GRANULOMATOUS MASTITIS IS NOT ALWAYS TUBERCULAR: ROLE OF FINE NEEDLE ASPIRATION CYTOLOGY IN EVALUATION OF GRANULOMATOUS MASTITIS

INTRODUCTION AND OBJECTIVES: Granulomatous mastitis is rare chronic inflammatory benign breast lesion, which clinically and radiologically resembles carcinoma breast thus creating a diagnostic dilemma. The term granulomatous mastitis includes two broad categories namely specific granulomatous mastitis for which aetiological factors can be defined such as infectious causes like Mycobacterium tuberculosis, blastomycosis, cryptococcosis, histoplasmosis, actinomycosis and filarial infection. Other factors include association with autoimmunue diseases such as Wegner’s granulomatosis and giant cell arteritis and there are other rare causes such as include duct ectasia, foreign body reaction and fat necrosis which also leads to granulomatous lesions of breast. Cytological features of granulomatous mastitis(GM) have not been widely discussed and described in literature, so through this study we have made an attempt to thoroughly discuss cytological spectrum of granulomatous mastitis. MATERIALS AND METHODS: A retrospective study was performed over a period of four years from 2016 to 2019. A total of 465 cases of breast lump reported to cytopathology section out of which 24 cases of GM diagnosed on FNAC were included in our study. Results of Erythrocyte sedimentation rate (ESR) and Mantoux test along with TB-PCR were recorded. FNAC slides were retrieved pertaining to study period. Granulomatous lesions of breast were further categorized broadly into IGM/ NGM, granulomatous mastitis without caseous necrosis and tubercular mastitis where diagnosis were made definite on basis of demonstration of AFB or positive TB-PCR . RESULTS: Patient age ranged from 23 years to 55 years with the mean age of 36.6 years with maximum of patients falling in second decade followed by third decade. Granulomatous lesions were broadly categorized into Idiopathic/ Non specific granulomatous mastitis(11 cases,45.8%), GM with caseous necrosis(8 cases, 33.3%) and tubercular mastitis(5 cases, 20.9%). Histopathology was available in 7 cases(29.2%). TB-PCR was sent in all cases of granulomatous mastitis diagnosed on cytology and was positive in 10 cases(41.7%). CONCLUSION: Idiopathic granulomatous mastitis and tubercular mastitis are rare inflammatory diseases of breast which mimic malignancy clinically and radiologically. FNAC plays important role in diagnosis of granulomatous diseases of breast and also their differentiation from malignant tumors. Tubercular mastitis needs to be differentiated from IGM since treatment options are different in both the cases. Cytopathology plays an important role in differentiationg both the diseases supplemented by radiological and microbiological investigations. The present study thus highlights the importance of FNAC as an infalliable tool in diagnosis of granulomatous mastitis and its differentiation from neoplastic lesions of breast thus avoiding time consuming histopathological work up of cases.

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Idiopathic granulomatous mastitis: a diagnostic dilemma

British Journal of Hospital Medicine ◽

10.12968/hmed.2019.0287 ◽

2020 ◽

Vol 81 (2) ◽

pp. 1-4

Author(s):

Dua Hashmi ◽

Ahmad Al Samaraee ◽

Bertram Marks ◽

Tarannum Fasih

Keyword(s):

Granulomatous Mastitis ◽

Diagnostic Dilemma ◽

Idiopathic Granulomatous Mastitis

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Idiopathic granulomatous mastitis: a diagnostic dilemma for the breast radiologist

Insights into Imaging ◽

10.1007/s13244-016-0497-2 ◽

2016 ◽

Vol 7 (4) ◽

pp. 523-529 ◽

Cited By ~ 5

Author(s):

Smiti Sripathi ◽

Anurag Ayachit ◽

Archana Bala ◽

Rajagopal Kadavigere ◽

Sandeep Kumar

Keyword(s):

Granulomatous Mastitis ◽

Diagnostic Dilemma ◽

Idiopathic Granulomatous Mastitis ◽

Breast Radiologist

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Preoperative Fibrinogen and Hematological Indexes in the Differential Diagnosis of Idiopathic Granulomatous Mastitis and Breast Cancer

Medicina ◽

10.3390/medicina57070698 ◽

2021 ◽

Vol 57 (7) ◽

pp. 698

Author(s):

Mehmet Velidedeoglu ◽

Berrin Papila Kundaktepe ◽

Hulya Aksan ◽

Hafize Uzun

Keyword(s):

