GRANULOMATOUS MASTITIS: PROBLEMS OF DIAGNOSIS AND TREATMENT
Background: Idiopathic granulomatous lobular mastitis (IGLM) is an uncommon non-specific inflammatory disease of the breast. The IGLM is a benign condition and it confuses the surgeons with cancer owing to its progressive breast lump. In the present study, the clinical characteristics, experiences of diagnosis, treatment, and outcomes of one and half year follow-up of 22 patients met the required histological criteria of idiopathic granulomatous lobular mastitis were examined and evaluated.
Subject and Methods: Between first November 2016 and 30th April 2018, twenty two married, parous, non-smoker, and non-alcoholic patients diagnosed with IGLM with an average mean of 32.5 years (23-41 years old) were included in the study. The patients underwent breast ultrasonography for the clinical features following clinical examinations. The first choice of the diagnosis was the fine needle aspiration cytology (FNAC) and the false negative results were sent to the core needle biopsy (CNB) for the final confirmation. No patients underwent mammography and breast magnetic resonance imaging. The patients have received steroids following accomplishment of antibiotics time period. The incision and drainage were performed for the patients with mass or abscesses and were followed-up for one and half year to find out the response or recurrence.
Results: The study showed that mass, skin thickening, and pain were the most prevalent clinical features and abscess as the sign in patients with IGLM and their clinical characteristics were unilateral. Only 6 patients had given history of taking oral contraceptive. The common physical findings of clinical features and ultrasonographic finding were irregular hypoechoic mass and collection (20 cases); multiple (14 cases); with an abscess (11 cases). The same numbers of patients were diagnosed with FNAC and CNB. The patients received steroids therapy, underwent drainage and excision were 13, 13, and 9, respectively. Of the total patients, the lesions of 15 patients were healed and the recurrence rate was 31.8%.
Conclusions: The patients were diagnosed with IGLM and recruited in the present study responded to different therapeutic interventions and the healing rate was 68.2%.
2. Baslaim MM, Khayat HA, Al-Amoudi SA. Idiopathic granulomatous mastitis: a heterogeneous disease with variable clinical presentation. World J Surg. 2007; 31(8):1677-81.
3. Harris JR, Lippman ME, Osborne CK, et al. Diseases of the Breast: Lippincott Williams & Wilkins; 2014.48-49.
4. Larsen LJH, Peyvandi B, Klipfel N, et al. Granulomatous lobular mastitis: imaging, diagnosis, and treatment. AJR. 2009; 193(2):574-81.
5. Li J. Diagnosis and Treatment of 75 Patients with Idiopathic Lobular Granulomatous Mastitis. J Invest Surg. 2018:1-7.
6. Seo HRN, Na KY, Yim HE, et al. Differential diagnosis in idiopathic granulomatous mastitis and tuberculous mastitis. JBC. 2012;15(1):111-8.
7. Boufettal H, Essodegui F, Noun M, et al. Idiopathic granulomatous mastitis: a report of twenty cases. Diagnostic and interventional imaging. 2012;93(7-8):586-96.
8. Imoto S, Kitaya T, Kodama T, et al. Idiopathic granulomatous mastitis: case report and review of the literature. JJCO. 1997;27(4):27-277.
9. Bani‐Hani KE, Yaghan RJ, Matalka II, et al. Idiopathic granulomatous mastitis: time to avoid unnecessary mastectomies. The breast. 2004;10(4):318-22.
10. Wilson JP, Chapman SW. Tuberculous mastitis. Chest. 1990;98(6):1505-9.
11. Jorgensen MB, Nielsen DM. Diagnosis and treatment of granulomatous mastitis. AMJMED 1992;93(1):97-101.
12. Donn W, Rebbeck P, Wilson C, et al. Idiopathic granulomatous mastitis. A report of three cases and review of the literature. APLM. 1994;118(8):822-5.
13. Akcan A, Akyıldız H, Deneme MA, et al. Granulomatous lobular mastitis: a complex diagnostic and therapeutic problem. WJS. 2006;30(8):1403-9.
