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Alipour S, Gholami B, Orouji M, Heydari S. Imiquimod as a new treatment in refractory idiopathic granulomatous mastitis: report of two cases. Daru 2024; 32:443-447. [PMID: 38151679 PMCID: PMC11087426 DOI: 10.1007/s40199-023-00501-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/15/2023] [Indexed: 12/29/2023] Open
Abstract
INTRODUCTION Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory lesion of the breast that mimics breast cancer or infection. Immunological pathogenesis is strongly suggested for the disease. REASON FOR THE REPORT The treatment remains controversial, comprising a spectrum from observation or NSAIDs to immunosuppressive agents and surgery. Intractable cases are not uncommon and represent a major treatment challenge. Therefore in this study, we examine the effect of a topical immunomodulator agent, imiquimod, on refractory IGM. Patient 1 had IGM for 9 months and had not responded to the existing treatments. She responded to a 7-week course of imiquimod. In patient 2, the disease had begun 4 months sooner and had been resistant to all treatments; it responded to imiquimod after 4 weeks. Ulcers appeared on the skin of both patients but resolved safely. OUTCOME Both patients were very satisfied with the results. Imiquimod can be an appropriate local treatment with limited adverse effects in refractory IGM. We propose similar studies to assess the efficacy of imiquimod in IGM further, paying attention to the possibility of developing skin wounds.
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Affiliation(s)
- Sadaf Alipour
- Breast Diseases Research Center (BDRC), Cancer Institute, Tehran University of Medical Sciences, Imam Khomeini Hospital, Keshavarz Boulevard, Tehran, 1419733141, Iran
- Department of Surgery, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bardia Gholami
- Breast Diseases Research Center (BDRC), Cancer Institute, Tehran University of Medical Sciences, Imam Khomeini Hospital, Keshavarz Boulevard, Tehran, 1419733141, Iran
- Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marzieh Orouji
- Department of Nursing, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Samareh Heydari
- Breast Diseases Research Center (BDRC), Cancer Institute, Tehran University of Medical Sciences, Imam Khomeini Hospital, Keshavarz Boulevard, Tehran, 1419733141, Iran.
- Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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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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Sarmadian R, Safi F, Sarmadian H, Shokrpour M, Almasi-Hashiani A. Treatment modalities for granulomatous mastitis, seeking the most appropriate treatment with the least recurrence rate: a systematic review and meta-analysis. Eur J Med Res 2024; 29:164. [PMID: 38475841 DOI: 10.1186/s40001-024-01761-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Granulomatous mastitis (GM) is a rare, benign, inflammatory breast disease with an unknown etiology that predominantly affects women of reproductive age. The definitive treatment of GM is currently controversial; an appropriate therapeutic strategy has yet to be identified, and the disease's high recurrence rate remains. This study aims to determine the recurrence rate for each GM treatment strategy to identify the most appropriate treatment modality. METHODS The search for relevant articles was undertaken using three international databases, including Medline, Scopus, and Web of Science. Articles published in English until the end of 2021 evaluating the recurrence rate of GM were included. Using Stata 13.0, the pooled incidence and 95% confidence interval (CI) for the recurrence rate were determined. RESULTS Sixty-five eligible studies were included in our study. The recurrence rates of systemic steroid use, topical steroid use, antibiotic use, methotrexate use, observation, drainage, excision, antibiotic use and surgery, steroid use and surgery, antibiotic and steroid use, methotrexate and steroid use were 24% (95% CI: 21-27%), 11% (95% CI: 6-21%), 18% (95% CI: 14-22%), 13% (95% CI: 7-22%), 11% (95% CI: 7-17%), 65% (95% CI: 50-78%), 13% (95% CI: 10-16%), 23% (95% CI: 14-36%), 7% (95% CI: 5-11%), 11% (95% CI: 6-18%), and 4% (95% CI: 2-8%), respectively. Drainage had the highest recurrence rate, while combined methotrexate and steroid treatment had the lowest rate. CONCLUSION The optimal treatment strategy for GM depends on the disease's severity, consequences, and the patient's features. The study results indicate that combination therapy is preferable for minimizing the risk of relapse and reducing treatment complications.
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Affiliation(s)
- Roham Sarmadian
- Student Research Committee, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Safi
- Department of Radiology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Hossein Sarmadian
- Department of Infectious Diseases, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Maryam Shokrpour
- Department of Gynecology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Basij Square, Arak, Iran.
- Traditional and Complementary Medicine Research Center (TCMRC), Arak University of Medical Sciences, Arak, Iran.
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Dilaveri C, Degnim A, Lee C, DeSimone D, Moldoveanu D, Ghosh K. Idiopathic Granulomatous Mastitis. Breast J 2024; 2024:6693720. [PMID: 38304866 PMCID: PMC10834090 DOI: 10.1155/2024/6693720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/06/2023] [Accepted: 01/09/2024] [Indexed: 02/03/2024]
Abstract
Idiopathic granulomatous mastitis (IGM) is a rare, benign inflammatory disorder of the breast that is often underrecognized. The exact etiology and pathophysiology are unknown, but milk stasis is felt to play a role. Classically, this condition is noninfectious, but many cases are noted to be associated with Corynebacterium species. Most patients affected are parous women with a mean age of 35, and many have breastfed within five years of diagnosis. Patients typically present with a painful mass and symptoms of inflammation, and these features can sometimes mimic breast cancer. Biopsy is needed to make a definitive diagnosis, and noncaseating granulomas are found on core biopsy. Many patients have a waxing and waning course over a period of six months to two years. Goal of treatment is to avoid surgery given poor wound healing, high risk of recurrence, and poor cosmetic outcomes. Medical treatment is preferred and includes observation, antibiotics, steroids, and immune modulators such as methotrexate. In more recent years, topical and intralesional steroids have become the treatment of choice, with similar outcomes to oral steroids.
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Affiliation(s)
- Christina Dilaveri
- Mayo Clinic, Department of Medicine, Division of General Internal Medicine, Rochester, USA
| | - Amy Degnim
- Mayo Clinic, Department of Surgery, Division of Breast and Melanoma Surgical Oncology, Rochester, USA
| | - Christine Lee
- Mayo Clinic, Department of Radiology, Division of Breast Imaging and Intervention, Rochester, USA
| | - Daniel DeSimone
- Mayo Clinic, Department of Medicine, Division of Infectious Diseases, Rochester, USA
| | - Dan Moldoveanu
- Mayo Clinic, Department of Surgery, Division of Breast and Melanoma Surgical Oncology, Rochester, USA
| | - Karthik Ghosh
- Mayo Clinic, Department of Medicine, Division of General Internal Medicine, Rochester, USA
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Moldoveanu D, Lee C, Hesley G. Framework and guide for intralesional steroid injections in idiopathic granulomatous mastitis. Eur J Radiol 2023; 168:111118. [PMID: 37804652 DOI: 10.1016/j.ejrad.2023.111118] [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: 08/09/2023] [Revised: 09/06/2023] [Accepted: 09/26/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE Literature on how to perform intralesional steroid injections, a valuable therapy for idiopathic granulomatous mastitis (IGM), is limited. This technical note offers a detailed technical guide on intralesional steroid injections for IGM and provides a framework for long-term follow-up. METHODS Ultrasound characterization of IGM severity considering breadth, depth, and ancillary findings was used to guide steroid dosing and injection frequency. Clinical and sonographic breast diagrams were designed for accurate longitudinal tracking of IGM. A step-by-step guide for ultrasound-guided IGM aspirations and intralesional steroid injections was developed. RESULTS A detailed approach for ultrasound-guided IGM interventions with clinical and sonographic breast diagrams for longitudinal follow-up is now in practice. CONCLUSIONS The treatment approach described provides a framework for multidisciplinary treatment of IGM and offers insights that may contribute to the ongoing development and improvement of management strategies for this challenging disease.
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Affiliation(s)
- Dan Moldoveanu
- Department of Surgery, Breast and Melanoma Surgical Oncology, Mayo Clinic, 200 First St SW, Rochester MN, 55905, United States.
| | - Christine Lee
- Department of Radiology, Breast Imaging and Intervention, Mayo Clinic, 200 First St SW, Rochester MN, 55905, United States. https://twitter.com/MayoRadiology
| | - Gina Hesley
- Department of Radiology, Breast Imaging and Intervention, Mayo Clinic, 200 First St SW, Rochester MN, 55905, United States.
