1
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Zhang M, Pu D, Feng D, Shi G, Li J. Rare and Complicated Granulomatous Lobular Mastitis (2000-2023): A Bibliometrics Study and Visualization Analysis. J Inflamm Res 2024; 17:3709-3724. [PMID: 38882188 PMCID: PMC11179654 DOI: 10.2147/jir.s465844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 05/28/2024] [Indexed: 06/18/2024] Open
Abstract
Purpose Granulomatous mastitis (GLM) is a rare and complex chronic inflammatory disease of the breast with an unknown cause and a tendency to recur. As medical science advances, the cause, treatment strategies, and comprehensive management of GLM have increasingly attracted widespread attention. The aim of this study is to assess the development trends and research focal points in the GLM field over the past 24 years using bibliometric analysis. Methods Using GLM, Granulomatous mastitis (GM), Idiopathic granulomatous lobular mastitis (IGLM), and Idiopathic granulomatous mastitis (IGM) as keywords, we retrieved publications related to GLM from 2000 to 2023 from the Web of Science, excluding articles irrelevant to this study. Citespace and VOSviewer were employed for data analysis and visualization. Results A total of 347 publications were included in this analysis. Over the past 24 years, the number of publications has steadily increased, with Turkey being the leading contributor in terms of publications and citations. The University of Health Sciences, Istanbul University, and Istanbul University Cerrahpasa were the most influential institutions. The Breast Journal, Breast Care, and Journal of Investigative Surgery were the journals that published the most on this topic. The research primarily focused on the cause, differential diagnosis, treatment, and comprehensive management of GLM. Issues related to recurrence, hyperprolactinemia, and Corynebacterium emerged as current research hotspots. Conclusion Our bibliometric study outlines the historical development of the GLM field and identifies recent research focuses and trends, which may aid researchers in identifying research hotspots and directions, thereby advancing the study of GLM.
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Affiliation(s)
- Mengdi Zhang
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan City, People's Republic of China
| | - Dongqing Pu
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan City, People's Republic of China
| | - Dandan Feng
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan City, People's Republic of China
| | - Guangxi Shi
- Department of Thyroid and Breast Diagnosis and Treatment Center, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan City, People's Republic of China
| | - Jingwei Li
- Department of Thyroid and Breast Diagnosis and Treatment Center, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan City, People's Republic of China
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2
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Shojaeian F, Haghighat S, Abbasvandi F, Houshdar Tehrani A, Najar Najafi N, Zandi A, Olfatbakhsh A, Sharifi M, Hashemi E, Nafissi N, Najafi S. Refractory and Recurrent Idiopathic Granulomatous Mastitis Treatment: Adaptive, Randomized Clinical Trial. J Am Coll Surg 2024; 238:1153-1165. [PMID: 38372343 DOI: 10.1097/xcs.0000000000001046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) is mostly described as an autoimmune disease with higher prevalence among Middle Eastern childbearing-age women. This study aimed to evaluate the best treatment of choice in patients with resistant or recurrent IGM. STUDY DESIGN Patients with established recurrent or resistant IGM who were referred to the Breast Cancer Research Center from 2017 to 2020 were randomly assigned to either one of the following treatment groups: A (best supportive care), B (corticosteroids: prednisolone), and C (methotrexate and low-dose corticosteroids). This adaptive clinical trial evaluated radiological and clinical responses, as well as the potential side effects, on a regular basis in each group, with patients followed up for a minimum of 2 years. RESULTS A total of 318 participants, with a mean age of 33.52 ± 6.77 years, were divided into groups A (10 patients), B (78 patients), and C (230 patients). In group A, no therapeutic response was observed; group B exhibited a mixed response, with 14.1% experiencing complete or partial responses, 7.7% maintaining stability, and 78.2% experiencing disease progression. Accordingly, groups A and B were terminated due to inadequate response. In group C, 94.3% achieved complete response, 3% showed partial remission, and 2.7% had no response to therapy. Among the entire patient cohort, 11.6% tested positive for antinuclear antibodies, 3.5% for angiotensin-converting enzyme, and 12.3% for erythema nodosum. Notably, hypothyroidism was a prevalent condition among the patients, affecting 7.2% of the cohort. The incidence of common side effects was consistent across all groups. CONCLUSIONS The most effective treatment option for patients with recurrent or resistant IGM is a combination therapy involving steroids and disease-modifying antirheumatic drugs such as methotrexate.