Breast Cancer ◽

Differential Diagnosis ◽

Sedimentation Rate ◽

White Blood Cells ◽

Negative Relationship ◽

Granulomatous Mastitis ◽

Idiopathic Granulomatous Mastitis ◽

Lymphocyte Ratio ◽

Study Results ◽

Significant Difference

Background and Aim: Studies on hematological parameters in the differential diagnosis of idiopathic granulomatous mastitis (IGM) and breast cancer (BC) are limited. This study investigated whether preoperative fibrinogen and hematological indexes can be used in the differential diagnosis of patients with IGM and early-onset BC. Methods: Fifty patients with BC, 55 patients with IGM, and 50 healthy volunteer women were included in the study. Results: There was a statistically significant difference between the IGM and the BC with respect to fibrinogen, fibrinogen/albumin (Fib/Alb) ratio, C-reactive protein (CRP), white blood cells (WBC), neutrophils, neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), and monocyte values. When fibrinogen (p < 0.001), the Fib/Alb ratio (p < 0.001), CRP (p < 0.001), WBC (p < 0.001), neutrophil (p < 0.001), NLR (p < 0.001), monocyte (p = 0.008), and 2-hour sedimentation rate (p < 0.001) were compared between the groups, the highest levels were found in the IGM group. There was a negative relationship between CRP and albumin, and a positive relationship was observed between CRP and WBC, NLR, PLR, and 2-h sedimentation rate. CRP had the highest sensitivity (95%), whereas the Fib/Alb ratio (86%) had the highest specificity. Patients with recurrent IGM had increased fibrinogen, Fib/Alb, CRP, neutrophils, NLR, and 2-h erythrocyte sedimentation rate (ESR) and decreased lymphocyte levels compared to non-recurrent patients. Conclusions: Preoperative CRP, albumin, fibrinogen, Fib/Alb, WBC, neutrophil, NLR, monocyte, and 2-h ESR have considerable potential to be early and sensitive biomarkers of IGM caused by inflammation compared to BC. These parameters also have a significant effect on the recurrence of the disease, suggesting their potential as a practical guide for the differential diagnosis of BC from IGM.

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DIAGNOSTIC DILEMMA AND TREATMENT CHALLENGES IN IDIOPATHIC GRANULOMATOUS MASTITIS

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i2.6611 ◽

2021 ◽

Vol 71 (2) ◽

pp. 702-05

Author(s):

Humera Latif ◽

Syeda Rifaat Qamar ◽

Razia Bano ◽

Nida Farrukh ◽

Kishwar Ali ◽

...

Keyword(s):

Conservative Treatment ◽

Military Hospital ◽

Granulomatous Mastitis ◽

Breast Clinic ◽

Diagnostic Dilemma ◽

Idiopathic Granulomatous Mastitis ◽

Incision And Drainage ◽

Tender Mass ◽

Diagnostic Difficulties ◽

Empirical Antibiotics

Objective: To outline diagnostic difficulties and problems in the treatment of Idiopathic Granulomatous Mastitis Study Design: Prospective observational study. Place and Duration of Study: Breast clinic, Combined Military Hospital Rawalpindi, from Aug 2019 to Jul 2020. Methodology: Patients with tender mass with or without signs of inflammation, mass with abscess, sinus formation, and with recurrent abscesses were included. Those cases were labelled as IGM whose histopathology showed granulomatous mastitis with no evidence of malignancy and tissue cultures were negative. Patients with mild to moderate symptoms were treated with reassurance, analgesia and multivitamins. Abscesses were treated with incision & drainage and empirical antibiotics for 1-2 weeks. All these patients were followed at 1, 3, 6 and 12 months. Results: A total of 35 patients fulfilled the criteria for Idiopathic Granulomatous Mastitis and were included in the study. Two patients had lactational abscess, 3 had bilateral disease and 1 patient was with diabetes 0% patients were having mass with abscess; spontaneous resolution was observed in majority of them with a few requiring incision and drainage. Of 31.4% presented with tender mass only; majority of them resolved with observation, except mass excision in two patients, 19.7% presented with discharging sinuses with underlying mass; among them 71% responded to conservative treatment while 29% were treated with anti-tuberculous therapy for recurrent sinuses. 8.5% presented with spontaneously ruptured abscesses with sinuses; they were managed conservatively. Conclusion: We concluded that Idiopathic Granulomatous Mastitisis a benign self-limiting disease which can be effectively managed with conservative treatment.

