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Shang B, Zhang T, Liu C, Lu J, Cui C, Feng J, Zhou Y. Analysis of three treatment methods for granulomatous lobular mastitis: a retrospective study in a single center. Front Oncol 2025; 15:1588836. [PMID: 40371221 PMCID: PMC12075127 DOI: 10.3389/fonc.2025.1588836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2025] [Accepted: 04/10/2025] [Indexed: 05/16/2025] Open
Abstract
Background Granulomatous lobular mastitis (GLM) is a rare, benign inflammatory condition of the breast that is difficult to distinguish from breast cancer on the basis of clinical and imaging findings. GLM typically has a long disease course, and is difficult to treat and prone to recurrence. Furthermore, there is currently no standard treatment for GLM. The aim of this study was to compare the therapeutic effects and patient satisfaction scores of surgery, triple anti-tuberculosis drug therapy, and combination treatment against GLM. Methods The medical records and follow-up data of GLM patients who underwent treatment at our center were retrospectively analyzed. Patients were divided into the treatment groups of surgery (group A), triple anti-tuberculosis drug therapy (group B), and combination therapy (group C). The demographic and clinical data, treatment outcomes, and patient satisfaction scores were compared among the three groups. Results Median follow-up duration of the patients was 35.43 months (range, 13.27-67.90 months). There were 106, 109, and 88 patients in groups A, B, and C respectively. The cure rates were similar among the groups (P = 0.220), although treatment duration was longest for group B, followed by group C and group A (P < 0.001). Group B had the highest patient satisfaction scores (P < 0.001),whereas the recurrence rate was highest in Group A (P < 0.001). Furthermore, no severe adverse drug reactions or major postoperative complications were observed in any of the patients. Conclusions Triple anti-tuberculosis drug therapy can effectively treat GLM patients with high patient satisfaction scores for potential application in clinical practice. The combination of surgery and triple anti-tuberculosis drug therapy is a suitable option for patients seeking rapid relief. Trial registration The study was registered at the Us Clinical Trial Registration Center (registration number: NCT06565845;date: 08/21/2024).
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Affiliation(s)
| | | | | | | | | | - Jing Feng
- Department of Breast Surgery, The First Affiliated Hospital of Harbin Medical
University, Harbin, China
| | - Yi Zhou
- Department of Breast Surgery, The First Affiliated Hospital of Harbin Medical
University, Harbin, China
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Shanbhag NM, Ameri MA, Shanbhag SN, Anandan N, Balaraj K, Bin Sumaida A. Diagnostic Challenges and Insights Into Granulomatous Mastitis: A Systematic Review. Cureus 2024; 16:e75733. [PMID: 39816317 PMCID: PMC11733251 DOI: 10.7759/cureus.75733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Accepted: 12/15/2024] [Indexed: 01/18/2025] Open
Abstract
Granulomatous mastitis (GM) is a chronic inflammatory breast condition that presents significant diagnostic challenges due to its clinical and imaging similarities to malignancies. Accurate diagnosis is crucial to avoid unnecessary interventions and ensure effective management. A total of 1,216 articles were initially identified through a comprehensive database search. After removing duplicates and conducting a systematic review, 73 studies were shortlisted for full-text evaluation, with 31 studies meeting the inclusion criteria. These studies were analyzed to extract data on diagnostic methodologies, sample sizes, accuracy, and limitations. The review highlights the central role of histopathology in the definitive diagnosis of GM, supported by adjunctive tools such as contrast-enhanced ultrasound, magnetic resonance imaging, and polymerase chain reaction. Imaging modalities, while valuable, often lack specificity and require histological confirmation. Emerging techniques, including quantitative imaging parameters and molecular diagnostics, offer promise in enhancing diagnostic precision. A multidisciplinary approach integrating clinical, radiological, and histopathological findings remains critical. GM diagnosis requires a nuanced approach combining traditional and emerging techniques. Histopathology remains the gold standard, but advancements in imaging and molecular diagnostics provide new avenues for improving accuracy and guiding management. The findings emphasize the need for further research and standardized diagnostic protocols to address the complexities of GM.
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Affiliation(s)
- Nandan M Shanbhag
- Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, ARE
- Radiation Oncology/Palliative Care, Tawam Hospital, Al Ain, ARE
| | | | - Sneha N Shanbhag
- Internal Medicine, Dubai Physiotherapy and Rehabilitation Centre, Dubai, ARE
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Parperis K, Costi E, Philippou S, Hadi M, Derk CT. >Efficacy of disease-modifying antirheumatic drugs in the treatment of granulomatous mastitis: a systematic review. Rheumatol Int 2024; 44:2371-2379. [PMID: 39283511 DOI: 10.1007/s00296-024-05719-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Accepted: 09/01/2024] [Indexed: 09/26/2024]
Abstract
INTRODUCTION Idiopathic granulomatous mastitis (IGM) is an inflammatory breast disorder of unknown etiology. This benign condition can mimic the clinical presentation of breast cancer and is characterized by symptoms such as breast pain, erythema, and swelling. Over the past few years, Disease-Modifying Antirheumatic Drugs (DMARDs) have been increasingly used to manage this condition. However, strong evidence to support their use is lacking. OBJECTIVES This systematic review aimed to summarize the evidence and evaluate the efficacy of DMARDs in the management of IGM. METHODS A systematic literature review, adhering to PRISMA guidelines, was conducted across electronic databases, including PubMed, EMBASE, SCOPUS, directory of open access journals (DOAJ) and Cochrane Library from their inception until May 2024. We included retrospective and prospective studies while excluding case reports and case series of less than 10 patients. RESULTS Eighteen studies met our eligibility criteria. Fifteen studies were retrospective, while 2 were prospective. No randomized controlled trials were identified. Of these, 16 papers examined the effect of methotrexate on IGM, revealing significant disease improvement in most cases. Several of the studies indicated that patients treated with azathioprine and mycophenolate mofetil also achieved favorable responses. CONCLUSION Given the rarity of IGM, only a limited number of studies have explored the use of DMARDs as a pharmacological treatment option. A significant barrier to advancing our understanding is the substantial heterogeneity in the quality and volume of data provided by these studies. Therefore, there is a need for well-designed, randomized, placebo-controlled trials to rigorously assess the efficacy of DMARDs in the treatment of IGM.
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Affiliation(s)
- Konstantinos Parperis
- University of Cyprus Medical School, Nicosia, Cyprus.
- University of Cyprus, Palaios dromos Lefkosias Lemesou No. 215/6, Aglantzia, Nicosia, 2029, Cyprus.
| | - Egli Costi
- University of Cyprus Medical School, Nicosia, Cyprus
| | | | - Mohanad Hadi
- Roger Williams Medical Center and Brown University, Providence, RI, USA
| | - Chris T Derk
- University of Cyprus Medical School, Nicosia, Cyprus
- University of Pennsylvania, Philadelphia, PA, USA
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Shanbhag SN, Shanbhag NM. Granulomatous Mastitis: An Autobiographical Case Report. Cureus 2024; 16:e66701. [PMID: 39135666 PMCID: PMC11318956 DOI: 10.7759/cureus.66701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2024] [Indexed: 08/15/2024] Open
Abstract
Granulomatous mastitis (GM) is a rare, benign inflammatory breast disease that predominantly affects women of childbearing age and often mimics breast carcinoma. The diagnosis requires histopathological examination due to nonspecific imaging findings. Treatment includes antibiotics, corticosteroids, and surgery, but no standardized protocols exist. This autobiographical case report describes a 34-year-old woman with a tender breast lump following trauma, initially misdiagnosed as a simple abscess. Despite incision and drainage, she developed erythema nodosum, persistent fever, and arthritis, which responded to corticosteroids. Further investigation, including an ultrasound-guided biopsy and MRI, confirmed GM. Recurrent symptoms were managed with prednisolone and doxycycline, leading to significant improvement. This case report aims to highlight the diagnostic challenges associated with GM, emphasizing the necessity for a detailed histopathological examination to achieve an accurate diagnosis. It also brings attention to the significant emotional impact on patients facing a rare and complex diagnosis. By presenting this case, we aim to highlight the critical importance of a comprehensive and multidisciplinary approach to patient care in managing GM effectively.
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Affiliation(s)
- Sneha N Shanbhag
- Department of Internal Medicine, Dubai Physiotherapy and Rehabilitation Centre, Dubai, ARE
| | - Nandan M Shanbhag
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, ARE
- Department of Radiation Oncology, Tawam Hospital, Al Ain, ARE
- Department of Palliative Care, Tawam Hospital, Al Ain, ARE
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Zhang M, Pu D, Feng D, Shi G, Li J. Rare and Complicated Granulomatous Lobular Mastitis (2000-2023): A Bibliometrics Study and Visualization Analysis. J Inflamm Res 2024; 17:3709-3724. [PMID: 38882188 PMCID: PMC11179654 DOI: 10.2147/jir.s465844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 05/28/2024] [Indexed: 06/18/2024] Open
Abstract
Purpose Granulomatous mastitis (GLM) is a rare and complex chronic inflammatory disease of the breast with an unknown cause and a tendency to recur. As medical science advances, the cause, treatment strategies, and comprehensive management of GLM have increasingly attracted widespread attention. The aim of this study is to assess the development trends and research focal points in the GLM field over the past 24 years using bibliometric analysis. Methods Using GLM, Granulomatous mastitis (GM), Idiopathic granulomatous lobular mastitis (IGLM), and Idiopathic granulomatous mastitis (IGM) as keywords, we retrieved publications related to GLM from 2000 to 2023 from the Web of Science, excluding articles irrelevant to this study. Citespace and VOSviewer were employed for data analysis and visualization. Results A total of 347 publications were included in this analysis. Over the past 24 years, the number of publications has steadily increased, with Turkey being the leading contributor in terms of publications and citations. The University of Health Sciences, Istanbul University, and Istanbul University Cerrahpasa were the most influential institutions. The Breast Journal, Breast Care, and Journal of Investigative Surgery were the journals that published the most on this topic. The research primarily focused on the cause, differential diagnosis, treatment, and comprehensive management of GLM. Issues related to recurrence, hyperprolactinemia, and Corynebacterium emerged as current research hotspots. Conclusion Our bibliometric study outlines the historical development of the GLM field and identifies recent research focuses and trends, which may aid researchers in identifying research hotspots and directions, thereby advancing the study of GLM.