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Affiliation(s)
- Fatemeh Shojaeian
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Shojaeian)
| | - Shahpar Haghighat
- Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran (Haghighat, Olfatbakhsh, Hashemi, Najafi)
| | - Fereshteh Abbasvandi
- ATMP Department, Breast Cancer Research Centre, Motamed Cancer Institute, Tehran, Iran (Abbasvandi)
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Abbasvandi)
| | - Alireza Houshdar Tehrani
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Houshdar Tehrani)
| | - Niki Najar Najafi
- Cellular Molecular Biology, Faculty of life sciences and Biotechnology, Shahid Beheshti University, Tehran, Iran (Najar Najafi)
| | - Ashkan Zandi
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA (Zandi)
| | - Asiie Olfatbakhsh
- Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran (Haghighat, Olfatbakhsh, Hashemi, Najafi)
| | - Maryam Sharifi
- Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran (Sharifi)
| | - Esmat Hashemi
- Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran (Haghighat, Olfatbakhsh, Hashemi, Najafi)
| | - Nahid Nafissi
- Department of General Surgery, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), Iran University of Medical Sciences, Tehran, Iran (Nafissi)
| | - Safa Najafi
- Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran (Haghighat, Olfatbakhsh, Hashemi, Najafi)
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3
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Dogan S, Dal F, Guler M, Sevik H, Oguz Idiz U. Is peripheral blood immunophenotyping useful to understand the etiology of Idiopathic Granulomatous? Hum Immunol 2023:S0198-8859(23)00070-8. [PMID: 37202243 DOI: 10.1016/j.humimm.2023.05.001] [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: 11/29/2022] [Revised: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND The etiology of idiopathic granulomatous mastitis (IGM) has not been clearly established. However, autoimmunity has recently become popular in etiopathogenesis. We aimed to investigate the immunophenotyping of immune cells to help clarify the etiopathogenesis of the disease. METHODS Patients with IGM and healthy volunteers were included in the study. Patients were divided into active and remission groups based on their disease status. The ratios of total T cells, helper T cells, cytotoxic T cells, natural killer cells, regulatory T cells, and monocyte subtypes were measured using flow cytometry. In addition, age, complete blood count for leukocyte, lymphocyte, neutrophil, and eosinophil counts, and the smoking status of all volunteers were evaluated. RESULTS A total of 33 volunteers, including 11 patients with active IGM, 10 patients with remission IGM, and 12 healthy volunteers, were included in the study. The neutrophil, eosinophil, neutrophil/lymphocyte, and non-classical monocyte values were significantly higher in IGM patients than in healthy volunteers. Additionally, the CD4+ CD25+ CD127- regulatory T cell was significantly lower in IGM patients than in healthy volunteers. Furthermore, neutrophil, neutrophil/lymphocyte ratio, CD4+ CD25+ CD127- regulatory T cells, and non-classical monocytes showed significant differences when IGM patients were divided into active and remission groups. IGM patients had higher smoking rates, but this was not statistically significant. CONCLUSION The changes in many cell types evaluated in our study were similar to the cell profiles of some autoimmune diseases. This could provide minor evidence to suggest that IGM is an autoimmune granulomatous disease with a local course.
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Affiliation(s)
- Selim Dogan
- Istanbul Teaching and Research Hospital, Department of General Surgery, Turkey
| | - Fatih Dal
- Istanbul Teaching and Research Hospital, Department of General Surgery, Turkey
| | - Mert Guler
- Istanbul Teaching and Research Hospital, Department of General Surgery, Turkey
| | - Husnu Sevik
- Istanbul Teaching and Research Hospital, Department of General Surgery, Turkey.
