Idiopathic Granulomatous Mastitis: Etiopathogenetic Considerations on a Rare Benign Inflammatory Breast Disease

Idiopathic granulomatous mastitis is a rare benign inflammatory breast disease that affects women of childbearing age with a history of breastfeeding. It usually presents as an enlarging breast mass that can greatly mimic breast cancer. Moreover, it does not have a specific radiographic finding, so the only way to reach a definitive diagnosis is by core biopsy and histology. Furthermore, a consensus regarding the best treatment modality has not been reached yet. In this report, we describe the cases of two patients who suffered from this disease, and to our knowledge, such a report is the first of its kind to address this topic in this region. Therefore, because of its uncommon nature and obscure presentation, we hereby report two cases of idiopathic granulomatous mastitis. The clinical presentation, treatment, and pathological findings are described, and a literature review on idiopathic granulomatous mastitis will be reported.

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Comparison of Conservative versus Surgical Treatment Protocols in Treating Idiopathic Granulomatous Mastitis: A Meta-Analysis

Breast Care ◽

10.1159/000503602 ◽

2019 ◽

Vol 15 (4) ◽

pp. 415-420

Author(s):

Fei Zhou ◽

Lu Liu ◽

Liyuan Liu ◽

Lixiang Yu ◽

Fei Wang ◽

...

Keyword(s):

Surgical Treatment ◽

Recurrence Rate ◽

Meta Analysis ◽

Clinical Effectiveness ◽

Breast Disease ◽

Granulomatous Mastitis ◽

Idiopathic Granulomatous Mastitis ◽

Treatment Protocols ◽

Significant Difference ◽

Conservative And Surgical Treatment

Background: Idiopathic granulomatous mastitis (IGM) is a rare, benign breast disease without any definitive therapeutic strategy. It is controversial whether to use conservative or surgical treatment of IGM and high-level evidence-based medicine data are lacking. The purpose of this study was to systemically evaluate the clinical effectiveness of the conservative versus surgical treatment for IGM. Methods: In this meta-analysis, we searched PubMed, EMbase, ScienceDirect, and Web of Science for comparative studies about the conservative versus surgical treatment of IGM. Two researchers independently identified reports and extracted data. We used Stata 11 for data analysis. A meta-analysis was performed to investigate the differences in the recurrence rate of conservative and surgical treatment using a random effects model. Results: A total of 10 studies involving 1,101 patients were included. The results demonstrated that there was no significant difference in the recurrence rate among patients who were treated by nonsurgical therapy and surgical treatment. No publication bias was detected. Conclusion: This meta-analysis demonstrates that both the conservative and surgical treatment approaches have appropriate efficacy in IGM treatment and relapse. Further randomized controlled trials with longer follow-up periods are required to confirm the advantages of each approach.

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Idiopathic Granulomatous Mastitis: Cytologic and Histologic Study of 65 Egyptian Patients

Acta Cytologica ◽

10.1159/000448800 ◽

2016 ◽

Vol 60 (5) ◽

pp. 438-444 ◽

Cited By ~ 7

Author(s):

Thanaa El A. Helal ◽

Lobna S. Shash ◽

Somaia A. Saad El-Din ◽

Sally M. Saber

Keyword(s):

Middle Eastern ◽

Breast Disease ◽

Needle Aspiration ◽

Granulomatous Mastitis ◽

Aspiration Cytology ◽

Idiopathic Granulomatous Mastitis ◽

Tissue Sections ◽

Egyptian Patients ◽

Needle Aspiration Cytology

Background: The etiology of idiopathic granulomatous mastitis (IGM) is unknown, and it is commonly misdiagnosed clinically and/or radiologically as breast cancer. The role of fine-needle aspiration cytology (FNAC) in its diagnosis is still a matter of debate. The aim of the current study is to assess the value of FNAC in the diagnosis of IGM, and to search for the presence of bacteria in IGM with cystic vacuoles, which was described recently by a few authors. Materials and Methods: Retrospective study of cytologic smears and histologic tissue sections of 65 Egyptian IGM cases was done along with microbiologic testing. A comparison of the frequency of IGM in Egypt to that of other populations was also made. Results: IGM has typical FNA features which can easily exclude malignancy. Histologically, cystic vacuoles were encountered in 35 out of 65 cases (53.9%), with only 6 (17.14%) of these cases showing Gram-positive bacilli (GPB). The frequency of IGM in Egypt is comparable to those in other Middle Eastern countries but much higher than in Western countries. Conclusion: IGM is a common breast disease in Egypt. FNAC in IGM has a high diagnostic accuracy. This study supports the few recent studies that have detected GPB in IGM with cystic vacuoles. Thus, bacteriologic examination in such cases may affect the treatment strategy.