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Cabioglu N, Uras C, Mutlu H, Sezgin D, Emiroglu S, Dulgeroglu O, Yilmaz R, Tukenmez M, Arikan AE, Kara H, Muslumanoglu M. Local steroid injection in severe idiopathic granulomatous mastitis as a new first-line treatment modality with promising therapeutic efficacy. Front Med (Lausanne) 2023; 10:1251851. [PMID: 37859855 PMCID: PMC10582626 DOI: 10.3389/fmed.2023.1251851] [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: 07/02/2023] [Accepted: 09/04/2023] [Indexed: 10/21/2023] Open
Abstract
Background Intralesional steroid injection has recently evolved as a novel treatment modality for localized idiopathic granulomatous mastitis (= IGM). We aimed to explore the therapeutic efficacy of local steroid injections (LSI) in patients with severe IGM. Methods Fifty-one patients diagnosed with severe IGM were included in the study and treated with either local steroid injection (LSI) alone (n = 25) or combined LSI with systemic oral steroid treatment (OST) (n = 26). The local steroid injection protocol included an intralesional triamcinolone acetonide injection into the palpable granulomas every 4-week, and topical administration of steroid-containing pomades twice a day on the affected surface of the breast. Patients with a combined LSI and OST received low-dose oral methylprednisolone (<16 mg). Results Patients with LSI alone required more LSI applications than those in the combined LSI with OST group (LSI: 5 ± 2.9; vs. LSI/OST: 3.5 ± 2.5; p = 0.080) to obtain an effective optimum therapeutic response. At a median of 12 months (range, 4-42), no difference was found in complete response rates between patients in the LSI group and the combined LSI group with OST (52 vs. 53.9%, p = 0.999). However, steroid-related systemic side effects were lower in the LSI alone group (p < 0.008). Conclusion Local steroid injection could be considered as the first-line treatment in patients with severe IGM until a therapeutic response has been obtained either as the sole treatment modality or combined with oral steroids. Compared with systemic oral steroid therapy, local steroid administration can be considered a new treatment modality with fewer side effects.
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Affiliation(s)
- Neslihan Cabioglu
- Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Cihan Uras
- Department of Surgery, School of Medicine, Acibadem University, Istanbul, Türkiye
| | - Halime Mutlu
- Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Derya Sezgin
- Department of Surgery, School of Medicine, Acibadem University, Istanbul, Türkiye
| | - Selman Emiroglu
- Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Onur Dulgeroglu
- Department of Surgery, School of Medicine, Acibadem University, Istanbul, Türkiye
| | - Ravza Yilmaz
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Mustafa Tukenmez
- Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Akif Enes Arikan
- Department of Surgery, School of Medicine, Acibadem University, Istanbul, Türkiye
| | - Halil Kara
- Department of Surgery, School of Medicine, Acibadem University, Istanbul, Türkiye
| | - Mahmut Muslumanoglu
- Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
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Alhalaseh S, Smith J, Alziadin N, Gandrabur L. Challenging Management of a Breast Mass: Case Report and Literature Review. Cureus 2023; 15:e41855. [PMID: 37583723 PMCID: PMC10423851 DOI: 10.7759/cureus.41855] [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: 06/07/2023] [Accepted: 07/13/2023] [Indexed: 08/17/2023] Open
Abstract
Idiopathic granulomatous mastitis (IGM) is a rare benign pathology of inflammation in the breast that commonly affects parous women of reproductive age and men although it is extremely rare. It has an unusual predilection for Hispanic women born outside of the United States, most notably in Mexico. Recently, this entity has been described more. However, the approach to management is still very controversial, and the approaches vary widely, although surgical approaches, including excision or mastectomy, have been less favored recently as a primary approach. Here, we present a case of a young female of reproductive age who presented initially with a suspicious breast lump diagnosed initially in the breast clinic as IGM and was referred to the rheumatology clinic for management with medical therapy.
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Affiliation(s)
- Saleh Alhalaseh
- Internal Medicine, St. Barnabas Hospital Health System, Bronx, USA
| | - Jordan Smith
- Internal Medicine, St. Barnabas Hospital Health System, Bronx, USA
| | - Nmair Alziadin
- Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, USA
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Abstract
RATIONALE Granulomatous mastitis (GM) is a rare inflammatory disease and the presentation mimics infectious mastitis or breast cancer. The disease usually develops at the unilateral breast in women with breast-feeding history at their child-bearing age. Systemic steroids had been proposed as the first-line treatment, the combination of surgery was also recommended for complicated disease. However, recurrence might still happen in some rare cases. Few studies have addressed the management of such difficult situations. PATIENT CONCERNS We report the case of a 33-year-old androgynous and nulliparous woman who initially presented left breast erythematous swelling and was treated as infectious mastitis with debridement and antibiotics. DIAGNOSIS After wider excision for pathology, the diagnosis of GM was confirmed. INTERVENTIONS Steroids combined with methotrexate were prescribed. However, the symptoms only subsided temporarily and progressed to the contralateral side within 3 months. She finally underwent double-incision mastectomy and free nipple grafting. OUTCOMES The surgery was completed uneventfully, and she had a satisfactory result with no more recurrence at the 6-month follow-up. LESSON This GM case with the refractory treatment courses brought out the importance of surgical resection and was the first case report of treating GM with top surgery in the literature. Total mastectomy facilitated a highest complete remission rate of GM and may be advantageous for selected patients, especially in cases where steroids are intolerable.
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Affiliation(s)
- Ya-Di Lu
- Department of Medical Education, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Yen-Chen Yu
- Division of Plastic and Aesthetic Surgery, Department of Surgery, Far Eastern Memorial Hospital, Taipei City, Taiwan
| | - Dun-Hao Chang
- Division of Plastic and Aesthetic Surgery, Department of Surgery, Far Eastern Memorial Hospital, Taipei City, Taiwan
- Department of Information Management, Yuan Ze University, Taoyuan, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- * Correspondence: Dun-Hao Chang, Division of Plastic and Aesthetic Surgery, Department of Surgery, Far Eastern Memorial Hospital, No.21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City 220, Taiwan (e-mail: )
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Toktas O, Toprak N, Elasan S, Calli I, Binici S. Treatment of Idiopathic Granulomatous Mastitis: Local Steroid Administration vs. Systemic (Oral) Steroid. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03447-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Alper F, Karadeniz E, Güven F, Çankaya BY, Yalcin A, Özden K, Eşdur V, Kaşali K, Akçay MN. Comparison of the Efficacy of Systemic Versus Local Steroid Treatment in Idiopathic Granulomatous Mastitis: A Cohort Study. J Surg Res 2022; 278:86-92. [PMID: 35594619 DOI: 10.1016/j.jss.2022.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 03/01/2022] [Accepted: 04/06/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Steroid therapy is known to be effective against granulomatous mastitis. We aimed to compare the efficacy of local versus systemic steroid administration in patients with idiopathic granulomatous mastitis. MATERIALS AND METHODS This prospective cohort study included 58 patients who had either local (n = 42) or systemic (n = 16) treatment due to granulomatous mastitis between 2015 and 2019. Recurrence rates were determined as per ultrasound and magnetic resonance imaging examinations and the rate of side effects was evaluated as per patient complaints and physical examinations at the end of a 2-year follow-up period. RESULTS Median doses of 140 mg and 3810 mg were administered to the local and systemic group, respectively. Six (14.3%) patients in the local treatment group and 13 (81.3%) in the systemic treatment group had steroid-related side effects. The local treatment group had significantly fewer side effects than the systemic treatment group (P < 0.001). The recurrence rates were similar in both groups (P > 0.05). CONCLUSIONS Local steroid injection was as effective as systemic steroid therapy. Compared to systemic therapy, local steroid administration can be considered as a new therapeutic protocol with a lower dose and side effect rate.
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Affiliation(s)
- Fatih Alper
- Department of Radiology, Ataturk University, Erzurum, Turkey; Clinical Research, Development and Design Application and Research Center, Erzurum, Turkey
| | - Erdem Karadeniz
- Department of General Surgery, Ataturk University, Erzurum, Turkey
| | - Fadime Güven
- Department of Radiology, Ataturk University, Erzurum, Turkey
| | | | - Ahmet Yalcin
- Department of Radiology, Ataturk University, Erzurum, Turkey.