| | - Ufuk Oguz Idiz
- Istanbul Teaching and Research Hospital, Department of General Surgery, Turkey
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4
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Muacevic A, Adler JR, Abdulrahman A, Abdulrahman AA, Mokhtar M, Mohamed K. A Rare Case of Granulomatous Mastitis Associated With Positive Systemic Lupus Erythematosus Serology in a Young Female Patient: A Case Report and Literature Review. Cureus 2023; 15:e33279. [PMID: 36741602 PMCID: PMC9892233 DOI: 10.7759/cureus.33279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2022] [Indexed: 01/04/2023] Open
Abstract
Granulomatous mastitis (GM) is a rare benign breast disease that affects women of childbearing age, usually within five years of pregnancy. The hallmark diagnostic feature of GM is the presence of lobular granulomatous inflammation. The occurrence of this clinicopathological entity is usually idiopathic. Nevertheless, GM has often been associated with systemic inflammatory conditions of either infectious (such as tuberculosis) or autoimmune etiology (particularly sarcoidosis, vasculitis, and less likely systemic lupus erythematosus [SLE]). In this report, the authors described an unusual case of GM that was associated with features of SLE in a young female patient who presented with a painful breast lump. Histopathological examination of the lump's biopsy showed GM. Further laboratory workup revealed evidence of some immunological criteria of SLE. Steroid therapy led to the resolution of the patient's breast swelling. The breast mass remained in remission with hydroxychloroquine treatment. Only a handful of similar cases in the current literature demonstrated a plausible association between SLE and GM. Our case provides a reference to consider SLE as a possible differential diagnosis when GM is encountered in young-aged female patients.
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5
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Rakotoarisaona MF, Razafimaharo TI, Razanakoto NH, Sendrasoa FA, Ducournau A, Devalland C, Dupond AS, Ranaivo IM, Ramarozatovo LS, Rapelanoro Rabenja F. Idiopathic Granulomatous Mastitis as an Unusual Cause of Erythema Nodosum in a Malagasy Woman. Int Med Case Rep J 2023; 16:159-165. [PMID: 36936184 PMCID: PMC10016364 DOI: 10.2147/imcrj.s403050] [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: 01/12/2023] [Accepted: 02/28/2023] [Indexed: 03/16/2023] Open
Abstract
Introduction Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory disease. Neoplastic and infectious etiologies must be ruled out. IGM is a diagnostic challenge for countries with high tuberculosis endemicity like Madagascar since it may clinically and radiologically mimic breast tuberculosis. We report a case of IGM associated with erythema nodosum in a Malagasy. Case Report A 29-year-old primiparous woman came to a dermatological consultation for typical erythema nodosum lesions that appeared one month after a breast swelling. She had no particular medical history. Examination revealed typical erythema nodosum lesions on the legs, voluminous tender mass in the right breast. Bacteriological samples and tuberculosis test were negative. Imaging showed mastitis on the right breast with no evidence of malignancy. Histology revealed a non-caseating granulomas on the lobule of the right breast. As part of an etiological work-up, COVID-19 serology was performed with a positive IgG antibody. The diagnosis of IGM associated with erythema nodosum was evocated. The evolution was favorable under systemic corticosteroid therapy. Discussion The cause of this uncommon lesion remains obscure. The extramammary localizations such as erythema nodosum and arthralgia suggest an autoimmune origin. This pathogenesis is also reinforced by a good response to systemic immunosuppression. In our patient, the etiological assessment of the mastitis revealed a chronic infection with SARS-CoV-2. Histopathology is the gold standard for the IGM diagnosis which demonstrates a lobulocentric granulomas without caseous necrosis. Oral corticosteroid therapy is the initial choice of treatment. Conclusion Now, with several cases of concomitant IGM and EN reported, dermatologists should be aware that erythema nodosum can be one of the presenting signs of IGM, since the two conditions appear to be associated. The particularity of our case lies in the incidental discovery of SARS-CoV-2 infection. Is a chronic granulomatous disease associated with SARS-CoV-2 infection, a coincidence?
