Idiopathic Granulomatous Mastitis- Where Do We Stand
Abstract
Granulomatous mastitis is a rare benign disease with chronic inflammatory features. Its diagnosis relies on a characteristic histological pattern, combined with the exclusion of other possible causes of chronic inflammatory lesions in the breast. It can occur between 0.025% and 3% of all breast diseases treated surgically. Only a few hundred cases had been reported in the literature and its treatment had been modulated from observation only, to multiple modality medication treatments and or extensive surgical treatment including mastectomy, with minimal or no changes of management. We present our experience of 31 cases diagnosed granulomatous mastitis managed according to a tailored treatment algorithm. This is an observational study with a comparison to new data consensus for management. Our results suggest oral corticosteroid treatment remains a good alternative for management. Further adjustments of algorithm to include proper differential diagnosis and new treatments are to be established.
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References
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16.Ruhwald M, Aggerbeck H, Gallardo RV, Hoff ST, Villate JI, Borregaard B, et al. "Safety and efficacy of the C-Tb skin test to diagnose Mycobacterium tuberculosis infection, compared with an interferon Îł release assay and the tuberculin skin test: a phase 3, double-blind, randomized, controlled trial, Lancet Respiratory Medicine Apr. 2017, pubmed.ncbi.nlm.nih.gov
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18.Ogura K, Matsumoto T, Aoki Y, Kitabatake T, Fujisawa M, Kojima K. âIgG4-related tumour-forming mastitis with histological appearances of granulomatous lobular mastitis: comparison with other types of tumour-forming mastitisâ. Histopathology. 2010;57(1):39.
19.Tang A, Dominguez DA, Edquilang JK, et al. âAssociation for Academic Surgery Granulomatous Mastitis: Comparison of Novel Treatment of Steroid Injection and Current Managementâ. Journal Surgery Research 2020;300-5. [Crossref] [PubMed]
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21. Erozgen F, Ersoy YE, Akaydin M, et al. âCorticosteroid treatment and timing of surgery in idiopathic granulomatous mastitis confusing with breast carcinomaâ. Breast Cancer Research Treatment 2010;123:447-52. [Crossref] [PubMed]
2-Kessler E, Wolloch Y et al.. âGranulomatous mastitis: a lesion clinically simulating carcinomaâ Am J Clin Pathol. 1972;58(6):642â646. [PubMed]
3-Renshaw AA, Derhagopian RP, Gould EW, et al. âCystic neutrophilic granulomatous mastitis: an underappreciated pattern strongly associated with gram-positive bacilliâ. Am J Clin Pathol. 2011;136(3):424â7.
4-Kristen Bede et al. â Idiopathic granulomatous mastitisâ Annals of Breast Surgery Vol 4 (December 2020)
5-Meguid MM, Kort KC, Numann PJ, Oler A et al.. âSubareolar breast abscess: the penultimate stage of the mammary duct-associated inflammatory disease sequenceâ. In: Bland KI, Copeland EM, editors. The Breast: Comprehensive Management of Benign and Malignant Disorders. 3rd ed. Philadelphia, PA: Elsevier;; 2004. pp. 93â131. In. eds.
6-Oran EĹ, GĂźrdal SĂ, Yankol Y, et al. âManagement of Idiopathic Granulomatous Mastitis Diagnosed by Core Biopsy: A Retrospective Multicenter Studyâ. Breast J 2013;19:411-8. [Crossref] [PubMed
7-Salim Baharoon et al âTuberculosis of the breastâ King, Fahad National Guard Hospital Ryadh, Saudi Arabia www.thoracicmedicine.org 2010, IP 62.193.94.5
8-Qian-Qian Yuan,et al âManagement of granulomatous lobular mastitis: an international multidisciplinary consensusâ (2021 edition) Military Medical Research volume 9, Article number: 20 (2022).
9-Joseph KA, Luu X, Mor A et al. âGranulomatous Mastitis: A New York Public Hospital Experienceâ . Ann Surg Oncol 2014;21:4159-63. [Crossref] [PubMed]
10-Baslaim MM, Khayat HA. Al-Amoudi et al. âIdiopathic granulomatous mastitis: a heterogeneous disease with variable clinical presentationâ. World J Surg. 2007;31(8):1677â1681. [PubMed]
11.Han BK, Choe YH, Park JM, et al. Granulomatous mastitis: mammographic and sonographic appearances. AJR1999; 173:317-
12.Lee JH, Oh KK, Kim EK, Kwack KS, Jung WH, Lee HK et al. âRadiologic and clinical features of idiopathic granulomatous lobular mastitis mimicking advanced breast cancerâ. Yonsei Med J 2006; 47:78-84 [Crossref] [Medline]
13. John W.Wilkins âExtrapulmonary tuberculosis diagnosis approachesâ, Mayo Clinic Center for Tuberculosis, 2013
14. Spyridon Marinopoulos et al âBreast tuberculosis : diagnosis, management and treatment, , International Journal Surgical Case Report. 2012; 3(11): 548â550.
15.Guerra RL, et al. âUse of the amplified mycobacterium tuberculosis direct test in a public health laboratory: test performance and impact on clinical careâ. Chest. 132 (3): 946â51. Sept 2007 doi:10.1378/chest.06-2959. PMID 17573496.
16.Ruhwald M, Aggerbeck H, Gallardo RV, Hoff ST, Villate JI, Borregaard B, et al. "Safety and efficacy of the C-Tb skin test to diagnose Mycobacterium tuberculosis infection, compared with an interferon Îł release assay and the tuberculin skin test: a phase 3, double-blind, randomized, controlled trial, Lancet Respiratory Medicine Apr. 2017, pubmed.ncbi.nlm.nih.gov
17.Davis J, Cocco D, Matz S, Hsu CH, Brown MJ, Lee J, et al. âRe-evaluating if observation continues to be the best management of idiopathic granulomatous mastitisâ pubmed.ncbi.nlm.nih.gov Surgery. 2019;166(6):1176â80.
18.Ogura K, Matsumoto T, Aoki Y, Kitabatake T, Fujisawa M, Kojima K. âIgG4-related tumour-forming mastitis with histological appearances of granulomatous lobular mastitis: comparison with other types of tumour-forming mastitisâ. Histopathology. 2010;57(1):39.
19.Tang A, Dominguez DA, Edquilang JK, et al. âAssociation for Academic Surgery Granulomatous Mastitis: Comparison of Novel Treatment of Steroid Injection and Current Managementâ. Journal Surgery Research 2020;300-5. [Crossref] [PubMed]
20. DeHertogh DA, Rossof AH, Harris AA, et al. âPrednisone Management of Granulomatous Mastitisâ. N Engl J Med 1980;303:799-800. [Crossref] [PubMed]
21. Erozgen F, Ersoy YE, Akaydin M, et al. âCorticosteroid treatment and timing of surgery in idiopathic granulomatous mastitis confusing with breast carcinomaâ. Breast Cancer Research Treatment 2010;123:447-52. [Crossref] [PubMed]
Authors
L, I. ., N., M. ., M, A. B. ., S., N. ., A, I. ., A, A. A. ., E, G. ., & E, G. . (2023). Idiopathic Granulomatous Mastitis- Where Do We Stand. Journal of Current Medical Research and Opinion, 6(08), 1634â1642. https://doi.org/10.52845/CMRO/2023/6-8-2
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