| | - Kemalettin Özden
- Department of Infectious Diseases and Clinical Microbiology, Atatürk University, Erzurum, Turkey
| | - Veysel Eşdur
- Department of Radiology, Ataturk University, Erzurum, Turkey
| | - Kamber Kaşali
- Department of Biostatistics, Atatürk University, Erzurum, Turkey
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Yuan QQ, Xiao SX, Farouk O, Du YT, Sheybani F, Tan QT, Akbulut S, Cetin K, Alikhassi A, Yaghan RJ, Durur-Subasi I, Altintoprak F, Eom TI, Alper F, Hasbahceci M, Martínez-Ramos D, Oztekin PS, Kwong A, Pluguez-Turull CW, Brownson KE, Chandanwale S, Habibi M, Lan LY, Zhou R, Zeng XT, Bai J, Bai JW, Chen QR, Chen X, Zha XM, Dai WJ, Dai ZJ, Feng QY, Gao QJ, Gao RF, Han BS, Hou JX, Hou W, Liao HY, Luo H, Liu ZR, Lu JH, Luo B, Ma XP, Qian J, Qin JY, Wei W, Wei G, Xu LY, Xue HC, Yang HW, Yang WG, Zhang CJ, Zhang F, Zhang GX, Zhang SK, Zhang SQ, Zhang YQ, Zhang YP, Zhang SC, Zhao DW, Zheng XM, Zheng LW, Xu GR, Zhou WB, Wu GS. Management of granulomatous lobular mastitis: an international multidisciplinary consensus (2021 edition). Mil Med Res 2022; 9:20. [PMID: 35473758 PMCID: PMC9040252 DOI: 10.1186/s40779-022-00380-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/07/2022] [Indexed: 02/07/2023] Open
Abstract
Granulomatous lobular mastitis (GLM) is a rare and chronic benign inflammatory disease of the breast. Difficulties exist in the management of GLM for many front-line surgeons and medical specialists who care for patients with inflammatory disorders of the breast. This consensus is summarized to establish evidence-based recommendations for the management of GLM. Literature was reviewed using PubMed from January 1, 1971 to July 31, 2020. Sixty-six international experienced multidisciplinary experts from 11 countries or regions were invited to review the evidence. Levels of evidence were determined using the American College of Physicians grading system, and recommendations were discussed until consensus. Experts discussed and concluded 30 recommendations on historical definitions, etiology and predisposing factors, diagnosis criteria, treatment, clinical stages, relapse and recurrence of GLM. GLM was recommended as a widely accepted definition. In addition, this consensus introduced a new clinical stages and management algorithm for GLM to provide individual treatment strategies. In conclusion, diagnosis of GLM depends on a combination of history, clinical manifestations, imaging examinations, laboratory examinations and pathology. The approach to treatment of GLM should be applied according to the different clinical stage of GLM. This evidence-based consensus would be valuable to assist front-line surgeons and medical specialists in the optimal management of GLM.
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Affiliation(s)
- Qian-Qian Yuan
- grid.413247.70000 0004 1808 0969Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Shu-Xuan Xiao
- grid.170205.10000 0004 1936 7822Department of Pathology, University of Chicago Pritzker School of Medicine, Chicago, IL 60637 USA
| | - Omar Farouk
- grid.10251.370000000103426662Department of Surgical Oncology and Breast Surgery, Oncology Center, Faculty of Medicine, Mansoura University, Mansoura, 35516 Egypt
| | - Yu-Tang Du
- grid.24695.3c0000 0001 1431 9176Department of Breast Surgery, Beijing University of Chinese Medicine, Beijing, 100700 China
| | - Fereshte Sheybani
- grid.411583.a0000 0001 2198 6209Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, 9177899191 Iran
| | - Qing Ting Tan
- grid.414963.d0000 0000 8958 3388Breast Department, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899 Singapore
| | - Sami Akbulut
- grid.411650.70000 0001 0024 1937Department of Surgery, Department of Public Health, Department of Biostatistics, Bioinformatics and Medical Informatics, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
| | - Kenan Cetin
- grid.412364.60000 0001 0680 7807Department of General Surgery, Faculty of Medicine, Çanakkale Onsekiz Mart University, 17020 Çanakkale, Turkey
| | - Afsaneh Alikhassi
- grid.411705.60000 0001 0166 0922Department of Radiology, Cancer Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, 1419733141 Iran
| | - Rami Jalal Yaghan
- grid.411424.60000 0001 0440 9653Department of Surgery, College of Medicine and Medical Sciences, Arabian Gulf University-Bahrain, Manama, 26671 Bahrain
| | - Irmak Durur-Subasi
- grid.411781.a0000 0004 0471 9346Department of Radiology, International Faculty of Medicine, Istanbul Medipol University, 34810 Istanbul, Turkey
| | - Fatih Altintoprak
- grid.49746.380000 0001 0682 3030Department of General Surgery, Faculty of Medicine, Sakarya University, 54050 Sakarya, Turkey
| | - Tae Ik Eom
- Department of Surgery, HiU Clinic, 170, Gwongwang-ro, Paldal-gu, Suwon, 16488 Korea
| | - Fatih Alper
- grid.411445.10000 0001 0775 759XDepartment of Radiology, Faculty of Medicine, Ataturk University, 25240 Erzurum, Turkey
| | - Mustafa Hasbahceci
- Academic Support and Education Center, Hırkai Serif District, Kececi Cesmesi Str, Doktorlar Building, B/7, 34091 Istanbul, Turkey
| | - David Martínez-Ramos
- grid.470634.2Department of General and Digestive Surgery, Hospital General Castellon, Avda Benicassim S/N, 12812004 Castellón, Spain
| | - Pelin Seher Oztekin
- grid.413783.a0000 0004 0642 6432Radiology Department, Ankara Training and Research Hospital, 305018 Ankara, Turkey
| | - Ava Kwong
- grid.440671.00000 0004 5373 5131Department of Surgery, The University of Hong Kong, China; The University of Hong Kong-Shenzhen Hospital, Shenzhen, 518053 China
| | - Cedric W. Pluguez-Turull
- grid.418456.a0000 0004 0414 313XUniversity of Miami Health System and Miller School of Medicine, 1475 NW 12th Avenue, Miami, FL 33136 USA
| | - Kirstyn E. Brownson
- grid.223827.e0000 0001 2193 0096Department of Surgery, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT 84112 USA
| | - Shirish Chandanwale
- grid.464654.10000 0004 1764 8110Department of Pathology, Dr D Y Patil Medical College Hospital and Research Centre, Pimpri, Pune, 603203 India
| | - Mehran Habibi
- Department of Surgery, Johns Hopkins Breast Center at Bayview Campus, 4940 Eastern Avenue, Rm. A-562, Baltimore, MD 21224 USA
| | - Liu-Yi Lan
- grid.413247.70000 0004 1808 0969Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Rui Zhou
- grid.413247.70000 0004 1808 0969Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Xian-Tao Zeng
- grid.413247.70000 0004 1808 0969Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Jiao Bai
- grid.413247.70000 0004 1808 0969Department of Diagnostic Ultrasound, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Jun-Wen Bai
- grid.413375.70000 0004 1757 7666Department of Surgery, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010110 China
| | - Qiong-Rong Chen
- grid.49470.3e0000 0001 2331 6153Center for Pathology and Molecular Diagnostics, Wuhan University, Wuhan, 430071 China
| | - Xing Chen
- grid.415108.90000 0004 1757 9178Department of General Surgery, Fujian Provincial Hospital, Fuzhou, 350001 China
| | - Xiao-Ming Zha
- grid.412676.00000 0004 1799 0784The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029 China
| | - Wen-Jie Dai
- grid.412596.d0000 0004 1797 9737Key Laboratory of Hepatosplenic Surgery and the First Department of General Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, 150007 China
| | - Zhi-Jun Dai
- grid.13402.340000 0004 1759 700XDepartment of Breast Surgery, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, 310003 China
| | - Qin-Yu Feng
- grid.413247.70000 0004 1808 0969Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Qing-Jun Gao
- grid.452244.1Department of General Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004 China
| | - Run-Fang Gao
- grid.464423.3Department of General Surgery, Shanxi Provincial People’s Hospital, Taiyuan, 030012 China
| | - Bao-San Han
- grid.412987.10000 0004 0630 1330Department of Breast Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200092 China
| | - Jin-Xuan Hou
- grid.413247.70000 0004 1808 0969Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Wei Hou
- Department of Cardiothoracic Surgery, Zaoyang People’s Hospital, Zaoyang, 441299 Hubei China
| | - Hai-Ying Liao
- grid.452702.60000 0004 1804 3009Department of Thyroid and Breast Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, 050004 China
| | - Hong Luo
- grid.411634.50000 0004 0632 4559Department of General Surgery, Guangshan County People’s Hospital, Guangshan County, Xinxiang, 465499 Henan China
| | - Zheng-Ren Liu
- grid.412604.50000 0004 1758 4073Department of Breast Surgery, First Affiliated Hospital of Nanchang University, Nanchang, 330006 China
| | - Jing-Hua Lu
- grid.9227.e0000000119573309Chinese Academy of Sciences, Beijing, 100045 China
| | - Bin Luo
- grid.12527.330000 0001 0662 3178Department of General Surgery, School of Clinical Medicine, Tsinghua University, Beijing Tsinghua Changgung Hospital, Beijing, 102218 China
| | - Xiao-Peng Ma
- grid.411395.b0000 0004 1757 0085Department of Breast and Thyroid Surgery, The First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Hospital, Hefei, 230001 China
| | - Jun Qian
- grid.414902.a0000 0004 1771 3912Department of Thyroid Surgery, First Affiliated Hospital of Kunming Medical University, Kunming, 650032 China
| | - Jian-Yong Qin
- Department of Oncology, Liwan Central Hospital of Guangzhou, Guangzhou, 510150 China
| | - Wei Wei
- grid.440601.70000 0004 1798 0578Department of Breast Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036 Guangdong China
| | - Gang Wei
- grid.413247.70000 0004 1808 0969Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Li-Ying Xu
- grid.413247.70000 0004 1808 0969Department of Computed Tomography, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Hui-Chao Xue