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Affiliation(s)
- Mengdi Zhang
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan City, People's Republic of China
| | - Dongqing Pu
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan City, People's Republic of China
| | - Dandan Feng
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan City, People's Republic of China
| | - Guangxi Shi
- Department of Thyroid and Breast Diagnosis and Treatment Center, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan City, People's Republic of China
| | - Jingwei Li
- Department of Thyroid and Breast Diagnosis and Treatment Center, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan City, People's Republic of China
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Ong SS, Ho PJ, Liow JJK, Tan QT, Goh SSN, Li J, Hartman M. A meta-analysis of idiopathic granulomatous mastitis treatments for remission and recurrence prevention. Front Med (Lausanne) 2024; 11:1346790. [PMID: 38873201 PMCID: PMC11170159 DOI: 10.3389/fmed.2024.1346790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/10/2024] [Indexed: 06/15/2024] Open
Abstract
Purpose The major aim of our meta-analysis was to review the effectiveness of various treatment modalities for achieving successful remission and preventing recurrence for women with idiopathic granulomatous mastitis (IGM). This knowledge is instrumental in developing evidence-based guidelines for clinicians to improve management strategies and outcomes for patients with IGM. Methods A systematic literature search was performed on MEDLINE (Ovid), Embase (Elsevier), PubMed, Cochrane Library, Web of Science, and Google Scholar; studies published to 19 January 2022 were included. A meta-analysis of 57 observational studies was performed. The results of two randomized controlled trials were also examined. Results There were 3,035 IGM patients across the observational and randomised studies. Overall recurrence and remission rates across all treatment strategies in 59 studies are 87.9% (2,667/3035) and 13.5% (359/2667), respectively. The studies reported 19 different treatment strategies, comprising observation, medical monotherapies, surgery, and combinations involving medical therapies, with and without surgery. Among monotherapy treatment, surgical management had the highest pooled remission rate (0.99 [95% confidence interval (CI) = 0.97-1.00]); among combination therapy, this was steroids and surgery (0.99 [0.94-1.00]). Antibiotic monotherapy had the lowest remission rate (0.72 [0.37-0.96]). The highest recurrence rates belonged to treatments that combined antibiotics and surgery (0.54 [0.02-1.00]), and antibiotics, steroids, and surgery (0.57 [0.00-1.00]). Most successful for preventing recurrence were observation (0.03 [0.00-0.10]), methotrexate (0.08 [0.00-0.24]), and steroids and surgery (0.05 [0.01-0.12]). There is a significant association between longer follow-up duration and recurrence rate reported, p = 0.002. Conclusion Combination therapies, especially those incorporating antibiotics, steroids, and surgery, have demonstrated higher remission rates, challenging the use of antibiotic monotherapy. There is an increased emphasis on the need for personalised, multi-pronged approach for preventing IGM recurrence, with longer follow-up care. More prospective future work in IGM research, with standardised diagnostic criteria, treatment protocols, and reporting guidelines will be important for developing treatment protocols and guidelines clinicians can adhere to in the clinical management of IGM patients.Systematic review registration: PROSPERO (CRD42022301386).
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Affiliation(s)
- Seeu Si Ong
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Peh Joo Ho
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jonathan Jun Kit Liow
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Qing Ting Tan
- KK Breast Department, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Serene Si Ning Goh
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Jingmei Li
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mikael Hartman
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
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Mithen R, Mahin Nallasivam RR, Thangaswamy D, Mohanapriya T. Evaluation of clinical profiles, imaging findings and antituberculosis treatment outcome in granulomatous mastitis: An Indian scenario. Indian J Tuberc 2024; 71:163-169. [PMID: 38589120 DOI: 10.1016/j.ijtb.2023.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/13/2023] [Accepted: 04/28/2023] [Indexed: 04/10/2024]
Abstract
BACKGROUND The management of choice for granulomatous mastitis (GM) has yet to be determined but few studies have demonstrated that anti-tubercular treatment (ATT) could be an effective alternative therapeutic option. Hence, the objective of the current study is to determine the clinical feature, radiological imaging findings, and histopathological examination results exhibited by GM and tuberculosis (TB)-proven GM as well as to evaluate the ATT clinical outcome in GM patients. METHODS The study was performed on 68 GM patients who were referred to the department of pulmonology by the breast clinic (from January 2018 to August 2021). Study populations were categorized into two groups GM and TB-proven GM patients and all were prescribed with standard ATT regimen and were continuously followed up. SPSS version 25 was employed for statistical assessment. RESULTS Our study showed that 6 patients from GM and 4 patients from the TB-proven GM group got relapsed. For patients who displayed partial remission, ATT treatment was started after assessing the side effects potential. 14.6% (n = 6) and 7.4% (n = 2) patients who initially demonstrated partial remission were also completely cured. ATT treatment curable rate was determined to be 90% (n = 37) and 81.5% (n = 22) for GM and TB-proven GM patients correspondingly. Therefore, the current study demonstrated nil significant differences between groups. CONCLUSION The current study warrants that ATT therapy could be an effective and better treatment of choice for GM patients irrespective of their clinical condition.
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Affiliation(s)
- R Mithen
- Department of Respiratory Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - R R Mahin Nallasivam
- Department of General Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Dhanasekar Thangaswamy
- Department of Respiratory Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - T Mohanapriya
- Department of General Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.
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Li Q, Wan J, Feng Z, Shi J, Wei W. Predictive Significance of the Preoperative Neutrophil-lymphocyte Ratio for Recurrence in Idiopathic Granulomatous Mastitis Patients. Am Surg 2023; 89:5577-5583. [PMID: 36880848 DOI: 10.1177/00031348231161793] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
BACKGROUND To investigate and assess the correlation between inflammatory markers, such as the preoperative neutrophil-lymphocyte ratio (NLR), and the recurrence of idiopathic granulomatous mastitis (IGM). METHODS All patients with IGM who were free of malignancy or inflammatory diseases were included in this retrospective analysis between January 2013 and December 2019. On the basis of the presence or absence of recurrence, the patients were split into two groups. After collecting retrospective data, the relationship between patient characteristics, hematological markers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), NLR, platelet-lymphocyte ratio (PLR), and white blood cell count (WBC), and their connection with postoperative recurrence were assessed utilizing univariate and multivariate analyses, receiver operating characteristic curves (ROC curves), and logistic regression. RESULTS Recurrences occurred in 40.0% (32/80) of the 80 patients over a median follow-up duration of 35.5 months (22.0-47.8 months). The recurrent group showed higher NLR and CRP than the non-recurrent group (PNLR = .003, PCRP = .02). Neutrophil-lymphocyte ratio and postoperative recurrence were associated (correlation coefficient r = .436, P = .01). The ROC curve's ideal threshold, which had predictive value for IGM recurrence, was 2.18 (sensitivity: 46.9%; specificity: 14.6%). CONCLUSION The preoperative NLR is a simple and affordable way to predict IGM relapse, which is important for directing clinical work.
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Affiliation(s)
- Qiang Li
- Department of Breast and Thyroid Surgery, the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Nanjing, China
| | - Jiangyang Wan
- Department of Breast and Thyroid Surgery, the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Nanjing, China
| | - Ziyu Feng
- Department of Breast and Thyroid Surgery, the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Nanjing, China
| | - Jianhua Shi
- Department of Breast and Thyroid Surgery, Nantong First People's Hospital, the Second Affiliated Hospital of Nantong University, Nanjing, China
| | - Wan Wei
- Department of Breast and Thyroid Surgery, the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Nanjing, China
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Wang YT, Tang YQ, Xu JY, Bian XM. The Disease Experience of Women with Granulomatous Lobular Mastitis. A Qualitative Interview Study. J Inflamm Res 2023; 16:4347-4361. [PMID: 37791120 PMCID: PMC10544261 DOI: 10.2147/jir.s419347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 08/25/2023] [Indexed: 10/05/2023] Open
Abstract
Background The incidence of granulomatous lobular mastitis (GLM) is increasing year by year, and the breast wounds of women patients with GLM can develop into abscesses, fistulas, sinuses, and sometimes orange-like degeneration similar to malignant tumors, which seriously affects the quality of life of women patients with GLM. In China, breast wounds in women patients with GLM have not been better managed. Therefore, the purpose of this study is to explore the disease experience of women patients with GLM, to provide a basis for the development of precise intervention and support strategies for women patients with GLM, and to further improve the quality of nursing management and enrich the research types of GLM. Methods In this study, 10 cases of GLM women patients from a tertiary hospital in Hangzhou, Zhejiang Province were selected by purposive sampling. After obtaining the informed consent of GLM women patients, semi-structured interviews were conducted with GLM women patients using the interview outline to collect qualitative data. The interview was recorded, transcribed verbatim in the local language, and then translated into English, and the content analysis method was used to analyze the data. The Consolidated Criteria for Reporting Qualitative Research (CORE-Q) checklist follows the report 's findings. Results Our study identified six themes: (a) Perception of the disease, (b) Emotional discomfort (c) Variety of changes (d) Lack of specific skills (e) Coping strategies adopted to rebuild health, (f) Expectation. Conclusion The experience of women with GLM is characterized by diversity and specificity. After experiencing physical trauma, most patients use support systems to change negative attitudes and rebuild physical and mental health. Family, hospital and society should be fully linked to strengthen the prevention of GLM and the popularization of nursing management knowledge; nurses should provide targeted nursing services. Nursing leaders should improve the medical security system, broaden the medical channels, and reduce the pain experience and pressure of patients.
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Affiliation(s)
- Yan Ting Wang
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Ya Qin Tang
- Department of Nursing, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Jia Yuan Xu
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Xue Mei Bian
- Department of Nursing, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
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Sarkar DK, Banerjee R, Gupta S, Singhal AK, Halder A. Management of idiopathic granulomatous mastitis: a prospective study. Ann R Coll Surg Engl 2023; 105:218-224. [PMID: 35638904 PMCID: PMC9974337 DOI: 10.1308/rcsann.2022.0017] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Idiopathic granulomatous mastitis (IGM) is an evolving problem with varied presentation. No definite treatment guidelines are available at present that may reduce rate of recurrence. Current evidence suggests a ductal pathology behind IGM, which leads to periductal mastitis, leakage and sinus/fistula formation. Thus, excision of the sinus/fistulous tract with en-bloc wide local excision (WLE) of the lesion could be curative. The objective of this study was to look for the basic aetiology of IGM and evaluate the effectiveness of WLE with total or partial duct excision as a curative approach. METHODS An institutional prospective comparative study was conducted over 4 years (2015-2019), in which 59 cases of IGM were randomly divided into three groups. After necessary investigations, patients in group A received steroid therapy, those in group B received WLE and patients in group C received WLE with total or partial duct excision as the mode of treatment. Postoperative follow-up was between 6 months and 3 years. RESULTS Histopathological examination (HPE) was found to be the most suitable diagnostic procedure. Patients in group B showed the highest rate of recurrence (73.6%), followed by group A (35.0%) and group C (5.0%). Patients in group C had a significantly lower chance of recurrence compared with both group A and group B (p < 0.05). HPE reports of excised ducts from patients in group C showed ductal disruption and leakage along with periductal granuloma in 70% of cases. CONCLUSIONS The presence of duct granuloma indicates the association of ductal pathology in IGM. IGM is therefore a disease of the mammary ducts and en-bloc duct excision is curative in non-responding cases.