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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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Management of idiopathic granulomatous mastitis: a surgical experience of ten cases

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20202910 ◽

2020 ◽

Vol 8 (7) ◽

pp. 2653

Author(s):

Abishek H. Karthik ◽

Lisha Suraj

Keyword(s):

Benign Breast Disease ◽

Connective Tissue Diseases ◽

Case Series ◽

Breast Disease ◽

Uneventful Recovery ◽

Breast Diseases ◽

Granulomatous Mastitis ◽

Idiopathic Granulomatous Mastitis ◽

Chronic Inflammatory Condition ◽

History Of

Granulomatous mastitis is a chronic inflammatory condition of the breast that is rarely described in literature. It mimics breast abscess on clinical presentation giving dilemma to the surgeon. The etiology can be infectious, autoimmune or idiopathic. The various modalities of treatment for idiopathic granulomatous mastitis includes drainage of abscess, antibiotics and corticosteroid therapy. This is a case series of ten cases of diagnosed with granulomatous mastitis treated in the period of 2 years from 2018 and 2019 in Department of General Surgery, MGM Hospital Navi Mumbai. The data of all the patients were collected from records. They were following at regular intervals in the outpatient department to assess recurrence. The mean age of the patients was 41 years (range 26–47 years). Six patients gave history of breast-feeding in the last 5 years, one was lactating at the time of presentation. One of the patients was treated empirically for Tuberculous mastitis for the opposite breast. Others had no history suggestive of tuberculosis or other connective tissue diseases, such as rheumatoid arthritis or sarcoidosis USG breast was performed in all cases. Hypoechoic abscess was seen in 5 cases. The time taken for complete resolution of the disease was ranging from 2 weeks to 2 months. All patients had an uneventful recovery and no recurrences reported till now. GM is a rare benign breast disease that is difficult to distinguish from other inflammatory breast diseases or cancer. The diagnosis of GM must be based on a multidisciplinary approach. Surgical management followed by antibiotics was found to be sufficient to treat the condition in our patients. Corticosteroids need not be administered in all cases of this benign breast disease.

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Difficulties of Differential Diagnostics of Idiopathic Granulomatous Mastitis with Contrast Enhanced Visualization Methods

Journal of oncology: diagnostic radiology and radiotherapy ◽

10.37174/2587-7593-2020-3-3-83-92 ◽

2020 ◽

Vol 3 (3) ◽

pp. 83-92

Author(s):

A. V. Chernaya ◽

A. V. Reva ◽

R. Kh. Ulianova ◽

L. N. Shevkunov ◽

P. V. Krivorotko ◽

...

Keyword(s):

Breast Carcinoma ◽

Breast Disease ◽

Differential Diagnostics ◽

Unknown Etiology ◽

Granulomatous Mastitis ◽

Idiopathic Granulomatous Mastitis ◽

Dynamic Contrast Enhancement ◽

Radiological Features ◽

Contrast Enhanced ◽

Radiological Methods

Mastitis is an inflammatory condition of the breast, which may or may not be accompanied by infection (WHO 2000).Idiopathic granulomatous mastitis is one of the forms of non-infectious mastitis. Granulomatous lobular mastitis is a rare inflammatory disease of the breast that was first described by Kessler and Wolloch in 1972.Idiopathic granulomatous mastitis (IGM) or granulomatous lobular mastitis is chronic inflammatory breast disease of unknown etiology, the clinical manifestation and radiological features of which may mimic other nosological entities.We report a case of 29 year old woman who was diagnosed with breast carcinoma by radiological methods, such as contrast enhanced spectral mammography (CESM), magnetic resonance imaging with dynamic contrast enhancement (MRI with DCE), SPECT/CT. However, performed core needle biopsy of a lesion shows no tumor cells. The conservative treatment was suggested, based on obtained information.Aim is a review of radiological features of IGM with contrast enhanced visualization methods, based on our clinical case; description of differential radiological features in comparison with similar diseases of the breast, such as inflammatory breast carcinoma, tuberculosis etc.

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Granulomatous mastitis-a challenging surgical entity

International Surgery Journal ◽

10.18203/2349-2902.isj20172052 ◽

2017 ◽

Vol 4 (6) ◽

pp. 2077 ◽

Cited By ~ 1

Author(s):

Thrishuli P. B. ◽

Akshata Kamath B.

Keyword(s):

Breast Disease ◽

Needle Aspiration ◽

Chronic Inflammatory Disease ◽

Wide Excision ◽

Reproductive Age ◽

Excision Biopsy ◽

Granulomatous Mastitis ◽

Idiopathic Granulomatous Mastitis ◽

Short Course ◽

Needle Aspiration Cytology

Background: Idiopathic granulomatous mastitis is a rare benign breast disease, first described by Kessler and Wolloch in 1972. It is characterized by chronic necrotizing granulomatous lobulitis of unknown aetiology. The objective of the study is to find out the clinical and management profile of granulomatous mastitis (GM). This study was carried out at JSS hospital, Mysore, Karnataka, India during the period 2014-2016.Methods: Histopathologically diagnosed cases of GM were studied. Data included, detailed history, examination, clinical diagnosis, ultrasound, mammogram and fine needle aspiration cytology (FNAC). All patients were followed for a period of 6 months. Recurrent cases were managed by wide excision and followed for another period of 6 months.Results: 8 patients who were hisptopathologically diagnosed to have granulomatous mastitis were studied. The mean age was found to be 43.5 years. All patients presented with a painless breast lump and were unilateral. The incidence of the same was found to be higher (3.7%) compared to other large volume studies. The best treatment modality with least recurrence in 4 cases was wide local excision and 1 case of quandrantectomy.Conclusions: GM is an uncommon chronic inflammatory disease of the breast. Usually involving a single non-lactating breast in reproductive age group. It clinically mimics tuberculosis and carcinoma. Mammography remains non-conclusive. Excision and wide excision biopsy are both diagnostic and therapeutic in majority of cases. Treatment includes short course of steroids and antibiotic along with close regular surveillance.