- grid.412990.70000 0004 1808 322XDepartment of General Surgery, Xinxiang Medical University First Affiliated Hospital, Xinxiang, 453100 Henan China
| | - Hua-Wei Yang
- grid.256607.00000 0004 1798 2653Department of Breast Surgery, Guangxi Medical University Cancer Hospital, Nanning, 530021 China
| | - Wei-Ge Yang
- grid.413087.90000 0004 1755 3939Department of General Surgery, Zhongshan Hospital Fudan University, Shanghai, 200032 China
| | - Chao-Jie Zhang
- grid.477407.70000 0004 1806 9292Department of Breast and Thyroid Surgery, Hunan Provincial People’s Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, 410005 China
| | - Fan Zhang
- grid.410726.60000 0004 1797 8419Department of Breast and Thyroid Surgery, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, 400013 China
| | - Guan-Xin Zhang
- Department of General Surgery, Qinghai Province People’s Hospital, Xining, 810007 China
| | - Shao-Kun Zhang
- grid.508137.80000 0004 4914 6107Department of Thyroid and Breast Surgery, Qingdao Women and Children’s Hospital, Qingdao, 266000 Shandong China
| | - Shu-Qun Zhang
- grid.43169.390000 0001 0599 1243Department of Oncology, Xi’an Jiaotong University Second Affiliated Hospital, Xi’an, 710004 China
| | - Ye-Qiang Zhang
- Department of Cardiothoracic Surgery, Zaoyang First People’s Hospital, Zaoyang, 441299 Hubei China
| | - Yue-Peng Zhang
- grid.413247.70000 0004 1808 0969Department of Diagnostic Ultrasound, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Sheng-Chu Zhang
- grid.508285.20000 0004 1757 7463Department of Thyroid and Breast Surgery, Yichang Central People’s Hospital, Yichang, 443003 Hubei China
| | - Dai-Wei Zhao
- grid.413458.f0000 0000 9330 9891Department of Thyroid Surgery, The Second Affiliated Hospital, Guizhou Medical University, Kaili, 556000 Guizhou China
| | - Xiang-Min Zheng
- grid.413810.fDepartment of General Surgery, Shanghai Changzheng Hospital, Shanghai, 200003 China
| | - Le-Wei Zheng
- grid.413247.70000 0004 1808 0969Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Gao-Ran Xu
- grid.413247.70000 0004 1808 0969Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Wen-Bo Zhou
- grid.452381.90000 0004 1779 2614Department of Surgery, Dongfeng General Hospital Affiliated with Hubei Medical College, Shiyan, 442001 Hubei China
| | - Gao-Song Wu
- grid.413247.70000 0004 1808 0969Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
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12
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Godazandeh G, Shojaee L, Alizadeh-Navaei R, Hessami A. Corticosteroids in idiopathic granulomatous mastitis: a systematic review and meta-analysis. Surg Today 2021; 51:1897-1905. [PMID: 33590327 DOI: 10.1007/s00595-021-02234-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/16/2020] [Indexed: 02/05/2023]
Abstract
Idiopathic granulomatous mastitis (IGM) is an inflammatory disease of the breasts with an unknown etiology. Corticosteroids are one the primary options for treating this disease, but the results of previous studies concerning their efficacy have been controversial. We, therefore, decided to assess the effectiveness of corticosteroids on IGM using a systematic review and meta-analysis. We conducted a systematic search using MeSH terms and all relevant keywords in PubMed, EMBASE, Cochrane Library and Web of Science until May 21, 2019. Data were analyzed using the Comprehensive Meta-Analysis (CMA) V.2 software program and presented as the event rate, risk ratio (RR) and risk difference (RD). Twelve studies including 559 IGM patients were entered into the meta-analysis. Our analysis showed that the RR and RD of recurrence in the steroid-only group compared with the surgery-only group were 2.99 (95% confidence interval [CI] 0.28-31.33) and 0.14 (95% CI - 0.01-0.30), respectively, showing no statistical significance. The meta-analysis of the steroid-only group and steroid + surgery group showed that the RR of recurrence was 6.13 (95% CI 0.41-81.62) with no significance. However, the meta-analysis of the RD showed that the risk of recurrence in the steroid group was significantly higher than that in the steroids + surgery group (RD: 0.28, 95% CI 0.11-0.44). This meta-analysis showed that managing IGM with only steroids may be less effective than the combination of steroids and surgery. This combination approach may result in a lower rate of recurrence and side effects in these patients.
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Affiliation(s)
- Gholamali Godazandeh
- Department of Surgery, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Leyla Shojaee
- Department of Surgery, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Reza Alizadeh-Navaei
- Gastrointestinal Cancer Research Center, Non-Communicable Disease Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Amirhossein Hessami
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
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13
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Kafadar MT, Bahadır MV, Girgin S. Low-Dose Methotrexate Use in Idiopathic Granulomatous Mastitis: An Alternative Treatment Method. Breast Care (Basel) 2021; 16:402-407. [PMID: 34602947 DOI: 10.1159/000513879] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/18/2020] [Indexed: 01/20/2023] Open
Abstract
Background Idiopathic granulomatous mastitis (IGM) is a rare, recurrent and progressive breast disease with an unknown etiology. Patients with IGM will probably face stressful, time-consuming treatment procedures with side effects due to medications. There are different treatment modalities in clinical use including medical and surgical interventions. Objective The aim of this study was to present the results of using the combination therapy of low-dose methotrexate (MTX) and steroid in IGM. Methods Seventeen patients diagnosed with IGM and treated with MTX were included into the study. Low-dose MTX at 5 mg/week and 8 mg/day prednisone were given for 2-3 months. Results After 2-3 months of treatment, 10 patients exhibited (58.5%) complete, 3 patients (17.6%) partial recovery, and no response to the treatment process was observed in 4 patients (23.5%). No side effects of MTX and recurrent events were noted in any of the patients. Conclusion Low-dose MTX and prednisone treatment for IGM patients, who did not respond to steroids alone, should be considered as an alternative treatment method instead of surgical intervention.
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Affiliation(s)
- Mehmet Tolga Kafadar
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Mehmet Veysi Bahadır
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Sadullah Girgin
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
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14
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Alsaleh N. Assertive clinical practice in managing patients with idiopathic granulomatous mastitis: Review of literature. Ann Med Surg (Lond) 2021; 70:102792. [PMID: 34691410 PMCID: PMC8519765 DOI: 10.1016/j.amsu.2021.102792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/24/2021] [Accepted: 09/02/2021] [Indexed: 12/19/2022] Open
Abstract
Idiopathic granulomatous mastitis (IGM) is a benign persistent inflammatory breast entity characterized histologically by lobulo centric granulomas. Diagnosis may be difficult and involves a strong index of suspicion. There are plentiful studies are published which render the disease more frequently than expected. The strategy for imaging IGM depends on patient age, clinical manifestations, and risk factors. Patients have an excellent prognosis when they are appropriately treated. The management remains contentious, good judgment is required to ensure optimum treatment form and timing.
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Affiliation(s)
- Nuha Alsaleh
- Division of General Surgery, Department of Surgery, College of Medicine and King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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15
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Velidedeoğlu M, Papila Kundaktepe B, Mete B, Uğurlu S. Idiopathic granulomatous mastitis associated with erythema nodosum may indicate a worse prognosis. Int J Rheum Dis 2021; 24:1370-1377. [PMID: 34514701 DOI: 10.1111/1756-185x.14218] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory breast disease of unknown etiology, and erythema nodosum (EN) is a rare extramammary manifestation of this entity characterized by reddish, tender nodules of the lower legs. We aimed to investigate whether the association of IGM with EN has a role as a prognostic indicator. There are few case reports, and only 1 original article including 12 IGM patients with EN has been reported. METHODS We present 43 women with IGM coexisting with EN and 43 with a diagnosis of IGM only, who were randomly selected from 610 patients for a control group. To the best of our knowledge, this paper comprises the first comparative study of the coexistence of IGM and EN to be reported in the literature. RESULTS Our findings show that the association of IGM with EN indicates a more aggressive disease course. White blood cells, erythrocyte sedimentation rate, and C-reactive protein were significantly higher in the EN-positive group (P < .05). Arthralgia, breast feeding, fistula distribution and recurrence distributions were significantly higher in the EN-positive group (P < .05). CONCLUSION Since fistula distribution and recurrence rates were higher in EN-positive group, association of IGM with EN may be an indictor of a worse prognosis. The present study highlights the importance of dermatological care. All physicians should not neglect questioning breast complaints in patients with EN since EN may be caused by IGM.