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Idiopathic Granulomatous Mastitis of the Breast: Radiologic–Pathologic Correlation

Journal of Breast Imaging ◽

10.1093/jbi/wbaa107 ◽

2020 ◽

Author(s):

Niketa Kataria ◽

Elizabeth U Parker ◽

Mark R Kilgore ◽

John R Scheel

Keyword(s):

Time Course ◽

Treatment Options ◽

Specific Treatment ◽

Granulomatous Inflammation ◽

Granulomatous Mastitis ◽

Idiopathic Granulomatous Mastitis ◽

Ongoing Research ◽

Foreign Materials ◽

Clinical Dilemma ◽

Multiple Recurrences

Abstract Granulomatous inflammation is an uncommon inflammatory condition of the breast that includes both infectious (bacterial, fungal, parasitic) and noninfectious (autoimmune, sarcoidosis, idiopathic granulomatous mastitis [IGM], reaction to foreign materials) etiologies. IGM is the most common subset of granulomatous inflammation where no underlying etiology is established. Infectious causes of granulomatous inflammation should be excluded, as these have established treatments that can significantly improve patient outcomes. IGM should be considered in the differential when mastitis is refractory to antibiotics. Patients usually present with an erythematous, tender, palpable unilateral breast mass. The most common mammographic presentation is a focal or global asymmetry. The imaging appearance mimics breast cancer, therefore diagnosis usually requires tissue sampling with histopathologic analysis and cultures to exclude infection. When patients are diagnosed with IGM, this poses a clinical dilemma as there are a variety of treatment options available, including oral and intralesional steroids. The time course of the disease is often prolonged by multiple recurrences, and specific treatment remains an area of ongoing research. The purpose of this article is to review the range of clinical features, imaging manifestations, associated histopathology, and management of IGM.

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Idiopathic Granulomatous Mastitis: Overcoming this Important Clinical Challenge

International Surgery ◽

10.9738/intsurg-d-16-00225.1 ◽

2017 ◽

Vol 103 (5-6) ◽

pp. 228-237 ◽

Cited By ~ 1

Author(s):

Arif Emre ◽

Sami Akbulut ◽

Mehmet Sertkaya ◽

Muharrem Bitiren ◽

Ilhami Taner Kale ◽

...

Keyword(s):

Treatment Options ◽

Radical Mastectomy ◽

High Volume ◽

Breast Conserving Surgery ◽

Lesion Size ◽

Diagnostic Tools ◽

Granulomatous Mastitis ◽

Idiopathic Granulomatous Mastitis ◽

Available N ◽

Significant Difference

The aim of this study was to determine possible risk factors for recurrence development in patients with idiopathic granulomatous mastitis (IGM). Demographic, clinical, radiologic, and histopathologic characteristics of 34 consecutive patients with IGM were retrospectively reviewed. Also, 32 patients who were informed about recurrence status were divided into non-recurrent (n = 27) and recurrent (n = 5) groups. Both groups were compared for demographic and clinical parameters. This study included 34 female patients with IGM aged between 26 and 70 years (median: 38 years). During the follow-up period, no recurrence occurred in 27 patients whereas recurrence developed in 5 patients. No significant difference was found between the groups with respect to age, lesion size, breast-feeding, number of child, marital status, use of oral contraceptive, familial or personal tuberculosis history, PPD test, smoking, lesion side, lesion location on the breast, and treatment choice. The diagnostic tools of the IGM as follows: tru-cut (n = 18); incisional (n = 6); tru-cut + incisional (n = 5); tru-cut + excisional (n = 2); tru-cut + FNAB (n = 1); FNAB + excisional (n = 1) and FNAB (n = 1). Treatment options were as follow: antibiotics + drainage (n = 10); antibiotics + drainage + corticosteroid (n = 9); wait and watch (n = 6); corticosteroid (n = 3); antibiotics + antituberculous (n = 1); antituberculous (n = 1); antibiotics + breast conserving surgery + chemotherapy (n = 1); modified radical mastectomy + chemotherapy + radiotherapy (n = 1); and no available (n = 2). This study shows that no demographic and clinical data contributes to the development of recurrence disease. To give a strong message, this study should be supported by other high volume and prospective studies.

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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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Rheumatic Immune-Related Adverse Events—A Consequence of Immune Checkpoint Inhibitor Therapy

Biology ◽

10.3390/biology10060561 ◽

2021 ◽

Vol 10 (6) ◽

pp. 561

Author(s):

Anca Bobircă ◽

Florin Bobircă ◽

Ioan Ancuta ◽

Alesandra Florescu ◽

Vlad Pădureanu ◽

...