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Affiliation(s)
- DK Sarkar
- IPGME&R & SSKM Hospital, Kolkata, India
| | | | - S Gupta
- Midnapore Medical College and Hospital, Midnapore, India
| | | | - A Halder
- IPGME&R & SSKM Hospital, Kolkata, India
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Zhang HJ, Ding PP, Zhang XS, Wang XC, Sun DW, Bu QA, Li XQ. MAC mediates mammary duct epithelial cell injury in plasma cell mastitis and granulomatous mastitis. Int Immunopharmacol 2022; 113:109303. [DOI: 10.1016/j.intimp.2022.109303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/01/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022]
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Velidedeoglu M, Umman V, Kilic F, Celik V, Gazioglu E, Hatipoglu E, Ozturk T, Mete B. 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. Surg Today 2022; 52:668-680. [PMID: 34549317 DOI: 10.1007/s00595-021-02367-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 07/28/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE The goals of this study were to report our clinical experience in a single center at a high-volume tertiary university hospital in Istanbul and to introduce a diagnostic algorithm based on a 5-year follow-up of 152 women with biopsy-proven idiopathic granulomatous mastitis (IGM). IGM is an uncommon, non-malignant, chronic inflammatory disease of the mammary gland with an unknown etiology. The symptoms, clinical presentation, and radiologic findings of IGM may resemble carcinomas. To our knowledge, this study comprises the largest series of IGM, especially with a 5-year follow-up, yet reported in the English literature. METHODS The present study reported our single-center clinical experience at a tertiary university hospital in Istanbul, Turkey, and introduced a diagnostic algorithm using our treatment protocol based on a 5-year follow-up of 152 women with biopsy-proven IGM. Our database of 10 years' experience containing over 700 patients with IGM was evaluated. However, to assess recurrence and resistance to treatment, only the 152 patients with a long follow-up period of 5 years were included in the study group. The analysis included 152 women with biopsy-proven IGM who were treated between January 2009 and March 2014. The clinical data of the presentation, histopathology, and treatment modalities were analyzed by reviewing the medical records. RESULTS Of the 152 patients diagnosed with granulomatous mastitis, 32 (21%) recovered by expectant management, while 14 (9%) responded to antibiotics, 65 (43%) received corticosteroids, 20 (13%) had antituberculosis medication, 16 (11%) underwent excision, and 5 (3%) responded to non-steroidal anti-inflammatory drugs. Fifty-one patients (33%) had recurrence; of these, 30 achieved a cure with second-line treatment, 16 underwent excision, and 5 achieved a cure with observation. CONCLUSION IGM is a rare benign breast disorder, and clinicians need a high index of suspicion to diagnose it, as IGM can be mistaken for breast cancer. Unlike periductal mastitis, IGM does not evolve secondary to nicotine addiction and is typically seen in women of childbearing age with a recent history of pregnancy and lactation. The diagnosis can be challenging, and an evaluation with a multidisciplinary team is necessary. There is no consensus concerning the definitive treatment approach. We suggested a diagnostic algorithm in the present study, using our treatment protocol based on the 5 years' follow-up of 152 women.
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Affiliation(s)
- Mehmet Velidedeoglu
- Department of General Surgery, Cerrahpasa School of Medicine, Istanbul University, 34098, Fatih, İstanbul, Turkey
| | - Veysel Umman
- Department of General Surgery, Cerrahpasa School of Medicine, Istanbul University, 34098, Fatih, İstanbul, Turkey.
| | - Fahrettin Kilic
- Department of Radiology, Cerrahpasa School of Medicine, Istanbul University, İstanbul, Turkey
| | - Varol Celik
- Department of General Surgery, Cerrahpasa School of Medicine, Istanbul University, 34098, Fatih, İstanbul, Turkey
| | - Ertugrul Gazioglu
- Department of General Surgery, Cerrahpasa School of Medicine, Istanbul University, 34098, Fatih, İstanbul, Turkey
| | - Engin Hatipoglu
- Department of General Surgery, Cerrahpasa School of Medicine, Istanbul University, 34098, Fatih, İstanbul, Turkey
| | - Tulin Ozturk
- Department of Pathology, Cerrahpasa School of Medicine, Istanbul University, İstanbul, Turkey
| | - Birgul Mete
- Department of Infectious Diseases, Cerrahpasa School of Medicine, Istanbul University, İstanbul, Turkey
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13
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Almobarak A, Siddig S, Hassan A, Ahmed M. Diagnosis of idiopathic granulomatous mastitis in a sudanese woman. J Microsc Ultrastruct 2022; 10:33-35. [PMID: 35433259 PMCID: PMC9012406 DOI: 10.4103/jmau.jmau_51_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/03/2020] [Accepted: 11/29/2020] [Indexed: 11/04/2022] Open
Abstract
Idiopathic granulomatous mastitis (IGM) is a relatively rare specific chronic inflammatory process of unknown etiology, that diagnostically overlaps with common breast pathologies in Sudan, namely breast cancer (BC) and tuberculous mastitis (TBM). We report the case of a 34-year-old female who presented with a 1-month history of a painful lump in the lower outer quadrant of her left breast. A tru-cut biopsy showed features of granulomatous inflammation suggestive of IGM. Four months later, she presented with similar features and fine-needle aspiration cytology (FNAC) confirmed the presence of IGM and excluded the presence of both, BC and TBM. Histology once again confirmed the diagnosis of granulomatous mastitis with no evidence of breast cancer. Grocott's Methenamine Silver, Ziehl–Neelsen stain, and polymerase chain reaction were negative and accordingly the possibility of fungal infection and TBM were excluded. To our knowledge, this is the first case report of IGM in Sudan. FNAC helped in correct diagnosis of our case and importantly, conditions such as BC and TBM were both excluded as common mimickers of IGM. Although breast biopsy is the main golden approach in the diagnosis of IGM in addition to the usefulness of adjunct ancillary microbiological techniques, still further research is needed to establish whether FNAC can be a reliable tool in the diagnosis of IGM with the common practice of this diagnostic tool in Sudan.
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Nguyen MH, Molland JG, Kennedy S, Gray TJ, Limaye S. Idiopathic granulomatous mastitis: case series and clinical review. Intern Med J 2021; 51:1791-1797. [PMID: 34713960 DOI: 10.1111/imj.15112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 06/15/2020] [Accepted: 07/12/2020] [Indexed: 01/16/2023]
Abstract
Idiopathic granulomatous mastitis is a chronic inflammatory breast disorder that typically affects young, parous women, often following lactation. Patients present with tender, erythematous breast lesions with histological evidence of non-caseating granulomata and an inflammatory cell infiltrate. An immune-mediated pathophysiology is hypothesised and an association with lipophilic Corynebacterium species is observed. Initial diagnosis is often delayed due to lack of awareness of the condition and management of refractory disease can be challenging. We present an extensive case series of patients collaboratively managed by subspecialty physicians and surgeons at a single centre in Sydney, Australia. The accompanying review expands on features of this condition and supports the utility of a multidisciplinary approach.
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Affiliation(s)
- Matthew H Nguyen
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Janice G Molland
- Department of Breast and Endocrine Surgery, Concord Hospital, Sydney, New South Wales, Australia
| | - Suellyn Kennedy
- Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia
| | - Timothy J Gray
- Department of Microbiology and Infectious Diseases, Concord Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, Concord Hospital Clinical School, Sydney, New South Wales, Australia
| | - Sandhya Limaye
- Faculty of Medicine, Concord Hospital Clinical School, Sydney, New South Wales, Australia.,Department of Immunology, Concord Hospital, Sydney, New South Wales, Australia
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Basim P, Argun D, Argun F. Risk Factors for Idiopathic Granulomatous Mastitis Recurrence after Patient-Tailored Treatment: Do We Need an Escalating Treatment Algorithm? Breast Care (Basel) 2021; 17:172-179. [PMID: 35707181 PMCID: PMC9149487 DOI: 10.1159/000517399] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/21/2021] [Indexed: 11/19/2022] Open
Abstract
<b><i>Objective:</i></b> Idiopathic granulomatous mastitis (IGM) is a rare, relapsing, benign inflammatory breast disease. Due to the conflicting etiology and differential diagnosis, the effect of varied treatment regimens on high recurrence is controversial. Therefore, we aimed to report our clinical experience in determining risk factors for recurrence after patient-tailored treatment. <b><i>Methods:</i></b> This study evaluated 122 patients diagnosed with IGM according to sociodemographic characteristics, reproductive history, clinical presentation, time of diagnosis and radiological examinations, treatment management, and outcomes. The patients were classified into three groups based on curative treatment settings: medical therapy alone, surgery alone, and combined therapy. <b><i>Results:</i></b> The rates of patients receiving medical therapy alone, surgical therapy alone, and combined therapy were 23, 15.6, and 62.4%, respectively. Low vitamin B<sub>12</sub> levels, accompanying rheumatological disease, complaints-fistulae, number of complaints ≥3, presence of erythema nodosum, multicentricity, and treatment modality had a significant effect on disease recurrence (<i>p</i> < 0.05). The effect on IGM recurrence was 2.8 times greater for the patients with lower vitamin B<sub>12</sub> levels, 4.5 times greater for those with rheumatological disease, 3.3 times greater for those with fistulae, 2.4 times greater for those presenting with ≥3 complaints, 2 times greater for the presence of multicentricity, 2.3 times greater for the presence of erythema nodosum, and 4.5 times greater for the patients receiving medical therapy alone. <b><i>Conclusion:</i></b> Describing a low-risk patient profile can be an alternative while choosing monotherapy methods. For IGM patients at high risk of recurrence, an escalating treatment system may be effective in preventing relapses.