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Affiliation(s)
- Mehmet Velidedeoğlu
- Department of General Surgery, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpasa, Fatih, Turkey
| | - Berrin Papila Kundaktepe
- Department of General Surgery, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpasa, Fatih, Turkey
| | - Bilgul Mete
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpasa, Fatih, Turkey
| | - Serdal Uğurlu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpasa, Fatih, Turkey
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16
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Chen X, Zhang W, Yuan Q, Hu X, Xia T, Cao T, Jia H, Zhang L. A novel therapy for granulomatous lobular mastitis: Local heat therapy. Exp Ther Med 2021; 22:1156. [PMID: 34504601 DOI: 10.3892/etm.2021.10590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/17/2020] [Indexed: 12/24/2022] Open
Abstract
Granulomatous lobular mastitis (GLM) is a chronic inflammatory breast condition that is characterized by granulomatous inflammation. GLM remains a refractory disease due to its failure to respond to routine anti-inflammatory therapies and its high recurrence rate. Thus, the present study aimed to investigate the application of local heat therapy in GLM as a potential therapeutic strategy. The results revealed that the application of local heat therapy was associated with a shortened remission time for GLM, while the remission and recurrence rates were similar to those of existing therapies. The median first remission time following local heat therapy was significantly decreased compared with that following corticosteroid therapy (5.30 months vs. 11.27 months; P<0.05). The remission rates were not significantly different between the local heat therapy (76.9%), extensive excision (90.4%) and the corticosteroid therapy (85.7%) groups (P>0.05). In addition, the recurrence rates were not statistically different between the groups (local heat therapy, 8.3%; extensive excision, 10%; and corticosteroid therapy, 10%; P>0.05). The local heat therapy showed mild adverse effects and shortened healing times compared to the other therapies; however, further confirmation is required.
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Affiliation(s)
- Xinxin Chen
- Department of Breast Surgery, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510260, P.R. China.,Guangdong Provincial Education Department, Key Laboratory of Nano-Immunoregulation Tumor Microenvironment, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510260, P.R. China
| | - Wangjian Zhang
- Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, NY 12144, USA
| | - Qiuer Yuan
- Department of Breast Surgery, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510260, P.R. China
| | - Xiaowu Hu
- Department of Breast Surgery, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510260, P.R. China
| | - Ting Xia
- Department of Breast Surgery, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510260, P.R. China
| | - Tengfei Cao
- Department of Breast Surgery, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510260, P.R. China
| | - Haixia Jia
- Department of Breast Surgery, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510260, P.R. China
| | - Lehong Zhang
- Department of Breast Surgery, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510260, P.R. China
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17
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Yaprak Bayrak B, Cam I, Eruyar AT, Utkan NZ. Clinicopathological evaluation of idiopathic granulomatous mastitis patients: A retrospective analysis from a tertiary care hospital in Turkey. Ann Diagn Pathol 2021; 55:151812. [PMID: 34500135 DOI: 10.1016/j.anndiagpath.2021.151812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 08/05/2021] [Accepted: 08/19/2021] [Indexed: 11/16/2022]
Abstract
Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory disease of the breast with unknown etiology that is characterized by granuloma formation. We analyzed the clinical, radiological, and therapeutic approaches; the recurrence rate of the disease; and the pathological findings diagnosed with mastitis in a retrospective study. We evaluated a total of 77 patients subjected to core needle or excisional biopsy with preliminary diagnosis of mastitis between January 2017-December 2019 who diagnosed with IGM, nonspecific mastitis/abscess, or periductal mastitis/plasma cell mastitis as a result of their pathological assessment. The mean age was 39.24 ± 10.6. Though 65 patients were diagnosed with IGM (84.4%), other diagnoses were reported as nonspecific mastitis/abscess (n = 9), periductal mastitis (n = 2) and plasma cell mastitis (n = 1). Recurrence occurred in 30 (39%) patients during follow-up. In patients without IGM, the number of 5-year postpartum mastitis diagnoses was significantly higher (p = 0.0008) while number of 2-year postpartum mastitis diagnoses was lower (p = 0.255) compared to those in IGM patients. The rates of axillary lymphadenopathy, bacterial culture, parity, and menopausal status were not different in patients without IGM. Linear correlation analysis did not reveal a significant relationship between radiological preliminary diagnosis and pathological diagnosis with BI-RADS classification. A detailed assessment, accompanied with clinical, radiological, and pathological findings, should be performed to achieve an accurate diagnosis and effective patient management in IGM. Furthermore, IGM should always be considered in the differential diagnosis of mastitis among breast masses.
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Affiliation(s)
- Busra Yaprak Bayrak
- Department of Pathology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
| | - Isa Cam
- Department of Radiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
| | - Ahmet Tugrul Eruyar
- Department of Pathology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
| | - Nihat Zafer Utkan
- Department of General Surgery, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
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18
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Akbulut S, Sahin TT. Comment on idiopathic granulomatous mastitis: A systematic review of 3060 patients. Int J Surg Case Rep 2021; 85:106250. [PMID: 34362684 PMCID: PMC8369293 DOI: 10.1016/j.ijscr.2021.106250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 07/27/2021] [Indexed: 02/07/2023] Open
Affiliation(s)
- Sami Akbulut
- Department of Surgery, Liver Transplant Institute, Inonu University Faculty of Medicine, 244280 Malatya, Turkey.
| | - Tevfik Tolga Sahin
- Department of Surgery, Liver Transplant Institute, Inonu University Faculty of Medicine, 244280 Malatya, Turkey
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19
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Toktas O, Toprak N. Treatment Results of Intralesional Steroid Injection and Topical Steroid Administration in Pregnant Women with Idiopathic Granulomatous Mastitis. Eur J Breast Health 2021; 17:283-287. [PMID: 34263157 DOI: 10.4274/ejbh.galenos.2021.2021-2-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/20/2021] [Indexed: 12/01/2022]
Abstract
Objective Idiopathic granulomatous mastitis (IGM) is an inflammatory and chronic benign breast disease that has proven difficult to diagnose and treat. Since most treatment modalities cannot be used in pregnant patients, the choice of treatment is more difficult and the need for surgery is more pressing. In this first and innovative study, we assess the results of local corticosteroid therapy of IGM in pregnant women. Materials and Methods Pregnant women with IGM were evaluated between June 2017 and May 2019. The six pregnant women were treated using intralesional steroid injections and topical steroid administration. The treatment response was evaluated, both clinically and radiologically, at the end of 2 weeks and once more at the end of 1 month. Results The median patient age was 26 years. The mean duration of complaints was 4.3 months. The median number of children was 2, and the mean breastfeeding time was 41 months. The predominant complaints at onset were a breast mass or local pain and inflammation in four (66.7%) patients and a breast mass with pain and without signs of local skin inflammation in two (33.3%) patients. Diagnosis was made using a tru-cut biopsy in two patients, and with an incisional biopsy in four patients who had abscess drainage and fistulation to the skin. Five (83.3%) patients achieved a complete response, and one (16.7%) patient responded only partially after the first course of treatment. A second course of treatment was given to the patient with partial response. All patients achieved complete response at the end of the second course of treatment. The mean follow-up time was 19.5 months. During the follow-up period, one patient experienced a recurrence at 4 months after giving birth, and she then received a third course of treatment. Topical and systemic side effects of the corticosteroids were not observed in any patient. Conclusion While the state of pregnancy generally precludes the use of most drugs, the use of local corticosteroid in the treatment of IGM is effective in terms of treatment response, treatment duration, need for surgery, and reduced recurrence and side effects.
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Affiliation(s)
- Osman Toktas
- Department of Surgery, Van Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
| | - Nurşen Toprak
- Department of Radiology, Van Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
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20
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Coombe RF, Hamed H. An update on granulomatous mastitis: a rare and complex condition. Br J Hosp Med (Lond) 2021; 82:1-7. [PMID: 34076525 DOI: 10.12968/hmed.2020.0718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Granulomatous mastitis is a rare inflammatory condition of the breast affecting women of child-bearing age. The disease is characterised by chronic and relapsing inflammation, resulting in scarring and discharging sinuses. Granulomatous mastitis is considered to be idiopathic and the pathogenesis is poorly understood. An amplified immune response has been proposed as a likely cause and there is evidence linking Corynebacterium to some cases of granulomatous mastitis. The presentation is similar to bacterial mastitis or abscess and antibiotics are commonly commenced empirically. The cornerstone of diagnosis is histopathological evaluation on core biopsy; an index of suspicion based on demographic assessment can avoid delays in diagnosis. Management is difficult and there is no consensus on best treatment. Various treatment regimens are described, with high relapse rates relating to the nature of the condition. Watchful waiting is appropriate for mild presentations and steroids are the mainstay of treatment for more severe cases. This article reviews the emerging evidence on granulomatous mastitis and describes an updated approach to management.