Keyword(s):

Immune System ◽

Adverse Events ◽

Immune Checkpoint ◽

Multidisciplinary Approach ◽

Malignant Tumors ◽

Checkpoint Inhibitors ◽

Treatment Options ◽

Cancer Cell Growth ◽

Inhibitory Mechanisms ◽

Checkpoint Inhibitor Therapy

The advent of immunotherapy has changed the management and therapeutic methods for a variety of malignant tumors in the last decade. Unlike traditional cytotoxic chemotherapy, which works by interfering with cancer cell growth via various pathways and stages of the cell cycle, cancer immunotherapy uses the immune system to reduce malignant cells’ ability to escape the immune system and combat cell proliferation. The widespread use of immune checkpoint inhibitors (ICIs) over the past 10 years has presented valuable information on the profiles of toxic adverse effects. The attenuation of T-lymphocyte inhibitory mechanisms by ICIs results in immune system hyperactivation, which, as expected, is associated with various adverse events defined by inflammation. These adverse events, known as immune-related adverse events (ir-AEs), may affect any type of tissue throughout the human body, which includes the digestive tract, endocrine glands, liver and skin, with reports of cardiovascular, pulmonary and rheumatic ir-AEs as well. The adverse events that arise from ICI therapy are both novel and unique compared to those of the conventional treatment options. Thus, they require a multidisciplinary approach and continuous updates on the diagnostic approach and management.

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Out Come of Wide Local Excision with and without Corticosteroid Therapy in Management of Idiopathic Granulomatous Mastitis

Tumori Journal ◽

10.1177/03008916211012342 ◽

2021 ◽

Vol 107 (1_suppl) ◽

pp. 13-13

Author(s):

R Amira Maher ◽

Ahmed Gamal Eldin Osman ◽

K Fahmy ◽

Shinamwi M ◽

Osama Al Atarash

Keyword(s):

Recurrence Rate ◽

Corticosteroid Therapy ◽

Surgical Excision ◽

Cosmetic Outcome ◽

Systemic Steroid ◽

Granulomatous Mastitis ◽

Idiopathic Granulomatous Mastitis ◽

Palpable Mass ◽

Group A ◽

Group B

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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Beneficial Actions of Orostachys japonica and Its Compounds against Tumors via MAPK Signaling Pathways

Nutrients ◽

10.3390/nu13020555 ◽

2021 ◽

Vol 13 (2) ◽

pp. 555

Author(s):

Soyoung Hur ◽

Eungyeong Jang ◽

Jang-Hoon Lee

Keyword(s):

Molecular Mechanisms ◽

Epithelial To Mesenchymal Transition ◽

Malignant Tumors ◽

Treatment Options ◽

Underlying Mechanism ◽

Mapk Signaling ◽

Mitogen Activated Protein Kinase ◽

Antitumor Effects ◽

Mesenchymal Transition ◽

Perennial Plant

Tumors are one of the most life-threatening diseases, and a variety of cancer treatment options have been continuously introduced in order to overcome cancer and improve conventional therapy. Orostachys japonica (O. japonica), which is a perennial plant belonging to the genus Orostachys of the Crassulaceae family, has been revealed to exhibit pharmacological properties against various tumors in numerous studies. The present review aimed to discuss the biological actions and underlying molecular mechanisms of O. japonica and its representative compounds—kaempferol and quercetin—against tumors. O. japonica reportedly has antiproliferative, anti-angiogenic, and antimetastatic activities against various types of malignant tumors through the induction of apoptosis and cell cycle arrest, a blockade of downstream vascular endothelial growth factor (VEGF)-VEGFR2 pathways, and the regulation of epithelial-to-mesenchymal transition. In addition, emerging studies have highlighted the antitumor efficacy of kaempferol and quercetin. Interestingly, it was found that alterations of the mitogen-activated protein kinase (MAPK) signaling cascades are involved in the pivotal mechanisms of the antitumor effects of O. japonica and its two compounds against cancer cell overgrowth, angiogenesis, and metastasis. In summary, O. japonica could be considered a preventive and therapeutic medicinal plant which exhibits antitumor actions by reversing altered patterns of MAPK cascades, and kaempferol and quercetin might be potential components that can contribute to the efficacy and underlying mechanism of O. japonica.

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