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Affiliation(s)
- Pelin Basim
- Department of General Surgery, Medical Faculty, Istanbul Medipol University, Istanbul, Turkey
- *Pelin Basim,
| | - Derya Argun
- Department of Internal Medicine, Medical Faculty, Istanbul Aydin University, Istanbul, Turkey
| | - Ferit Argun
- Department of Internal Medicine, Medical Faculty, Istanbul Aydin University, Istanbul, Turkey
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16
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Dağ A, Edizsoy A, Berkeşoğlu M. Oncoplastic Breast Surgery Techniques When Surgery is Essential for the Management of the Idiopatic Granulomatous Mastitis. J INVEST SURG 2021; 35:653-658. [PMID: 34180771 DOI: 10.1080/08941939.2021.1922552] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Immunosuppressive agents are the main treatment options for idiopathic granulomatous mastitis (IGM). However, in some patients, the remaining large pouch and seroma may cause recurrence and severe deformity. Oncoplastic breast surgery (OBS) techniques can be used when surgery is required. MATERIAL AND METHODS In this study, surgical results of the patients histopathologically diagnosed with IGM who underwent any of the OBS techniques between 2016 and 2020 were evaluated. Patient characteristics, surgical indications, and technical details of the surgery were recorded. RESULTS Eighteen patients who underwent wide excision combined with the OBS technique were included in the study. Surgery was performed owning to persistent disease (n = 12), recurrence (n = 3), and patient preference (n = 3). No major complications occurred after the OBS technique. None of the patients had recurrence at the surgical site. CONCLUSIONS When surgery is indicated in patients with IGM, successful results can be obtained with acceptable complication rates by using the simplest and easiest applicable OBS techniques, including volume displacement technique.
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Affiliation(s)
- Ahmet Dağ
- Faculty of Medicine, Clinic of General Surgery, Mersin University, Mersin, Turkey
| | - Akay Edizsoy
- Clinic of Surgical Oncology, Isparta City Hospital, Isparta, Turkey
| | - Mustafa Berkeşoğlu
- Faculty of Medicine, Clinic of General Surgery, Mersin University, Mersin, Turkey
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17
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Papila Kundaktepe B, Velidedeoğlu M, Mete B. The effect of methotrexate monotherapy on treatment-resistant idiopathic granulomatous mastitis patients. Surgeon 2021; 20:e13-e19. [PMID: 33836950 DOI: 10.1016/j.surge.2021.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/16/2021] [Accepted: 03/09/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) is a disease of unknown etiology, involving a chronic inflammatory process, characterized by noncaseating granuloma formation. IGM can mimic a tumor clinically and radiologically. Since we are a tertiary referral center, most of our patients (n = 56, 87.5%) are secondary admissions who have previously had antibiotics and steroid treatments; therefore, we accept these patients as resistant cases. Here, we aim to present our single-center series of 64 patients with resistant IGM who underwent methotrexate monotherapy. To the best of our knowledge, our study includes the highest number of patients described in the literature with IGM who have undergone this treatment. METHODS This study included 64 patients, 56 of which were resistant cases, diagnosed with IGM between January 2013 and January 2020 at Istanbul University Cerrahpasa, Cerrahpasa Medical Faculty, General Surgery Breast Outpatient Clinic that were followed-up at least once. These patients were administered oral methotrexate monotherapy 15 mg/week for 24 weeks, and in relapsed cases, the treatment was up to 20 mg/week for 1 year. Folic acid 10 mg/week was given as a supplement to all patients. RESULTS Complete recovery was observed in 52 (81.25%) of the 64 patients. Follow-up was discontinued by 4 patients. The dose was increased and the duration of treatment was extended up to 1 year when relapse was observed in 8 patients and complete response was then obtained in these cases. Only 3 patients (4.69%) experienced side effects and were switched to subcutaneous treatment due to nausea. CONCLUSION Considering the high patient compliance, low recurrence, minimal side effects, and overall success of the treatment, we believe that methotrexate monotherapy may be used in treatment-resistant IGM patients and may also be the first choice for first-line treatment in the future.
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Affiliation(s)
- Berrin Papila Kundaktepe
- Istanbul University-Cerrahpasa, Cerrahpaşa Faculty of Medicine, Department of General Surgery, Turkey.
| | - Mehmet Velidedeoğlu
- Istanbul University-Cerrahpasa, Cerrahpaşa Faculty of Medicine, Department of General Surgery, Turkey.
| | - Bilgül Mete
- Istanbul University-Cerrahpasa, Cerrahpaşa Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Turkey.
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18
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Chen R, Chen J, Peng A, Yang L, Zhou R. Clinical therapeutic evaluation of vacuum sealing drainage and precise ultrasound-guided debridement in the treatment of non-lactational mastitis. Exp Ther Med 2021; 21:480. [PMID: 33767775 PMCID: PMC7976372 DOI: 10.3892/etm.2021.9911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 02/10/2021] [Indexed: 12/02/2022] Open
Abstract
The aim of the present study was to compare the efficacy of vacuum sealing drainage (VSD) and precise ultrasound-guided debridement in the treatment of non-lactational mastitis and to determine the optimal surgical treatment. A set of 60 cases diagnosed with non-lactational mastitis who had received surgical treatment at the Department of Thoracic and Breast Surgery of Xiamen Hospital of Traditional Chinese Medicine (Xiamen, China) between July 2017 and June 2019 were included. According to the surgical method, 30 patients were assigned to the VSD group and 30 patients were assigned to the precise ultrasound-guided debridement group. The clinicopathological data of the two groups were compared. The overall rates of recurrence and new incidence were 6.8 and 8.5%, respectively. The mean total disease course was 5.3 months and all of the patients were cured after treatment. Except for the hospitalization time and postoperative pain scores, the clinicopathological data between the two groups were similar. The hospitalization time in the VSD group was significantly longer than that in the precise ultrasound-guided debridement group. Pain scores on the first and third days after the operation in the precise ultrasound-guided debridement group were significantly higher than those in the VSD group (P=0.008 and 0.001, respectively). In conclusion, the efficacies of VSD and precise ultrasound-guided debridement for the treatment of non-lactational mastitis were generally both satisfactory without significant differences. Of note, the former is suitable for patients with inverted nipples and obvious skin ulcerations, while the latter is mainly suitable for patients with abscesses, small surgical incisions and those who require short hospital stays.
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Affiliation(s)
- Ruifu Chen
- Department of Thoracic and Breast Surgery, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, Fujian 361000, P.R. China
| | - Junpeng Chen
- Department of Thoracic and Breast Surgery, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, Fujian 361000, P.R. China
| | - Ajing Peng
- Department of Thoracic and Breast Surgery, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, Fujian 361000, P.R. China
| | - Lihua Yang
- Department of Thoracic and Breast Surgery, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, Fujian 361000, P.R. China
| | - Ruijuan Zhou
- Department of Thoracic and Breast Surgery, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, Fujian 361000, P.R. China
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Yin Y, Liu X, Meng Q, Han X, Zhang H, Lv Y. Idiopathic Granulomatous Mastitis: Etiology, Clinical Manifestation, Diagnosis and Treatment. J INVEST SURG 2021; 35:709-720. [PMID: 33691563 DOI: 10.1080/08941939.2021.1894516] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Idiopathic granulomatous mastitis (IGM) is a rare form of chronic inflammatory breast disease. Although it is a benign breast lesion, it may be sometimes difficult to distinguish from breast cancer. The cause of IGM is unknown, but may be associated with autoimmunity, abnormal hormone levels and infection. While the clinical manifestations of IGM involve various manifestations of inflammation, the diagnosis is principally established by histopathology, characterized by non-caseating granulomas and microabscess formation centered on the breast lobules. Therapeutic options for IGM range from observation to various medical treatments, such as steroids, immunosuppressants, and antibiotics, to surgical intervention, particularly if secondarily infected. Given that the controversy on etiology and treatment choices, we accomplished the present review through reviewing IGM-related literature published in 'Pubmed' and 'Web of science' databases during 1997 to 2020, aiming to provide the basis for rational clinical diagnosis and treatment.
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Affiliation(s)
- Yulong Yin
- Department of Thyroid Breast Surgery, The Affiliated Hospital of Northwest University, Xi'an, Shaanxi Province, China
| | - Xianghua Liu
- Department of Thyroid Breast Surgery, The Affiliated Hospital of Northwest University, Xi'an, Shaanxi Province, China
| | - Qingjie Meng
- Department of Thyroid Breast Surgery, The Affiliated Hospital of Northwest University, Xi'an, Shaanxi Province, China
| | - Xiaogang Han
- Department of Thyroid Breast Surgery, The Affiliated Hospital of Northwest University, Xi'an, Shaanxi Province, China
| | - Haomeng Zhang
- Department of Thyroid Breast Surgery, The Affiliated Hospital of Northwest University, Xi'an, Shaanxi Province, China
| | - Yonggang Lv
- Department of Thyroid Breast Surgery, The Affiliated Hospital of Northwest University, Xi'an, Shaanxi Province, China
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20
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Granulomatous mastitis, erythema nodosum and arthritis syndrome: case-based review. Rheumatol Int 2021; 41:1175-1181. [PMID: 33649961 DOI: 10.1007/s00296-021-04820-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/20/2021] [Indexed: 10/22/2022]
Abstract
Granulomatous mastitis (GM) is a rare form of inflammatory breast condition associated with unilateral or bilateral breast pain, swelling and mass formation. Although the disease pathogenesis remains unknown, several reports have associated GM with manifestations such as erythema nodosum and occasionally with arthritis, suggesting that GM might have an autoimmune disease component. We aim to describe two cases of coexistence of GM, erythema nodosum, and arthritis. We also conducted a literature review to comprehensively assess and describe the characteristics of patients with GM, erythema nodosum, and arthritis, and identify effective treatment options. A literature review was conducted using PubMed and EMBASE, and 14 case reports/series were retrieved, with a total number of 29 patients. All patients are women and unilateral breast involvement was evident in the majority of patients. Nine patients (31%) presented with arthritis, 6 patients (20.7%) had a fever, and 6 patients (20.7%) developed the symptoms during pregnancy. All patients had normal chest radiograph and tissue cultures were negative. In most of the cases (n = 25, 86.2%), symptom improvement was observed with glucocorticoids and four patients (13.8%) underwent surgical treatment for the GM. Given the clinical characteristics of patients with GM, with erythema nodosum, with or without arthritis, and the positive response to glucocorticoids, we propose that the described phenotype represents an underrecognized systemic autoimmune disease that could be designated by the acronym "GMENA" (granulomatous mastitis, erythema nodosum, arthritis) syndrome. Further studies are needed to elucidate the pathogenesis of the syndrome.
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21
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Oak J, Nadkarni M, Shetty A, Sardar S, Kulkarni B. Methotrexate in the Treatment of Idiopathic Granulomatous Mastitis. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02754-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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22
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Yu H, Wang Q. Severe idiopathic granulomatous mastitis treated with systemic medication; A case report. J Int Med Res 2020; 48:300060519895685. [PMID: 31937165 PMCID: PMC7114291 DOI: 10.1177/0300060519895685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Idiopathic granulomatous mastitis is a benign chronic inflammatory breast disease and a confused treatment plan may result in worsening of the disease, unacceptable cosmetic damage for the patient and even mastectomy. We report a case of a 39-year-old Chinese woman with a two-month history of painful, solid, diabrotic, left breast lesions that measured 10 × 15 cm. Misdiagnosis had led to delayed wound healing with extensive ulcerative skin lesions. The patient was successfully treated with oral corticosteroids and bromocriptine without requirement for surgery.