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Affiliation(s)
- Robyn F Coombe
- Guy's Hospital Breast Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.,School of Medicine, Griffith University, Queensland, Australia
| | - Hisham Hamed
- Guy's Hospital Breast Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.,School of Medicine, Kings College, London, UK
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21
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Shojaee L, Rahmani N, Moradi S, Motamedi A, Godazandeh G. Idiopathic granulomatous mastitis: challenges of treatment in iranian women. BMC Surg 2021; 21:206. [PMID: 33882924 PMCID: PMC8061012 DOI: 10.1186/s12893-021-01210-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/14/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVE As a chronic inflammatory disease of an unknown origin, the treatment of granulomatous mastitis has always been controversial. According to some researchers, surgical treatment and certain medications, especially steroids, are more effective in treating the disease. This study aimed at evaluating the results of treatment in a group of patients with granulomatous mastitis. MATERIALS AND METHODS This longitudinal cohort study evaluated the treatment outcomes of 87 patients with pathology-confirmed granulomatous mastitis referred to the surgical clinic of Central Hospital in Sari, Iran. Demographic, clinical, and pathological information, treatment methods and results, and the recurrence rate were analyzed. FINDINGS A total of 87 female patients with granulomatous mastitis aged 22-52 years with a mean age of 34 years were evaluated. All patients had palpable masses; the breast masses were painful in 48.3% of patients, and 55.2% of patients suffered from erythema and inflammation, and8% had fistulas and ulcers at the inflammation site. The patients were followed-up for an average duration of 26 months (8-48 months) after treatment and recovery. The overall recurrence rate was 24.1%, and the recurrence rate was 29.4% in patients underwent surgery, 34.8% in patients received high-dose prednisolone, and 17% in those received low-dose prednisolone together with drainage (p < 0.001). CONCLUSIONS According to the results, the low-dose prednisolone plus drainage was more effective with a lower recurrence rate than only surgical excision or high-dose prednisolone. In fact, the use of minimally invasive methods such as drainage plus low-dose steroids is a more effective method with fewer side effects than the other two methods.
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Affiliation(s)
- Leyla Shojaee
- Department of Surgery, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Nasrin Rahmani
- Department of Surgery, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Siavash Moradi
- Community Medicine Specialist, Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Gholamali Godazandeh
- Department of Surgery, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
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22
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Şener Bahçe Z, Aktaş H. Patients with idiopathic granulomatous mastitis accompanied by erythema nodosum. Int J Clin Pract 2021; 75:e13928. [PMID: 33305438 DOI: 10.1111/ijcp.13928] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/08/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) is a rare, chronic inflammatory disease of the breast. The aetiology is unknown. Erythema nodosum (EN) is a rare skin disease associated with IGM. EN is a disease in which the aetiologic factors include infection, malignancy, autoimmune diseases, and pregnancy. OBJECTIVE The objective of this study was to evaluate the incidence and coexistence of EN with IGM and the approach to treatment. METHODS Patients who were admitted to the General Surgery and Dermatology Department of our hospital and diagnosed with EN and IGM were evaluated. Demographic data, symptoms, examination findings, number of birth, smoking, diagnosis and treatment methods, recurrence, and follow-up periods of the patients were evaluated. RESULTS EN was seen in six of the patients admitted to the clinic for IGM. Four patients with EN had pregnancy and all had arthritis. Two patients were not pregnant. Oral methylprednisolone treatment was started in patients whose IGM diagnosis was verified pathologically. CONCLUSION IGM may be associated with extramammary symptoms such as EN, arthralgia, and episcleritis. These extramammary findings suggest that IGM may be an autoimmune disease. For this reason, breast examination and history of IGM of the breast should be questioned in female patients admitted to different clinics with EN. This way, delays in the diagnosis and treatment of IGM can be prevented.
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Affiliation(s)
- Zeynep Şener Bahçe
- Department of General Surgery, Private Memorial Hospital, Diyarbakir, Turkey
| | - Hamza Aktaş
- Department of Dermatology, Private Memorial Hospital, Diyarbakir, Turkey
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23
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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: 19] [Impact Index Per Article: 6.3] [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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24
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Effectiveness of Methotrexate in Idiopathic Granulomatous Mastitis Treatment. Am J Med Sci 2020; 360:560-565. [DOI: 10.1016/j.amjms.2020.05.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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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25
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Stachs A, Stubert J, Reimer T, Hartmann S. Benign Breast Disease in Women. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 116:565-574. [PMID: 31554551 DOI: 10.3238/arztebl.2019.0565] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/02/2019] [Accepted: 07/02/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Most clinical breast changes in women are benign; in only 3% to 6% of cases are they due to breast cancer. How- ever, there is a lack of up-to-date, evidence-based treatment recommendations for the various benign differential diagnoses. METHODS Selective literature search of PubMed from 1985 to May 2019, including current national (AWMF, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften [Association of Scientific Medical Societies in Germany]) and inter- national guidelines. RESULTS Mastalgia and fibrocystic changes are common (around 50% of all women over the age of 30). Fibroadenomas occur in 25% of women; they are the most common benign tumors of the breast and do not require treatment. With most benign breast changes the risk of dedifferentiation is very low. However, it is important in the differential diagnosis to distinguish between such benign changes and breast cancer or changes that carry a risk of malignancy. Complex cysts, for example, carry a risk of malig- nancy of 23% to 31%, papillary lesions 16% , and radial scars 7%. Where there is doubt, histological confirmation should be sought by means of percutaneous biopsy. CONCLUSION Benign breast changes can be definitively distinguished from malignant lesions through the selective use of avail- able diagnostic investigations and interdisciplinary collaboration. When lesions of uncertain malignant potential are found (B3 in the biopsy classification), complete excision is indicated. Prospective studies on the early diagnosis of breast cancer in lesions carrying a risk of malignancy are desirable.
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Affiliation(s)
- Angrit Stachs
- Department of Obstetrics and Gynecology, University of Rostock
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26
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Çetin K, Sıkar HE, Göret NE, Rona G, Barışık NÖ, Küçük HF, Gulluoglu BM. Comparison of Topical, Systemic, and Combined Therapy with Steroids on Idiopathic Granulomatous Mastitis: A Prospective Randomized Study. World J Surg 2020; 43:2865-2873. [PMID: 31297582 DOI: 10.1007/s00268-019-05084-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) is a benign disorder of the breast, for which the optimal treatment modality remains missing. METHODS A total of 124 patients with a histopathologically proven diagnosis of IGM were enrolled in a prospective, randomized parallel arm study. Patients were treated with topical steroids in Group T (n: 42), systemic steroids (0.8 mg/kg/day peroral) in Group S (n: 42), and combined steroids (0.4 mg/kg/day peroral + topical) in Group C (n: 40). Compliance with the therapy, response to the therapy, the duration of therapy, side effects and the recurrence rates were compared. RESULTS Sixteen patients did not comply with the treatment, and the highest ratio of compliance with therapy was seen in Group T (p < 0.05). Complete clinical regression (CCR) was observed in 90 (83.3%) patients. Response to the treatment (RT) was evaluated radiologically and observed in 89.8% of the patients. There was no statistically significant difference between groups regarding CCR, RT and the recurrence rate. The longest duration of therapy was observed in Group T (22 ± 9.1-week), whereas the shortest was observed in Group S (11.7 ± 5.5-week) (p < 0.001). The systemic side effects were significantly lower in Group T in comparison with Groups S and C (2.4% vs. 38.2% and 30.3%, respectively) (p < 0.001). CONCLUSIONS The efficiency of the treatment was similar for all groups, both clinically and radiologically. Although the duration of therapy was longer in Group T, the lack of systemic side effects increased the compliance of the patients with the therapy. Therefore, topical steroids would be among first-line treatment options of IGM.
