2017 ◽

Vol 28 (1) ◽

pp. 14-16

Author(s):

Sharmistha Roy ◽

Samiron Kumar Mondal ◽

Md Ruhul Amin ◽

Indira Sufia Khan

Keyword(s):

Benign Breast Disease ◽

Clinical Presentation ◽

Surgical Intervention ◽

Breast Disease ◽

Diagnosis And Treatment ◽

Incisional Biopsy ◽

Unknown Aetiology ◽

Granulomatous Mastitis ◽

Idiopathic Granulomatous Mastitis

Idiopathic Granulomatous Mastitis (IGM) is a benign breast disease. Owing to its unknown aetiology, rareness,variation of presentation - diagnosis and treatment is still a challenge. This is a retrospective review of clinical presentation and investigation finding of all patients histopathologically diagnosed as IGM from February 2010 to January 2014. Treatment outcome and follow up information were recorded. 6(42%) patient presented with breast abscess, 5(35.7%) patient had features of mastitis without abscess, 3(21.4%) patient had painful firm to hard lump. Diagnosis confirmed by excisional/ incisional biopsy. 9(64%) patients needed more than one surgical intervention. Mean follow up period was 27months. Standardization and optimization of treatment is yet to be achieved.Medicine Today 2016 Vol.28(1): 14-16

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AB1053 EFFECTIVENESS OF METHOTREXATE IN IDIOPATHIC GRANULOMATOUS MASTITIS TREATMENT

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.679 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1816.1-1817

Author(s):

D. Yalcin Kehribar ◽

T. Izci Duran ◽

A. Kamali Polat ◽

M. Ozgen

Keyword(s):

Surgical Treatment ◽

Nipple Discharge ◽

Treatment Protocol ◽

Post Treatment ◽

Granulomatous Mastitis ◽

Idiopathic Granulomatous Mastitis ◽

Clin Pathol ◽

Methotrexate Treatment

Background:Idiopathic granulomatous mastitis (IGM) is a rare inflammatory disease of the breast [1], for which there is a lack of consensus on the treatment protocol [2, 3]; it requires long-term follow-up and is associated with a high rate of relapse after surgical treatment. In this study, we report on the largest single-center cohort of idiopathic granulomatous mastitis treated with steroids + methotrexate.Objectives:We present this study believing that our experience with patients with IGM and use of steroid + methotrexate treatment in them will contribute to the literature.Methods:We retrospectively examined the data of 33 patients histopathologically diagnosed with idiopathic granulomatous mastitis who were evaluated by our Rheumatology or General Surgery Clinics between 2013 and 2016.Results:Of the 33 female patients (age: 38.64 ± 6.9 years), 24 were admitted with an initial diagnosis of Idiopathic granulomatous mastitis, whereas 9 were admitted after surgical treatment. The breast symptoms and laboratory values of the patients before and after the steroid and methotrexate treatment are shown in Table 1. Remission was achieved in 87.9% patients with steroid + methotrexate treatment, and there were no relapses during the 24-month follow-up.Table 2.Pre- and post-treatment laboratuary and clinical findings.Pre-treatmentPost-treatmentP valueESR (mm/h)42.45±28.8817.24±11.31<0.001*CRP (mg/L)24.72±35.325.37±6.50.004*Mass Size (mm)36.94±16.4010.79±15.01<0.001*Fistula (n)15/33 (45%)2/33(6%)<0.001**Nipple discharge(n)17/33(52%)1/33(3%)<0.001**ESR: Erythrocyte sedimentation rate; CRP: C-reactive protein; *Paired T Test;**Chi-Square test.Conclusion:Methotrexate has so far been added to IGM treatment in order to decrease steroid dosage or to treat relapses, and it has been reported to be effective in case study and a limited number of studies with few patients [2, 4, 5]. Steroid + methotrexate treatment used by us in patients with IGM, which is a rare disease and for which no consensus exists regarding the treatment protocol, is effective and reliable in providing clinical improvement and long-term remission. Therefore, this treatment appears to be successful owing to long-term remission outcomes and very low relapse rates, without the patients having to undergo a surgical procedure and experience the associated anxiety and complications.References:[1]Kessler, E. and Y. Wolloch, Granulomatous mastitis: a lesion clinically simulating carcinoma. Am J Clin Pathol, 1972. 58(6): p. 642-6.[2]Schmajuk, G. and M.C. Genovese, First report of idiopathic granulomatous mastitis treated with methotrexate monotherapy. J Rheumatol, 2009. 36(7): p. 1559-60.[3]Patel, R.A., et al., Idiopathic granulomatous mastitis: case reports and review of literature. J Gen Intern Med, 2010. 25(3): p. 270-3.[4]Sheybani, F., et al., Treatment for and clinical characteristics of granulomatous mastitis. Obstet Gynecol, 2015. 125(4): p. 801-7.[5]Aghajanzadeh, M., et al., Granulomatous mastitis: Presentations, diagnosis, treatment and outcome in 206 patients from the north of Iran. Breast, 2015. 24(4): p. 456-60.Disclosure of Interests:None declared

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