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Affiliation(s)
- Haijing Yu
- Breast Centre Department, Guangdong Women and Children Hospital, Guangzhou, China
| | - Qi Wang
- Breast Centre Department, Guangdong Women and Children Hospital, Guangzhou, China
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23
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Xu H, Jiang Y, Liao M, Li D, Zhu C. Continuous postoperative negative pressure irrigation assisted mammaplasty in treating chronic refractory plasma cell mastitis. Gland Surg 2020; 9:2071-2078. [PMID: 33447558 DOI: 10.21037/gs-20-795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Chronic refractory plasma cell mastitis (CRPCM) is an aseptic inflammation of the breast with a chronic course of the disease, extended treatment cycle (months to years), with a high recurrence rate. The objective of this study was to evaluate the efficacy of continuous postoperative negative pressure irrigation assisted mammaplasty (CPNPIAM) in treating CRPCM. Methods Between 2016 and 2018, 36 CRPCM patients receiving CPNPIAM were enrolled in this study. CPNPIAM mainly involved complete lesion removal, immediate breast mammaplasty, and continuous postoperative negative pressure irrigation. The age of the patients, local symptoms, history of treatment, the duration of the disease before surgery, hospitalization period, related risk factors, the success rate, the recurrence rate and patients' overall satisfaction ratings were analyzed in the article. Results Patients were aged between 22 and 53 years (mean 34.64 years). All patients had a history of conservative treatment or simple drainage. Local symptoms included inflammatory mass (n=36, 100%), abscess (n=33, 92%), nipple discharge (n=7, 19%), inflammatory plaque (n=34, 94%), and sinus tract formation (n=19, 53%). The lesion sizes ranged from 3 to 10 cm (mean 5.13 cm) in diameter. The mean hospitalization period was 8.42 days. The success rate was 100% (36/36) and the recurrence rate was 0% (0/36) at a 3-month follow-up. The patients' overall satisfaction ratings were "very good" (n=22, 61%), "good" (n=12, 33%), and "moderate" (n=2, 6%) with no poor or unsatisfactory ratings. Conclusions CPNPIAM is an effective way of treating CRPCM, and showed a high success rate, a low recurrence rate, and high patient satisfaction.
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Affiliation(s)
- Hua Xu
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Mingjuan Liao
- Department of Traditional Chinese Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Dongliang Li
- Department of Thoracic Surgery, Shanxi Provincial Tumor Hospital, Taiyuan, China
| | - Chenfang Zhu
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
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Chalmers R, McClellan P, Silva V, Shutt N, Restini C. Red flags for the differential diagnosis of granulomatous mastitis: a case report. J Med Case Rep 2020; 14:215. [PMID: 33168069 PMCID: PMC7654600 DOI: 10.1186/s13256-020-02563-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 10/22/2020] [Indexed: 11/17/2022] Open
Abstract
Background Granulomatous mastitis (GM) is a rare benign chronic inflammatory breast disease. GM presents as a heterogeneous illness with variable clinical presentations, and its diagnosis is usually made by exclusion. There are no guidelines for the treatment of GM. This manuscript describes the management of a patient with GM, initially unsuccessfully treated outside our clinic under a diagnosis of mastitis. The patient’s history, physical examination, and needle biopsy flagged the patient’s findings as nonmalignant; however, imaging studies indicated a tumor. Differential diagnosis became a critical element of her care. This case report represents a valuable resource to foster more assertive clinical practice in managing patients with GM. The case coordination and its course were led by a team from an outreach clinic that provides health care services to underserved communities in the state of Michigan. Case presentation A 41-year-old G1P1 Hispanic female immigrant from Central America presented with a rare breast disease, granulomatous mastitis. A similar presentation occurred 5 years before pregnancy when she had an episode of pain and swelling in the left breast, which resolved spontaneously. She sought our services after being diagnosed with mastitis that was unsuccessfully treated. Physical examination revealed a nodular mass in the outer quadrants of the left breast without regional lymphadenopathy. Needle biopsy showed fibrohistiocytic and florid inflammatory reactions, with no evidence of invasive carcinoma. However, this result was inconsistent with the degree of abnormality revealed by the mammogram (BI-RADS grade 5), ultrasound, and physical examination. Full incisional biopsy revealed cystic neutrophilic GM. The surgical procedure, antibiotics, and corticosteroids resulted in a successful combination to secure the stable control of the symptoms and progression of this rare benign breast disease to date. Conclusions This patient’s case highlights the importance of integrated communication among front-line primary care and other health care professionals to reduce the risk of invasive procedures and avoid institutional costs. GM is a rare disease. We raised the manifold red flags in which the multiple professional chains recruited to care for this patient were concerning for advanced breast cancer. The lack of experience and evidence-based medicine contributed to the contradictory interpretation of the findings on GM's diagnosis.
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Affiliation(s)
- Richard Chalmers
- Family Medicine Residency Program, McLaren Macomb Hospital, 1000 Harrington Blvd, Mount Clemens, MI, 48043, USA
| | - Patrick McClellan
- Family Medicine Residency Program, McLaren Macomb Hospital, 1000 Harrington Blvd, Mount Clemens, MI, 48043, USA
| | - Vixey Silva
- Department of Pharmacology and Toxicology, College of Osteopathic Medicine, Michigan State University, 44575 Garfield Road, Building UC4., Clinton Township, MI, 48038, USA
| | - Natalie Shutt
- Department of Pharmacology and Toxicology, College of Osteopathic Medicine, Michigan State University, 44575 Garfield Road, Building UC4., Clinton Township, MI, 48038, USA
| | - Carolina Restini
- Department of Pharmacology and Toxicology, College of Osteopathic Medicine, Michigan State University, 44575 Garfield Road, Building UC4., Clinton Township, MI, 48038, USA.
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25
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Effectiveness of Methotrexate in Idiopathic Granulomatous Mastitis Treatment. Am J Med Sci 2020; 360:560-565. [PMID: 32635989 DOI: 10.1016/j.amjms.2020.05.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/08/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023]
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26
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Granulomatous Mastitis: Comparison of Novel Treatment of Steroid Injection and Current Management. J Surg Res 2020; 254:300-305. [PMID: 32497924 DOI: 10.1016/j.jss.2020.04.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/06/2020] [Accepted: 04/11/2020] [Indexed: 12/14/2022]
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27
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Gupta N, Vats M, Garg M, Dahiya DS. Bilateral idiopathic granulomatous mastitis. BMJ Case Rep 2020; 13:13/8/e234979. [PMID: 32868320 DOI: 10.1136/bcr-2020-234979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
A 35-year-old woman presented to the surgery outpatient department with a lump in her right breast for 2 months and pain for 1 month. After clinical examination and relevant investigations, we kept a working diagnosis of antibioma. The lump was excised under local anaesthesia and biopsy was sent. However, histopathological examination reported multiple non-caseating granulomas without acid-fast bacilli. Two months later, she developed a sinus with serous discharge at the scar site. At the same time, she developed pain in the left upper breast, which subsequently progressed to an abscess. Incision and drainage of the abscess was done, but the wound did not heal, and a discharging sinus appeared at the site. Finally, a diagnosis of idiopathic granulomatous mastitis was made, after excluding all other causes, and the patient was prescribed oral steroids. She recovered fully after 8 months and there is no recurrence till date.
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Affiliation(s)
- Nikhil Gupta
- Department of Surgery, PGIMER, Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Manu Vats
- Department of Surgery, PGIMER, Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Mradul Garg
- Department of Minimal Invasive, GI and Bariatric Surgery, Metro Heart Institute with Multispeciality, Faridabad, India
| | - Davinder Singh Dahiya
- Department of Advanced Laparoscopy, Gastrointestinal and Bariatric Surgery, Noble Heart Super Speciality Hospital, Rohtak, India
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Liu Z, Li J, Yang F, Hu Y, Liu J, Hu H, Su W. Sodium valproate combined with levetiracetam in pediatric epilepsy and its influence on NSE, IL-6, hs-CRP and electroencephalogram improvement. Exp Ther Med 2020; 20:2043-2048. [PMID: 32782515 PMCID: PMC7401305 DOI: 10.3892/etm.2020.8916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 12/10/2019] [Indexed: 01/25/2023] Open
Abstract
Efficacy of sodium valproate combined with levetiracetam (LEV) in pediatric epilepsy and its influence on neuron-specific enolase (NSE), interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP) as well as electroencephalogram (EEG) improvement were studied. Patients (n=100) with pediatric epilepsy admitted to and treated in Xiantao First People's Hospital Affiliated to Yangtze University from December 2015 to 2018 were enrolled in this study and randomly divided into observation group (n=50) and control group (n=50). Sodium valproate was administered in the control group, and the treatment with LEV was combined with sodium valproate in the observation group. After 12 weeks the cognitive function of patients was assessed using the Mini-Mental State Examination (MMSE) scale, Montreal cognitive assessment (MoCA) scale and Wechsler Memory Scale-Revised in China (WMS-RC). The quality of life (QOL) of patients was evaluated with the QOL in epilepsy-31 inventory (QOLIE-31) scale and Barthel Index, and blood was drawn from the patients to detect the neurological function indicators [NSE and glial fibrillary acidic protein (GFAP)] and inflammatory indicators (IL-6, IL-2 and hs-CRP). After treatment, the incidence rates of adverse reactions notably declined in the observation group (P<0.05), and the improvement in the cognitive function in the observation group were both superior to those in the control group (P<0.05). Observation group had lowered content of NSE, GFAP, IL-6, hs-CRP and IL-2 (P<0.05), and α wave was markedly decreased, but θ and δ waves were notably increased in the observation group (P<0.05). In the treatment of pediatric epilepsy, sodium valproate combined with LEV produces better efficacy, fewer adverse reactions, significantly improves patients' QOL and notably lowers the content of NSE, IL-6 and hs-CRP with notable EEG improvement, so it is a safe and reliable treatment that is worth popularization.