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Affiliation(s)
- Kenan Çetin
- Department of General Surgery, University of Health Sciences, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey.
| | - Hasan E Sıkar
- Department of General Surgery, University of Health Sciences, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Nuri E Göret
- Department of General Surgery, University of Health Sciences, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Günay Rona
- Department of Radiology, University of Health Sciences, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Nagehan Ö Barışık
- Department of Pathology, University of Health Sciences, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Hasan F Küçük
- Department of General Surgery, University of Health Sciences, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Bahadır M Gulluoglu
- Breast and Endocrine Surgery Unit, Department of General Surgery, Marmara University School of Medicine, 34899, Pendik, Istanbul, Turkey
- Department of Breast Surgery, SENATURK (Turkish Academy of Breast Sciences), 34710, Kadikoy, Istanbul, Turkey
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27
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Toktas O, Konca C, Trabulus DC, Soyder A, Koksal H, Karanlik H, Kamali Polat A, Ozbas S, Yormaz S, Isik A, Sezgin E, Soran A. A Novel First-Line Treatment Alternative for Noncomplicated Idiopathic Granulomatous Mastitis: Combined İntralesional Steroid İnjection with Topical Steroid Administration. Breast Care (Basel) 2020; 16:181-187. [PMID: 34012373 DOI: 10.1159/000507951] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/16/2020] [Indexed: 01/01/2023] Open
Abstract
Background Idiopathic granulomatous mastitis (IGM) is a rare form of nonlactational mastitis. Due to the small number of case series and consequently inadequate prospective studies, there is still no consensus on the optimal treatment of IGM. In this study, we aimed to compare the efficacy of intralesional steroid injection with concomitant topical steroids to systemic steroid therapy only in the treatment of noncomplicated IGM. Methods Between June 2015 and April 2018, the patients' data was prospectively collected and analyzed retrospectively. The study included a total of 78 female patients diagnosed with IGM. Patients were divided into 2 groups: the local steroid treatment group (intralesional steroid injection with topical steroid administration; group 1, n = 46) and the peroral systemic steroid treatment group (group 2, n = 32). Response to the therapy, side effects, recurrence, the need for surgical treatment, and complication rates were compared. Results Forty-three patients (93.5%) in group 1 achieved a partial or complete response compared to 23 patients (71.9%) in group 2 after 3 months; this difference was significant (p = 0.012). The recurrence rates were significantly lower in group 1 (8.7%) compared to group 2 (46.9%; p = 0.001), and the need for surgical treatment was significantly less in group 1 (2.2%) than in group 2 (9.4%; p = 0.001). While the complication rates were similar between groups, a higher rate of systemic side effects was observed in group 2. Conclusion Based on the results of our study, combined steroid injection and topical steroid treatment in IGM is as effective as systemic steroid treatment. We suggest that this combination therapy of topical steroids and local steroid injection should be used as first-line therapy in patients with noncomplicated IGM.
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Affiliation(s)
- Osman Toktas
- Department of Surgery, Medical Faculty, Van Yuzuncu Yıl University, Van, Turkey
| | - Can Konca
- Department of Surgery, Medical Faculty, Ankara University, Ankara, Turkey
| | - Didem Can Trabulus
- Department of Surgery, Istanbul Samatya Training and Research Hospital, İstanbul, Turkey
| | - Aykut Soyder
- Department of Surgery, Medical Faculty, Adnan Menderes University, Aydın, Turkey
| | - Hande Koksal
- Department of Surgery, Konya Training and Research Hospital, Konya, Turkey
| | - Hasan Karanlik
- Department of Surgery, Istanbul University Institute of Oncology, İstanbul, Turkey
| | - Ayfer Kamali Polat
- Department of Surgery, Medical Faculty, 19 Mayıs University, Samsun, Turkey
| | - Serdar Ozbas
- Department of Surgery, Ankara Guven Hospital, Ankara, Turkey
| | - Serdar Yormaz
- Department of Surgery, Medical Faculty, Selcuk University, Konya, Turkey
| | - Arda Isik
- Department of Surgery, Medical Faculty, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Efe Sezgin
- Izmir Instıtute of Technology, İzmir, Turkey
| | - Atilla Soran
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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28
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Azizi A, Prasath V, Canner J, Gharib M, Sadat Fattahi A, Naser Forghani M, Sajjadi S, Farhadi E, Vasigh M, Kaviani A, Omranipour R, Habibi M. Idiopathic granulomatous mastitis: Management and predictors of recurrence in 474 patients. Breast J 2020; 26:1358-1362. [PMID: 32249491 DOI: 10.1111/tbj.13822] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/03/2020] [Accepted: 03/10/2020] [Indexed: 01/23/2023]
Abstract
Idiopathic Granulomatous Mastitis (IGM) is an uncommon inflammatory disease of the breast, with similar presentations as breast cancer and a relatively high recurrence rate. We reviewed the demographics, clinical presentations, and treatment modalities of a large cohort of patients in Iran. Most of the patients had history of pregnancy and breastfeeding. The most common clinical finding was pain and a palpable mass, respectively. Most of the patients received medical treatment, and about half of the patients had surgery. The recurrence rate was 24.8%, and breast skin lesions were associated with a significantly higher odds of recurrence.
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Affiliation(s)
- Armina Azizi
- Department of General Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Vishnu Prasath
- Department of General Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Joseph Canner
- Department of General Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | | | | | | | - Effat Farhadi
- Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahtab Vasigh
- Breast Disease Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Ahmad Kaviani
- Breast Disease Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Ramesh Omranipour
- Breast Disease Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Mehran Habibi
- Department of General Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
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29
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Wu JM, Turashvili G. Cystic neutrophilic granulomatous mastitis: an update. J Clin Pathol 2020; 73:445-453. [PMID: 32094275 DOI: 10.1136/jclinpath-2019-206180] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 02/07/2023]
Abstract
Cystic neutrophilic granulomatous mastitis (CNGM) is a rare subtype of granulomatous mastitis with a highly distinct histological pattern often associated with Corynebacterium species. CNGM is characterised by suppurative lipogranulomas that are composed of central lipid vacuoles rimmed by neutrophils and an outer cuff of epithelioid histiocytes. Some of the lipid vacuoles may contain sparse, rod-shaped, gram-positive bacilli that can be easily missed or dismissed. The surrounding mixed inflammatory infiltrate contains Langhans-type giant cells, lymphocytes and neutrophils. CNGM occurs in reproductive age women with a history of pregnancy and typically presents as a palpable mass that can be painful. CNGM has many mimickers, most significantly breast carcinoma. In many cases, CNGM has significant pathological and clinical overlap with other forms of granulomatous mastitis. Given the association with Corynebacterium species, early diagnosis of CNGM is essential in offering patients the most appropriate treatment. Prolonged antibiotic therapy specifically directed to corynebacteria is required, sometimes even beyond resolution of clinical symptoms. This comprehensive review of the existing literature on CNGM describes clinical-pathological features, microbiological findings, challenges associated with the microscopic differential diagnosis, clinical implications of this diagnosis and emerging treatment options. Morphological criteria and suggested comments to convey the degree of diagnostic certainty are also proposed for standard pathology reporting.
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Affiliation(s)
- Jessie M Wu
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Gulisa Turashvili
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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30
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Ma X, Min X, Yao C. Different Treatments for Granulomatous Lobular Mastitis: A Systematic Review and Meta-Analysis. Breast Care (Basel) 2020; 15:60-66. [PMID: 32231499 PMCID: PMC7098302 DOI: 10.1159/000501498] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 06/14/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Granulomatous lobular mastitis (GLM) is infrequently diagnosed. This study aimed to evaluate the efficacy and safety of managements for GLM in the nonlactation period. METHODS Publications were retrieved from PubMed, EMBASE, and the Cochrane library on September 10, 2018. We pooled and compared the outcome parameters and complete remission (CR) rates between different treatments using a meta-analysis. RESULTS Twenty-one publications including 970 patients treated with surgical excision, steroids, abscess drainage, antibiotics, and observation were included. Surgery significantly improved CR rate compared with steroids (p = 0.0003). There was no difference in the CR rate in patients treated with surgery alone or combined with steroids (p = 0.28). Surgery showed borderline significant efficacy in the CR rate compared with antibiotics (p = 0.06) and abscess drainage (p = 0.06). No difference was observed in effectiveness between observation and surgical management in patients diagnosed with early GLM and mild symptoms. CONCLUSIONS Although surgery was the ideal management for GLM, steroids and antibiotics might be ideal managements for GLM patients who are worried about surgical scars. Observation was an impressive alternative for patients with early GLM.