14. Han BK, Choe YH, Park JM, et al. Granulomatous mastitis: mammographic and sonographic appearances. AJR. 1999;173(2):317-20.
15. Boné B, Pentek Z, Perbeck L, et al. Diagnostic accuracy of mammography and contrast-enhanced MR imaging in 238 histologically verified breast lesions. Acta Radiologica. 1997;38(4):489-96.
16. Sardanelli F, Boetes C, Borisch B, et al. Magnetic resonance imaging of the breast: recommendations from the EUSOMA working group. EJC. 2010;46(8):1296-316.
17. Kriege M, Brekelmans CT, Boetes C, et al. Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. NEJM. 2004;351(5):427-37.
18. Aghajanzadeh M, Hassanzadeh R, Sefat SA, et al. Granulomatous mastitis: presentations, diagnosis, treatment and outcome in 206 patients from the north of Iran. The Breast. 2015;24(4):456-60.
19. Bakaris S, Yuksel M, Cιragil P, et al. Granulomatous mastitis including breast tuberculosis and idiopathic lobular granulomatous mastitis. CJS. 2006;49(6):427.
20. Kessler E, Wolloch Y. Granulomatous mastitis: a lesion clinically simulating carcinoma. AJCP. 1972;58(6):642-6.
21. Hladik M, Schoeller T, Ensat F, et al. Idiopathic granulomatous mastitis: successful treatment by mastectomy and immediate breast reconstruction. JPRASURG. 2011;64(12):1604-7.
22. Dixon JM. ABC of breast diseases: John Wiley & Sons; 2012.
23. Raj N, Macmillan R, Ellis I, et al. Rheumatologists and breasts: immunosuppressive therapy for granulomatous mastitis. Rheumatology. 2004;43(8):1055-6.
24. Akbulut S, Arikanoglu Z, Senol A, et al. Is methotrexate an acceptable treatment in the management of idiopathic granulomatous mastitis? Arch Gynecol Obstet. 2011;284(5):1189-95.
25. DeHertogh DA, Rossof AH, Harris AA, et al. Prednisone management of granulomatous mastitis. NEJM. 1980;303(14):799-800.
26. Vingerhoedt N, Janssen S, Mravunac M, et al. Granulomatous lobular mastitis: a benign abnormality that mimics malignancy. NTVG. 2008;152(18):1052-6.
27. Ayeva-Derman M, Perrotin F, Lefrancq T, et al. Idiopathic granulomatous mastitis. Review of the literature illustrated by 4 cases. Journal de gynecologie, obstetrique et biologie de la reproduction. 1999;28(8):800-7.
28. Yilmaz E, Lebe B, Usal C, et al. Mammographic and sonographic findings in the diagnosis of idiopathic granulomatous mastitis. EJRADIOLOGY. 2001;11(11):2236-40.
29. Lin C-H, Hsu C-W, Tsao T-Y, et al. Idiopathic granulomatous mastitis associated with risperidone-induced hyperprolactinemia. Diagnostic pathology. 2012;7(1):2.
30. Ergin AB, Cristofanilli M, Daw H, et al. Recurrent granulomatous mastitis mimicking inflammatory breast cancer. BMJ case reports. 2011;2011:bcr0720103156.
31. Kok K, Telisinghe P. Granulomatous mastitis: presentation, treatment and outcome in 43 patients. The surgeon. 2010;8(4):197-201.
32. Bellavia M, Damiano G, Palumbo VD, et al. Granulomatous Mastitis during Chronic Antidepressant Therapy: Is It Possible a Conservative Therapeutic Approach? JBC. 2012;15(3):371-2.
33. Cakir B, Tuncbilek N, Karakas H, et al. Granulomatous mastitis mimicking breast carcinoma. The breast. 2002;8(4):251-2.
34. Walker S. Treatment of systemic lupus erythematosus with bromocriptine. Lupus. 2001;10(3):197-202.