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Affiliation(s)
- Zhaoyang Liu
- Department of Pediatrics, Xiantao First People's Hospital Affiliated to Yangtze University, Xiantao, Hubei 433000, P.R. China
| | - Jianmu Li
- Department of Pediatrics, Xiantao First People's Hospital Affiliated to Yangtze University, Xiantao, Hubei 433000, P.R. China
| | - Fan Yang
- Department of Pediatrics, Xiantao First People's Hospital Affiliated to Yangtze University, Xiantao, Hubei 433000, P.R. China
| | - Yongbo Hu
- Department of Gastrointestinal Surgery, Xiantao First People's Hospital Affiliated to Yangtze University, Xiantao, Hubei 433000, P.R. China
| | - Jun Liu
- Department of Oncology, Xiantao First People's Hospital Affiliated to Yangtze University, Xiantao, Hubei 433000, P.R. China
| | - Hongmei Hu
- Department of Ophthalmology, Xiantao First People's Hospital Affiliated to Yangtze University, Xiantao, Hubei 433000, P.R. China
| | - Wenbing Su
- Department of Gastrointestinal Medicine, Xiantao First People's Hospital Affiliated to Yangtze University, Xiantao, Hubei 433000, P.R. China
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Chandanwale S, Naragude P, Shetty A, Sawadkar M, Raj A, Bhide A, Singh M. Cytomorphological Spectrum of Granulomatous Mastitis: A Study of 33 Cases. Eur J Breast Health 2020; 16:146-151. [PMID: 32285037 DOI: 10.5152/ejbh.2020.5185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/05/2020] [Indexed: 12/24/2022]
Abstract
Objective Granulomatous mastitis is an uncommon benign breast disease. Varied aetiologies such as tuberculosis, foreign body reactions, sarcoidosis, fungal and parasitic infections and autoimmunity have been suggested. Pre-operative definitive diagnosis is essential for proper treatment. In developing countries like India, fine needle aspiration is still widely used as a reliable technique for preoperative evaluation of palpable breast lumps. The objective of this study is to study the cytomorphological features of different forms of granulomatous mastitis and correlate with other clinical findings including histological features. Materials and Methods A total of 33 cases of granulomatous mastitis were reviewed. The patients underwent fine needle aspiration. Cytomorphological features were studied in detail and correlated with histopathological features and other clinical findings. Results All the 33 patients showed varied cytomorphological features which included epithelioid cells/granuloma with lymphocytes/plasma cells/polymorphs with or without necrosis/caseous necrosis and with or without giant cells. Ziehl Nelson stain showed acid fast bacilli in 13 smears. Out of 17 cases, the eight cases showed positive acid fast bacilli culture. Fungal stain such as Grocott-Gommeri Methane amine did not show fungi. Based on cytomorphological features in aspiration smears, they were grouped into 4 Groups. A total of 27 breast lesions were diagnosed as tuberculous mastitis, the four lesions were diagnosed as idiopathic granulomatous lobular mastitis and two lesions were diagnosed as foreign body granulomatous mastitis. Grocott-Gommeri Methane amine did not showed fungi. Based on cytomorphological features in aspiration smears, they were grouped into 4 Groups. A total of 27 breast lesions were diagnosed as tuberculous mastitis, the four lesions were diagnosed as idiopathic granulomatous lobular mastitis and two lesions were diagnosed as foreign body granulomatous mastitis. Conclusion Epithelioid granulomas with caseous necrosis with or without acid fast bacilli in cytology smears are diagnostic of tuberculosis. Cytology smears showing epithelioid granulomas with predominant polymorphs without necrosis and acid fast bacilli, a diagnosis of idiopathic granulomatous lobular mastitis must be considered. Histopathological examination is essential for definitive diagnosis in these cases.
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Affiliation(s)
- Shirish Chandanwale
- Department of Pathology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pimpri Pune, India
| | - Piyusha Naragude
- Department of Pathology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pimpri Pune, India
| | - Abhinav Shetty
- Department of Pathology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pimpri Pune, India
| | - Manoj Sawadkar
- Department of Pathology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pimpri Pune, India
| | - Akshi Raj
- Department of Pathology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pimpri Pune, India
| | - Aniket Bhide
- Department of Pathology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pimpri Pune, India
| | - Madhuri Singh
- Department of Pathology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pimpri Pune, India
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Zhang X, Li Y, Zhou Y, Liu D, Chen L, Niu K, Sun Q, Huang H. A systematic surgical approach for the treatment of idiopathic granulomatous mastitis: a case series. Gland Surg 2020; 9:261-270. [PMID: 32420250 DOI: 10.21037/gs.2020.02.06] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Surgical resection can be performed for idiopathic granulomatous mastitis (IGM), but recurrence and tissue defects remain issues. Here we report our 6-year experience with a four-pattern surgical approach for IGM that involves the use of a random breast dermo-glandular flap (BDGF). Methods Sixty-eight consecutive patients with IGM were prospectively enrolled from 01/2012 and 03/2017. Based on the extent, shape, and location of the lesions, four different patterns of surgery based on BDGF were used to remove the lesion and repair the defect. Operative data (time, blood loss, and intraoperative complications), primary healing time, recurrence, and patient-reported outcomes (cosmetic outcome, and improvement in dressing change and bathing) at 2 years were evaluated. Results Patients' median age was 35 (range, 22-55) years. Duration of IGM was 3-22 months, with a median lesion size of 3.5 (range, 0.9-9.1) cm. The operative time was significantly longer, and blood loss was more important with the increasing lesion size (both P<0.05). No significant intraoperative complications occurred. All wounds healed by primary intention. IGM relapsed in three patients (3/68, 4.4%); they were treated successfully with a second operation. The self-evaluated cosmetic outcome was "much better" in 45 patients (66.2%), "a little better" in 18 (26.5%), and "same or worse" in five (7.3%). The self-evaluated improvement in dressing change and bathing was "improved a lot" in 51 patients (75.0%), "improved a little" in 11 (16.2%), and "not improved or getting worse" in six (8.8%). Conclusions The BDGF-based systematic four-pattern surgical approach is effective in the treatment of IGM. Recurrence rate is low, there are no complications, and the cosmetic results and improvement in dressing change and bathing are generally favourable.
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Affiliation(s)
- Xiaohui Zhang
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science (CAMS) and Peking Union Medical College, Beijing 100730, China
| | - Yan Li
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science (CAMS) and Peking Union Medical College, Beijing 100730, China
| | - Yidong Zhou
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science (CAMS) and Peking Union Medical College, Beijing 100730, China
| | - Deshun Liu
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science (CAMS) and Peking Union Medical College, Beijing 100730, China
| | - Linlin Chen
- Department of Breast Surgery, Beijing Dangdai Hospital, Beijing 100010, China
| | - Kunying Niu
- Department of Breast Surgery, Beijing Dangdai Hospital, Beijing 100010, China
| | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science (CAMS) and Peking Union Medical College, Beijing 100730, China
| | - Hanyuan Huang
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science (CAMS) and Peking Union Medical College, Beijing 100730, China
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[Idiopathic granulomatous mastitis associated with erythema nodosum]. Ann Dermatol Venereol 2020; 146:571-576. [PMID: 31151772 DOI: 10.1016/j.annder.2019.04.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 12/24/2018] [Accepted: 04/08/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) is a rare, chronic, granulomatous, inflammatory disorder with potentially misleading clinical and radiological features. IGM is diagnosed after exclusion of infectious or tumoral diseases. Herein we report a case of erythema nodosum associated with IGM, which serves as a reminder that erythema nodosum may constitute an extra-mammary sign of IGM. PATIENTS AND METHODS A 36-year-old nulliparous woman presented with fever and skin rash at our dermatology clinic at the North Franche-Comté hospital in July 2017. Symptoms had occurred 2 days previously. The patient had a fever of 38.8°C and typical erythema nodosum on the limbs. Physical examination showed an irregular, inflammatory, abscessed mass measuring 20cm with multiple shrinkage zones that had been developing for 4 weeks and for which breast examinations were being performed. Laboratory tests showed an inflammatory state (CRP 155mg/mL, WBC 14.6×109/L), other tests (serum electrolytes and calcium, hepatic and renal tests, Streptotest, T-spot, HIV, HBV, HCV serology, anti-streptolysin, anti-streptodornase, local microbiology samples, antinuclear antibodies, soluble antigens antibodies, hemocultures, angiotensin-converting-enzyme and chest x-rays) were normal. Microbiology investigations were negative. Mammography revealed invasive mastitis. Breast sample biopsies showed giant cell granulomas without caseous necrosis or tumor cells, and histochemical staining (PAS, Ziehl, Grocott, Gram) was negative. The final diagnosis was of IGM associated with erythema nodosum. Symptoms rapidly improved with oral steroids. DISCUSSION As reported herein, erythema nodosum may be associated with IGM and support the diagnosis thereof. This association is rare, with fewer than 30 case reports described in the literature. IGM is an uncommon benign disorder of the breast that can mimic two frequent breast disorders: breast carcinoma and breast abscess. It usually occurs in young sexually active women. It appears as a tumor with an inflammatory solid painful mass, with nipple and skin retraction, occasionally with abscesses and accompanied by homolateral axillary lymphadenopathies. Radiologic findings are usually not specific for or suggestive of cancer. The histopathological picture of IGM is characterized by the presence of multinucleated giant cells and epithelioid histiocytes forming non-caseating granulomas around lobules. Minor ductal and periductal inflammation is usually present. IGM is rarely associated with autoimmune system manifestations, especially erythema nodosum, arthritis, episcleritis or hidradenitis suppurativa. Although the physiopathology of IGM remains unclear, this case serves as additional evidence that the etiology of IGM is of autoimmune origin. While there is no recommendation for the treatment of IGM, oral steroids remain the cornerstone of therapy. CONCLUSION We report a case of IGM associated with erythema nodosum. Dermatologists must be aware of this association.
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Vorburger D, Frauchiger-Heuer H, Dedes KJ. [Rare Forms of Mastitis]. PRAXIS 2020; 109:1055-1062. [PMID: 33050811 DOI: 10.1024/1661-8157/a003509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Rare Forms of Mastitis Abstract. Inflammatory breast diseases caused by bacterial infections represent the main cause for mastitis in breastfeeding and non-breastfeeding women. The clinical appearance and a standardized evaluation can indicate rare inflammatory breast diseases. An underlying comorbidity or the evidence of rare pathogens could be suggestive. However, core needle biopsy is the main step in diagnostics. Malignancy, e.g. an inflammatory breast cancer must consistently be excluded. This mini review outlines a few rare inflammatory breast diseases, their initial presentation, and how to diagnose them accurately.