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Affiliation(s)
- Xiaojia Ma
- Nanjing University of Chinese Medicine, Nanjing, China
- Yunnan Provincial Hospital of Traditional Chinese Medicine, Kunming, China
| | - Xiaoli Min
- Department of Cerebrovascular Diseases, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Chang Yao
- The First Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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31
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Altunkeser A, Arslan FZ, Eryılmaz MA. Magnetic resonance imaging findings of idiopathic granulomatous mastitis: can it be an indirect sign of treatment success or fail? BMC Med Imaging 2019; 19:94. [PMID: 31842782 PMCID: PMC6916024 DOI: 10.1186/s12880-019-0397-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 12/03/2019] [Indexed: 02/01/2023] Open
Affiliation(s)
- Ayşegül Altunkeser
- Department of Radiology, University of Health Science, Konya Trainning and Research Hospital, Konya, Turkey
| | - Fatma Zeynep Arslan
- Department of Radiology, University of Health Science, Konya Trainning and Research Hospital, Konya, Turkey.
| | - Mehmet Ali Eryılmaz
- Department of General Surgery, University of Health Science, Konya Trainning and Research Hospital, Konya, Turkey
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32
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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: 11] [Impact Index Per Article: 2.2] [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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Alper F, Karadeniz E, Güven F, Yılmaz Çankaya B, Özden K, Akçay MN. The evaluation of the efficacy of local steroid administration in idiopathic granulomatous mastitis: The preliminary results. Breast J 2019; 26:309-311. [PMID: 31495032 DOI: 10.1111/tbj.13588] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/13/2019] [Accepted: 06/13/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Fatih Alper
- Department of Radiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Erdem Karadeniz
- Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Fadime Güven
- Department of Radiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Bahar Yılmaz Çankaya
- Department of Radiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Kemalettin Özden
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Müfide Nuran Akçay
- Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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34
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Koksal H. Human leukocyte antigens class I and II in patients with idiopathic granulomatous mastitis. Am J Surg 2019; 218:605-608. [DOI: 10.1016/j.amjsurg.2019.01.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/04/2019] [Accepted: 01/10/2019] [Indexed: 12/13/2022]
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35
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Chen K, Zhu L, Hu T, Tan C, Zhang J, Zeng M, Li S, Song E. Ductal Lavage for Patients With Nonlactational Mastitis: A Single-Arm, Proof-of-Concept Trial. J Surg Res 2019; 235:440-446. [PMID: 30691827 DOI: 10.1016/j.jss.2018.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/09/2018] [Accepted: 10/17/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Surgery, steroids, and/or observations alone have been proposed for patients with nonlactational mastitis (NLM), but most of these studies were retrospective. The optimal treatment for these patients remains unclear. This prospective, single-arm, proof-of-concept trial aimed to evaluate the feasibility and safety of ductal lavage as a novel treatment for patients with NLM. METHODS Eligible patients with NLM received an intraductal infusion of corticosteroids and antimicrobial agents and returned the next day for a breast massage. This cycle was repeated for 2 wk, and we followed up these patients for 1 y. Patients did not receive surgery or steroids after ductal lavage. The primary endpoint was the time to complete response (CR). RESULTS This trial included 32 patients with a median (range) age of 32 (20-53). Skin erythema and tenderness were the major symptoms. The median (range) visual analog score was 5 (0-9). There were 21 (65.6%), 4 (12.5%), and 7 (21.9%) patients diagnosed as idiopathic granulomatous mastitis, periductal mastitis, and unspecific NLM, respectively. During the ductal lavage, the median (range) number of cannulated ducts at first attempt was 5 (3-8). Ductal lavage significantly reduced the visual analog score and mastitis score (M-score) (P < 0.01). Within a median follow-up of 15.6 mo, 93.8% (30/32) of patients achieved CR. The median (range) time to CR was 6 (0.5-21) mo. Three patients (10.0%) relapsed. No adverse events associated with ductal lavage were observed. CONCLUSIONS Ductal lavage for patients with NLM is feasible and safe, and a definitive randomized controlled trial for further investigation is warranted. TRIAL REGISTRATION ClinicalTrials.gov, NCT02794688.
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Affiliation(s)
- Kai Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, PR China.
| | - Liling Zhu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Tingting Hu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Cui Tan
- Department of pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Jian Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Minhua Zeng
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Shunrong Li
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, PR China.
| | - Erwei Song
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, PR China.
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Efficacy of topical clobetasol propionate in the treatment of idiopathic granulomatous mastitis. MARMARA MEDICAL JOURNAL 2018. [DOI: 10.5472/marumj.474170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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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: 48] [Impact Index Per Article: 8.0] [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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Lei X, Chen K, Zhu L, Song E, Su F, Li S. Treatments for Idiopathic Granulomatous Mastitis: Systematic Review and Meta-Analysis. Breastfeed Med 2017; 12:415-421. [PMID: 28731822 DOI: 10.1089/bfm.2017.0030] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Idiopathic granulomatous mastitis (IGM) is a benign breast disease with no ideal treatment regimen so far. This study aimed to evaluate the complete remission/resolution (CR) rate and recurrence rate of different treatment options. METHODS We systematically searched and identified eligible studies from January 1, 2010, to December 31, 2015, in PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Medline databases. We included original studies reporting the CR and/or recurrence rate of each treatment used. The pooled incidence and 95% confidence interval (95% CI) for CR and recurrence rate were calculated using Stata 13.0. RESULTS Fifteen eligible studies were included in our study. Six, nine, and five studies with 138, 358, and 106 patients were analyzed for surgical managements, oral steroids, and oral steroids+surgical managements, respectively. The pooled estimates for CR rate of them were 90.6% (95% CI 83.8%, 95.7%), 71.8% (95% CI 67.1%, 76.3%), and 94.5% (95% CI 88.9%, 98.3%). The pooled estimates for recurrence rate were 6.8% (95% CI 3.3%, 11.5%), 20.9% (95% CI 9.2%, 16.1%), and 4.0% (95% CI 1.5%, 8.4%), respectively. Other interventions analyzed were topical steroids, observation, oral steroids+MTX, and steroids+prolactin lowering agent, with varied pooled estimates for CR and recurrence rate. CONCLUSION Surgical managements had high CR rate with relatively low recurrence rate, with or without steroids. Thus, it was suitable for patients requiring rapid remission. However, for patients with concerns about surgical scarring, oral steroids could be an acceptable option. Further investigations are still needed to better understand the managements of IGM.
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Affiliation(s)
- Xin Lei
- 1 Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou, People's Republic of China .,2 Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou, China
| | - Kai Chen
- 1 Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou, People's Republic of China .,2 Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou, China
| | - Liling Zhu
- 1 Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou, People's Republic of China .,2 Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou, China
| | - Erwei Song
- 1 Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou, People's Republic of China .,2 Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou, China
| | - Fengxi Su
- 1 Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou, People's Republic of China .,2 Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou, China
| | - Shunrong Li
- 1 Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou, People's Republic of China .,2 Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou, China
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Uysal E, Soran A, Sezgin E. Factors related to recurrence of idiopathic granulomatous mastitis: what do we learn from a multicentre study? ANZ J Surg 2017; 88:635-639. [DOI: 10.1111/ans.14115] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/10/2017] [Accepted: 05/20/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Erdal Uysal
- Department of General Surgery; Sanko University School of Medicine; Gaziantep Turkey
| | - Atilla Soran
- Department of Breast Surgery; Magee-Womens Hospital of UPMC; Pittsburgh Pennsylvania USA
| | - Efe Sezgin
- Laboratory of Nutrigenomics and Epidemiology, Department of Food Engineering, İzmir İnstitute of Technology; Izmir Turkey
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Rifampicin for Idiopathic Granulomatous Lobular Mastitis: A Promising Alternative for Treatment. World J Surg 2017; 41:1313-1321. [PMID: 28050664 DOI: 10.1007/s00268-016-3857-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Idiopathic granulomatous lobular mastitis (IGLM) is a chronic, non-caseating, inflammatory breast disease of obscure aetiology characterized by multiple masses, abscesses and sinus formation. There is no standard treatment to date, but surgical procedures and systemic corticosteroids are effective in its treatment despite high recurrence rates. PATIENTS AND METHODS This prospective study including 30 patients with IGLM between November 2012 and May 2016 aimed to investigate the possibility of administration of Rifampicin (300 mg twice daily for a period of 6-9 months) as an alternative therapy for both surgery and corticosteroids in patients with IGLM. All patients were diagnosed by core needle biopsy. RESULTS All patients were of reproductive age and had a history of breast feeding, which is the most important predisposing factor for IGLM. The mean age was 31.6 ± 5.8 years (range 23-42 years). Eighteen patients (60%) were treated by Rifampicin for 6 months, whereas 12 patients (40%) were treated for 9 months. Twelve months after the beginning of therapy, all patients showed complete clinical and ultrasonographic responses. No serious side effects were reported to stop the treatment course. The median follow-up after finishing the course of treatment was 15.5 months (average 3-35 months) with no episodes of disease relapse. CONCLUSION Rifampicin is effective in the treatment of patients with IGLM with complete clinical and ultrasonographic response after 6-9 months and could be used as a solo medical therapy alternative to both surgery and corticosteroids.
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Çiftci F, Anuk T. İdiopatik granulomatöz mastit: Zor tanı ve yönetim. DICLE MEDICAL JOURNAL 2017. [DOI: 10.5798/dicletip.319745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tahmasebi S, Karami MY, Maalhagh M. Granulomatous Mastitis: Time to Introduce New Weapons. World J Surg 2016; 40:2827-2828. [PMID: 26920409 DOI: 10.1007/s00268-016-3438-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Sedighe Tahmasebi
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Yasin Karami
- Department of Surgery, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mehrnoosh Maalhagh
- Department of Surgery, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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