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The role of dapsone in refractory idiopathic granulomatous mastitis

Case Reports in Internal Medicine ◽

10.5430/crim.v4n1p72 ◽

2017 ◽

Vol 4 (1) ◽

pp. 72

Author(s):

Ayla Pelleg ◽

Kirangowda Pombarahalli Varadaraju ◽

Swati Datta

Keyword(s):

Case Report ◽

Alternative Treatment ◽

Treatment Guidelines ◽

Breast Disease ◽

Breast Mass ◽

Treatment Modalities ◽

Granulomatous Mastitis ◽

Idiopathic Granulomatous Mastitis

Idiopathic Granulomatous Mastitis (IGM) is a benign inflammatory breast disease. A definite etiology of IGM is still unknown. IGM classically presents as an unilateral, painful breast mass in women who are 30-40 years of age. Consensus treatment guidelines do not exist for the management of IGM. In this case report, we present a patient with IGM who was refractory to Prednisone and started on Dapsone as an alternative treatment. This case report highlights the use of Dapsone and the need for further research of IGM treatment modalities.

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Methotrexate in the Treatment of Idiopathic Granulomatous Mastitis

The Journal of Rheumatology ◽

10.3899/jrheum.181205 ◽

2019 ◽

Vol 47 (6) ◽

pp. 924-927 ◽

Cited By ~ 5

Author(s):

Anna Postolova ◽

Megan L. Troxell ◽

Irene L. Wapnir ◽

Mark C. Genovese

Keyword(s):

Effective Treatment ◽

Chart Review ◽

Surgical Intervention ◽

Breast Disease ◽

Granulomatous Mastitis ◽

Idiopathic Granulomatous Mastitis ◽

Rheumatology Clinic ◽

Disease Remission ◽

Female Patients

Objective.Idiopathic granulomatous mastitis (IGM) is a disfiguring inflammatory breast disease without effective treatment. We report the largest IGM cohort treated with methotrexate (MTX) monotherapy.Methods.Chart review was performed on patients evaluated by the Stanford Immunology and Rheumatology Clinic, with histopathologically established IGM treated with MTX, and at least 1 followup appointment.Results.Nineteen female patients with a mean age of 33.5 years were identified. Most failed treatment with antibiotics, prednisone, and surgical intervention. By 15 months of treatment with MTX, 94% had disease improvement and 75% achieved disease remission.Conclusion.MTX monotherapy is an effective treatment for IGM.

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Serum C-Reactive Protein and Interleukin-6 Levels as Biomarkers for Disease Severity and Clinical Outcomes in Patients with Idiopathic Granulomatous Mastitis

Journal of Clinical Medicine ◽

10.3390/jcm10102077 ◽

2021 ◽

Vol 10 (10) ◽

pp. 2077

Author(s):

Yi-Min Huang ◽

Chiao Lo ◽

Chiao-Feng Cheng ◽

Cheng-Hsun Lu ◽

Song-Chou Hsieh ◽

...

Keyword(s):

Disease Severity ◽

Severe Disease ◽

Linear Regression Analysis ◽

Multiple Linear Regression Analysis ◽

Serum Biomarkers ◽

Healthy Controls ◽

Granulomatous Mastitis ◽

C Reactive Protein ◽

Idiopathic Granulomatous Mastitis ◽

Reactive Protein

Idiopathic granulomatous mastitis (IGM) is a rare inflammatory breast disease mimicking breast cancer. Limited research has been conducted on the application of serum biomarkers. This study aims to investigate the association of serum biomarkers with disease severity in patients with IGM. From November 2011 to March 2020, medical records of patients with IGM were reviewed. Serum cytokine levels were measured in patients and healthy controls between July 2018 and March 2020. A total of 41 patients with histologically proven IGM were found. Serum interleukin (IL)-6 level was significantly higher in patients with IGM (n = 11) than healthy controls (n = 7). Serum IL-6 and C-reactive protein (CRP) levels were significantly higher in patients with severe disease than mild and moderate disease. Serum IL-6 (Spearman’s ρ = 0.855; p < 0.001) and CRP (Spearman’s ρ = 0.838; p = 0.001) levels were associated with time to resolution. A higher serum CRP level was associated with a longer time to resolution (B = 0.322; p < 0.001) in multiple linear regression analysis. Serum IL-6 and CRP levels can be used as biomarkers for the evaluation of disease severity in IGM. IL-6 may play a crucial role in the immunopathology of IGM.

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