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Zhao Q, Xie T, Fu C, Chen L, Bai Q, Grimm R, Peng W, Wang S. Differentiation between idiopathic granulomatous mastitis and invasive breast carcinoma, both presenting with non-mass enhancement without rim-enhanced masses: The value of whole-lesion histogram and texture analysis using apparent diffusion coefficient. Eur J Radiol 2019; 123:108782. [PMID: 31864142 DOI: 10.1016/j.ejrad.2019.108782] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 11/28/2019] [Accepted: 12/04/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE The aim of this study was to investigate whether whole-lesion histogram and texture analysis using apparent diffusion coefficient can discriminate between idiopathic granulomatous mastitis (IGM) and invasive breast carcinoma (IBC), both of which appeared as non-mass enhancement lesions without rim-enhanced masses. METHOD This retrospective study included 58 pathology-proven female patients at two independent study sites (27 IGM patients and 31 IBC patients). Diffusion-weighted imaging (3b values, 50, 400 or 500, and 800 s/mm2) was performed using 1.5 T or 3 T MR scanners from the same vendor. Whole-lesions were segmented and 11 features were extracted. Univariate analysis and multivariate logistic regression analysis were performed to identify significant variables for differentiating IGM from IBC. Receiver operating characteristic curve was assessed. The interobserver reliability between two observers for the histogram and texture measurement was also reported. RESULTS The 5th percentile, difference entropy and entropy of apparent diffusion coefficient showed significant differences between the two groups. An area under the curve of 0.778 (95 % CI: 0.648, 0.908), accuracy of 79.3 %, and sensitivity of 87.1 % was achieved using these three significant features. No significant feature was found with the multivariate analysis. For the interobserver reliability, all apparent diffusion coefficient parameters except skewness and kurtosis indicated good or excellent agreement, while these two features showed moderate agreement. CONCLUSIONS Whole-lesion histogram and texture analysis using apparent diffusion coefficient provide a non-invasive analytical approach to the differentiation between IGM and IBC, both presenting with non-mass enhancement without rim-enhanced masses.
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Affiliation(s)
- Qiufeng Zhao
- Department of Radiology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Tianwen Xie
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Caixia Fu
- MR Application Development, Siemens Shenzhen Magnetic Resonance, Shenzhen, China
| | - Ling Chen
- Department of Pathology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qianming Bai
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Robert Grimm
- MR Application Predevelopment, Siemens Healthcare, Erlangen, Germany
| | - Weijun Peng
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
| | - Song Wang
- Department of Radiology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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Granulomatous Mastitis and Factors Associated with Recurrence: An 11-Year Single-Centre Study of 113 Patients in Singapore. World J Surg 2019; 43:1737-1745. [PMID: 31049604 DOI: 10.1007/s00268-019-05014-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Granulomatous mastitis (GM) is an inflammatory breast disease of unknown aetiology. It poses diagnostic and therapeutic challenges with myriad forms of clinical presentation, varying results to treatments and propensity to recur. This study aims to look at clinical and treatment factors that predispose to recurrence of GM. METHODS We performed a retrospective review of 113 patients in our unit with histologically proven GM from 2006 to 2016. Demographic, clinical, treatment and outcomes data were collected and analysed. RESULTS Eighty-nine patients were treated with antibiotics (78.8%), 79 (69.9%) with steroids and 23 (20.4%) patients underwent surgery. Twenty (17.7%) patients had recurrence. Patients who presented with inflammatory signs and symptoms had increased odds of having subsequent recurrence: skin changes (1.50), pain (2.00), fistula (4.39) and antibiotic treatment (6.65). Four patients (20%) with recurrence had positive bacterial cultures. All 4 grew Corynebacterium. Patients with Corynebacterium infection had a 2.64 times higher risk of recurrence. Surgery did not preclude recurrence. There was a 70% (7/10) penicillin resistance rate in our patients with positive cultures for Corynebacterium. CONCLUSION Initial presentation with inflammatory signs and symptoms may confer increased risk of recurrence, warranting closer monitoring. Corynebacterium infection may play a part as a causative factor and risk factor for recurrence. Non-penicillin antibiotics should be considered as first-line antibiotics for patients presenting with inflammatory changes. Further prospective studies with larger patient populations might reveal information on the aetiology of GM and result in the development of a more standardized and effective treatment regimen.
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Priego PIR, Pedroso-Rea JG, Mancera-Resendiz MA, Ortiz-Iturbide C, Romo-Aguirre C, Stuht-Lopez D, Ubiergo-García M. Idiopathic granulomatous mastitis: a new algorithm. ACTA ACUST UNITED AC 2019. [DOI: 10.15406/ogij.2019.10.00465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Yazigi G, Trieu BH, Landis M, Parikh JG, Mangal M. Granulomatous Mastitis: A Rare Case with Sjogren's Syndrome and Complications. Cureus 2019; 11:e5359. [PMID: 31608194 PMCID: PMC6783204 DOI: 10.7759/cureus.5359] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Granulomatous mastitis (GM) is a rare benign chronic inflammatory process of the breast in reproductive aged females. Although considered idiopathic in many cases, it has been associated with other conditions. Herein we report a highly complex and interesting case of GM in a young female with Sjogren's syndrome. We also review the literature and discuss challenges pertaining to the management of patients with similar risk factors. According to our knowledge, this is the third case documenting the co-occurrence of GM and Sjogren's syndrome. We focus on the challenges and complications of GM in the context of an autoimmune disease. With evidence from our patient's disease course and support from the literature, we advocate the use of corticosteroids for GM to prevent complications in patients with additional risks factors such as an autoimmune disease.
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Affiliation(s)
- George Yazigi
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Becca H Trieu
- Miscellaneous, University of Central Florida College of Medicine, Orlando, USA
| | - Michael Landis
- Miscellaneous, University of Central Florida College of Medicine, Orlando, USA
| | | | - Mamta Mangal
- Internal Medicine, University of Central Florida College of Medicine/Orlando VA Medical Center, Orlando, USA
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Alrayes A, Almarzooq R, Abdulla HA. Surgical treatment of granulomatous mastitis: Our experience in Bahrain. Breast J 2019; 25:958-962. [DOI: 10.1111/tbj.13378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/08/2019] [Accepted: 02/11/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Amal Alrayes
- Department of Surgery Salmaniya Medical Complex Manama Bahrain
| | - Raed Almarzooq
- Department of Surgery Salmaniya Medical Complex Manama Bahrain
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McLean NR, Chummun S, Youssef MK, Bristow G. Delayed breast reconstruction in idiopathic granulomatous mastitis. EUROPEAN JOURNAL OF PLASTIC SURGERY 2019. [DOI: 10.1007/s00238-018-1474-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Agrawal A, Pabolu S. A Rare Case of Idiopathic Granulomatous Mastitis in a Nulliparous Woman with Hyperprolactinemia. Cureus 2019; 11:e4680. [PMID: 31328071 PMCID: PMC6634339 DOI: 10.7759/cureus.4680] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Idiopathic granulomatous mastitis (IGM) is a rare, benign, and chronic inflammatory condition of the breast. Women of child-bearing age with a recent history of pregnancy and lactation are usually affected, and clinical picture mimics inflammatory breast cancer or breast abscess. The etiology is not well defined but proposed to be a localized immune reaction to the breast tissue. Here, we report a case of a 41-year-old female who presented with left breast pain and discharge and a clinical diagnosis of breast abscess was made. No improvement with antibiotics was noted and she underwent mammography and diagnostic ultrasound of the affected breast. A biopsy of the lesion was obtained which revealed chronic granulomatous inflammation confirming the diagnosis of IGM. She was also found to have hyperprolactinemia secondary to a prolactinoma following which the patient was started on steroid and bromocriptine.
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Affiliation(s)
- Ankit Agrawal
- Internal Medicine, Saint Peter's University Hospital - Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Sangeetha Pabolu
- Rheumatology, Saint Peter's University Hospital - Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
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Saied GM, Moustafa KG. Satisfactorily responds to antituberculous treatment: Surgery has no role in the management of tuberculous mastitis in Egyptian women population. A sample study. Breast J 2019; 25:328-330. [PMID: 30738000 DOI: 10.1111/tbj.13220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/03/2017] [Accepted: 11/07/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Gamal M Saied
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Karim G Moustafa
- Department of Reproductive Health, National Research Centre, Giza, Egypt
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Kıvılcım T, Altıntoprak F, Memiş B, Ferhatoğlu MF, Kartal A, Dikicier E, Ciftçi İH, Dilek FH. Role of Bacteriological Agents in Idiopathic Granulomatous Mastitis: Real or Not? Eur J Breast Health 2019; 15:32-36. [PMID: 30816358 PMCID: PMC6385714 DOI: 10.5152/ejbh.2018.4249] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 08/29/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Granulomatous mastitis is a rare, benign, chronic inflammatory disease of the breast of unknown etiology. This study evaluated bacteriologic agents that might play a role in the etiology of granulomatous mastitis using a molecular method with a universal primer after isolating deoxyribonucleic acid (DNA) from pathology specimens from patients diagnosed with granulomatous mastitis. MATERIALS AND METHODS Breast biopsy material in the pathology department obtained between July 2008 and June 2013 was analyzed. The history of the granulomatous mastitis patients was examined in detail and paraffin block sections of the biopsy material were used to determine the presence of bacteria with a universal DNA primer. RESULTS This study examined 45 granulomatous mastitis patients who had been diagnosed using excisional, incisional, or core biopsies. We evaluated multiple bacterial taxa, but obtained no positive result using a nucleic-acid-based assay with a universal primer. CONCLUSION The etiology of idiopathic granulomatous mastitis remains unclear. Further studies with a large number of patients should aim to identify the causative agent.
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Affiliation(s)
- Taner Kıvılcım
- Department of General Surgery, Okan University School of Medicine, İstanbul, Turkey
- Department of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Fatih Altıntoprak
- Department of General Surgery, Sakarya University School of Medicine, Sakarya, Turkey
- Department of General Surgery, İstinye University School of Medicine, İstanbul, Turkey
| | - Bahar Memiş
- Department of Pathology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | | | - Abdulcabbar Kartal
- Department of General Surgery, Okan University School of Medicine, İstanbul, Turkey
| | - Enis Dikicier
- Department of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - İhsan Hakkı Ciftçi
- Department of Microbiology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Fatma Hüsniye Dilek
- Department of Pathology, İzmir Katip Çelebi University School of Medicine, İzmir, Turkey
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Co M, Cheng VCC, Wei J, Wong SCY, Chan SMS, Shek T, Kwong A. Idiopathic granulomatous mastitis: a 10-year study from a multicentre clinical database. Pathology 2018; 50:742-747. [PMID: 30389215 DOI: 10.1016/j.pathol.2018.08.010] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 08/17/2018] [Accepted: 08/22/2018] [Indexed: 12/14/2022]
Abstract
Idiopathic granulomatous mastitis (IGM) is an uncommon, chronic inflammatory breast disease with elusive aetiology, simulating malignancy clinically and radiologically. Here we present our 10-year review on a region-wide multicentre IGM database. A retrospective study was performed on a prospectively maintained database from three University affiliated hospitals in Hong Kong and Shenzhen, China. All patients with biopsy proven IGM were included while patients with positive culture of Mycobacterium tuberculosis were excluded. Disease recurrence rate and its prognosticators were evaluated. A total of 102 patients were included between January 2007 and December 2017. Median age was 33 years (range 20-54). Most patients presented with painful inflammatory mass (n = 57); median size at presentation was 37 mm (6-92 mm). Sixty-three patients had bacterial culture performed on the pus sample: eight patients had Corynebacterium kroppenstedtii while four had Corynebacterium species not otherwise specified. Seventy-seven (75.5%) patients received conservative treatment with oral corticosteroid (±antibiotics) and drainage only, while 25 (24.5%) patients received breast lump excision after initial medical treatment. Twelve (11.8%) patients developed recurrence after a median follow-up interval of 14 months (4-51 months). Univariate analysis revealed that abscess on presentation, history of smoking, and presence of C. kroppenstedtii were significant prognosticators for recurrence. Subsequent multivariate analysis with logistic regression revealed cigarette smoking and isolation of C. kroppenstedtii as independent risk factors for disease recurrence (p < 0.05). In conclusion, IGM is uncommon with a recurrence rate of 12%, especially in patients with history of smoking and isolation of C. kroppenstedtii.
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Affiliation(s)
- Michael Co
- Department of Surgery, Queen Mary Hospital, Hong Kong; Department of Surgery, The University of Hong Kong, Hong Kong
| | | | - Jiannan Wei
- Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Sally C Y Wong
- Department of Microbiology, Queen Mary Hospital, Hong Kong
| | - Sally M S Chan
- Department of Surgery, The University of Hong Kong, Hong Kong
| | - Tony Shek
- Department of Pathology, Queen Mary Hospital, Hong Kong
| | - Ava Kwong
- Department of Surgery, Queen Mary Hospital, Hong Kong; Department of Surgery, The University of Hong Kong, Hong Kong.
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Russu MC, Nastasia Ş, Degeratu D, Stănculescu RV. Breast and Cervix Uteri: Rare Locations for Mycobacterium Tuberculosis Infections and Complications-Cases Report and Literature Review. Tuberculosis (Edinb) 2018. [DOI: 10.5772/intechopen.75044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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44
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Kanao S, Kataoka M, Iima M, Ikeda DM, Toi M, Togashi K. Differentiating benign and malignant inflammatory breast lesions: Value of T2 weighted and diffusion weighted MR images. Magn Reson Imaging 2018; 50:38-44. [DOI: 10.1016/j.mri.2018.03.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 03/10/2018] [Accepted: 03/10/2018] [Indexed: 12/17/2022]
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Etiología de la mastitis crónica: propuesta de secuencia diagnóstica. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2018. [DOI: 10.1016/j.gine.2016.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Yılmaz TU, Gürel B, Güler SA, Baran MA, Erşan B, Duman S, Utkan Z. Scoring Idiopathic Granulomatous Mastitis: An Effective System for Predicting Recurrence? Eur J Breast Health 2018; 14:112-116. [PMID: 29774320 DOI: 10.5152/ejbh.2018.3709] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 11/22/2017] [Indexed: 12/19/2022]
Abstract
Objective Idiopathic granulomatous mastitis is a breast disease without a definitive etiology. There are no definitive classifications, scoring systems or certitudes. The aim of this study is to define the factors related to the recurrence and design a scoring system. Material and Methods Patients who were admitted to the general surgery department with symptoms of granulomatous mastitis were evaluated by ultrasonography and underwent antibiotic therapy. Granulomatous mastitis is diagnosed by core biopsy and treated with steroid therapy. Patients without improvement underwent surgery and were included in the study. In total, 53 patients were included in the study. There were 8 recurrent cases. Factors related with recurrences were defined. Results Number of births over 2, duration of lactation more than 18 months, body mass index greater than 31, having fistula in physical examination, abscess collection in ultrasonographic examination, and luminal inflammation score over 2 were scored as 1. Severity score in recurrent cases were 5.1±0.6 whereas 1.9±1.0 in nonrecurrent cases. Conclusion Granulomatous mastitis score is a tool targeted at predicting the risk of recurrences. The patients with these factors are more prone for recurrences.
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Affiliation(s)
- Tonguç Utku Yılmaz
- Department of General Surgery, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Bora Gürel
- Department of Pathology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Sertaç Ata Güler
- Department of General Surgery, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Mehmet Ali Baran
- Department of General Surgery, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Büşra Erşan
- Department of Pathology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Seda Duman
- Department of Pathology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Zafer Utkan
- Department of General Surgery, Kocaeli University School of Medicine, Kocaeli, Turkey
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Pluguez-Turull CW, Nanyes JE, Quintero CJ, Alizai H, Mais DD, Kist KA, Dornbluth NC. Idiopathic Granulomatous Mastitis: Manifestations at Multimodality Imaging and Pitfalls. Radiographics 2018; 38:330-356. [PMID: 29528819 DOI: 10.1148/rg.2018170095] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory breast entity characterized by lobulocentric granulomas. IGM has a persistent or recurrent disease course and affects parous premenopausal women with a history of lactation. It has also been associated with hyperprolactinemia. The most common clinical sign is a palpable tender mass. However, the nonspecific manifestations and varied demographic features of this condition, as well as the other similar-appearing and superimposed breast entities, pose substantial diagnostic challenges. Entities with similar manifestations include inflammatory breast cancer (IBC), infective mastitis, foreign body injection granulomas, mammary duct ectasia, diabetic fibrous mastopathy, and systemic granulomatous processes. The strategy for imaging IGM depends on patient age, clinical manifestations, and risk factors. Targeted ultrasonography, mammography, and less commonly, magnetic resonance imaging have proven to be useful for imaging evaluation. Core-needle biopsy, with or without fine-needle aspiration for cytopathologic examination, and culture analysis are usually required to exclude IBC and other benign inflammatory breast processes. Patients with IGM have an excellent prognosis when they are appropriately treated with oral steroids or second-line immunosuppressive and prolactin-lowering medications. However, surgical excision may be an option for patients in whom medication therapy is unsuccessful. Imaging surveillance can be offered to patients with incidentally encountered IGM or mild symptoms. Clinical suspicion for this rare disease and the breast imager's prompt diagnosis can lead to an improved patient outcome. The purpose of this article is to review the imaging manifestations of IGM in a multimodality case-based format and to describe relevant clinical and imaging-based differential diagnoses. The associated pitfalls, epidemiologic and histopathologic factors, clinical manifestations, natural course, and management of IGM also are discussed. ©RSNA, 2018.
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Affiliation(s)
- Cedric W Pluguez-Turull
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Jennifer E Nanyes
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Cristina J Quintero
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Hamza Alizai
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Daniel D Mais
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Kenneth A Kist
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Nella C Dornbluth
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
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Abstract
Idiopathic granulomatous lobular matitis (IGLM) is a rare non-specific inflammatory disease of the breast. Although IGLM is completely benign, it is easily confused with cancer due to progressive breast lump with firmly unilateral and discrete mass, nipple retraction and sinus formation. Patients with IGLM are usually associated with inflammation of the overlying skin. This study aimed to investigate the clinical characteristics of IGLM, treatment options and prognosis. From January 2010 to February 2015, 75 IGLM patients in our hospital were included, with an average age of 35.9 ± 10.0 (range 21-61) years. Most of them were parous. The main clinical characteristic was the presence of a large, irregular and painful mass. Hypoechoic lobulated, irregular tubular or oval shaped masses were detected by breast gland ultrasound. Ill-defined mass, enlarged axillary lymph nodes, asymmetric density, and architectural distortion were found by breast molybdenum palladium X-ray. Diagnosis of IGLM was confirmed with histological examination. The majority (60/75) of the IGLM patients received surgical treatment, including lumpectomy, abscess drainage or mastectomy. Antibiotics were used after surgery. The disease recurred in three patients during the follow-up period. Our study suggested that IGLM diagnosis more depends on CNB and postoperative histopathological examination, and surgery and symptomatic treatment can completely remove the lesions, in order to cure the disease.
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Affiliation(s)
- Jieqing Li
- a Department of Breast Surgery, Tianjin Central Hospital of Gynecology and Obstetrics , Tianjin , China
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Jeon J, Lee K, Kim Y, Chun YS, Park HK. Retrospective Analysis of Idiopathic Granulomatous Mastitis: Its Diagnosis and Treatment. ACTA ACUST UNITED AC 2017. [DOI: 10.14449/jbd.2017.5.2.82] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Wang Z, Wang N, Liu X, Wang Q, Xu B, Liu P, Zhu H, Chen J, Situ H, Lin Y. Broadleaf Mahonia attenuates granulomatous lobular mastitis‑associated inflammation by inhibiting CCL‑5 expression in macrophages. Int J Mol Med 2017; 41:340-352. [PMID: 29138800 PMCID: PMC5746325 DOI: 10.3892/ijmm.2017.3246] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 11/01/2017] [Indexed: 12/22/2022] Open
Abstract
Granulomatous lobular mastitis (GLM) is a type of chronic mammary inflammation with unclear etiology. Currently systematic corticosteroids and methitrexate are considered as the main drugs for GLM treatment, but a high toxicity and risk of recurrence greatly limit their application. It is therefore an urgent requirement that safe and efficient natural drugs are found to improve the GLM prognosis. Broadleaf Mahonia (BM) is a traditional Chinese herb that is believed to have anti-inflammatory properties according to ancient records of traditional Chinese medicine. The present study investigated this belief and demonstrated that BM significantly inhibited the expression of interleukin-1β (IL-1β), IL-6, cyclooxygenase-2 and inducible nitric oxide synthase in RAW264.7 cells, but had little influence on the cell viability, cell cycle and apoptosis. Meanwhile, the lipopolysaccharide-induced elevation of reactive oxygen species and nitric oxide was also blocked following BM treatment, accompanied with decreased activity of nuclear factor-κB and MAPK signaling. A cytokine array further validated that BM exhibited significant inhibitory effects on several chemoattractants, including chemokine (C-C motif) ligand (CCL)-2, CCL-3, CCL-5 and secreted tumor necrosis factor receptor 1, among which CCL-5 exhibited the highest inhibition ratio in cell and clinical GLM specimens. Collectively, the results show that BM is a novel effective anti-inflammatory herb in vitro and ex vivo, and that CCL-5 may be closely associated with GLM pathogenesis.
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Affiliation(s)
- Zhiyu Wang
- Department of Mammary Disease, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Neng Wang
- Department of Breast Oncology, Sun Yat‑Sen Univeristy Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong Guangzhou, Guangdong 510060, P.R. China
| | - Xiaoyan Liu
- Department of Mammary Disease, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Qi Wang
- Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Biao Xu
- Department of Mammary Disease, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Pengxi Liu
- Department of Mammary Disease, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Huayu Zhu
- Department of Mammary Disease, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Jianping Chen
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, SAR 00852, P.R. China
| | - Honglin Situ
- Department of Mammary Disease, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Yi Lin
- Department of Mammary Disease, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
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