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Affiliation(s)
- Mendrika Fifaliana Rakotoarisaona
- Department of Dermatology, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
- Correspondence: Mendrika Fifaliana Rakotoarisaona, Department of Dermatology, University Hospital Joseph Raseta Befelatanana, Rue Dr Davioud Jacques, Antananarivo, 101, Madagascar, Tel/Fax +261 34 61947 34, Email
| | | | | | | | - Anne Ducournau
- Department of Dermatology, Nord Franche-Comté Hospital, Trevenans, France
| | | | - Anne-Sophie Dupond
- Department of Dermatology, Nord Franche-Comté Hospital, Trevenans, France
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6
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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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7
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Laor L, Ganguli S, Fakioglu E. Granulomatous mastitis, erythema nodosum, and polyarthritis: a case report. J Med Case Rep 2022; 16:146. [PMID: 35382864 PMCID: PMC8985372 DOI: 10.1186/s13256-022-03327-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 02/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Granulomatous mastitis is a rare inflammatory disease of the breast, typically seen in woman of child-bearing age. No definitive etiology has been described. In rare instances, this condition has been reported to be associated with extramammary manifestations such as erythema nodosum and arthritis. We describe this rare condition in an adolescent female. CASE PRESENTATION A 16-year-old, Hispanic female presented with right-sided painful breast swelling, polyarthritis, and erythema nodosum on bilateral shins and lower thighs. Physical examination was negative for lymphadenopathy and pulmonary, gastrointestinal, and cardiovascular findings. Ophthalmologic examination for uveitis and serologic tests for autoimmune diseases were negative. Diagnosis of idiopathic granulomatous mastitis was made by exclusion of other etiologies and conditions. Confirmation was made by histopathologic examination demonstrating noncaseating granuloma within breast lobules with neutrophils and microabscess formation. After wide local excision and a short course of trimethoprim-sulfamethoxazole, our patient was placed on naproxen and prednisone, the latter being tapered off over 3 months, with steady and complete resolution of all symptoms. CONCLUSION This is the first reported case of idiopathic granulomatous mastitis in a pediatric patient who also had extramammary manifestations, including erythema nodosum and polyarthritis. In this case-based review, we summarize the phenotype, risk factors, prognosis, and treatment options of this rare condition, chiefly to make the readers cognizant of such a diagnostic possibility in similar clinical presentation in the future.
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Affiliation(s)
- Leanna Laor
- Flushing Hospital Medical Center, 4500 Parsons Boulevard, Flushing, NY, 11355, USA.
| | - Suhas Ganguli
- Pediatric Rheumatology Marshfield Clinic, 1000 North Oak Ave, Suite 1A1,, Marshfield, WI, 5449, USA
| | - Esra Fakioglu
- Flushing Hospital Medical Center, 4500 Parsons Boulevard, Flushing, NY, 11355, USA
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Saydam M, Yilmaz KB, Sahin M, Yanik H, Akinci M, Yilmaz I, Balas S, Azili C, Gulcelik MA. New Findings on Autoimmune Etiology of Idiopathic Granulomatous Mastitis: Serum IL-17, IL-22 and IL-23 Levels of Patients. J INVEST SURG 2021; 34:993-997. [PMID: 32046543 DOI: 10.1080/08941939.2020.1725190] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Idiopathic Granulomatous Mastitis (IGM) is a benign chronic inflammatory breast disease that mimics breast cancer, and the etiopathogenesis has not yet been fully evaluated. Autoimmunity has received the most focus as a possible etiology. Our aim in this prospective clinical study was to investigate the possible association between the cytokines, interleukin IL-17, IL-22, IL-23 and IGM. MATERIALS AND METHODS The current study was conducted in 26 women with histopathologically diagnosed IGM, and 15 control women of reproductive age having no breast disease history. Blood samples were collected, and serum concentrations of IL-17, IL-22, and IL-23 were determined. RESULTS In the analysis of variables, the patients with IGM and the control group had statistically significant differences between serum IL-22 titers (p = 0.0378) and IL-23 titers (p = 0.0469. No statistically significant difference was found between IGM patients and the control group in serum IL-17 titers (p = 0.9724). CONCLUSION The results of the current study, especially pertaining to serum IL-22 and IL-23 levels, support the etiopathogenesis of IGM in favor of the autoinflammatory thesis. Nevertheless, this thesis should be supported by a large case number and prospective clinical studies.
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Affiliation(s)
- Mehmet Saydam
- Department of General Surgery, University of Health Sciences, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Kerim Bora Yilmaz
- Department of General Surgery, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
- Department of Medical and Surgical Research, University of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Mutlu Sahin
- Department of General Surgery, University of Health Sciences, Ankara Kecioren Training and Research Hospital, Ankara, Turkey
| | - Hamdullah Yanik
- Department of Basic Oncology, Cancer Institute, Hacettepe University, Ankara, Turkey
| | - Melih Akinci
- Department of General Surgery, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Ibrahim Yilmaz
- Department of General Surgery, University of Health Sciences, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Sener Balas
- Department of General Surgery, University of Health Sciences, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Cem Azili
- Department of General Surgery, University of Health Sciences, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Mehmet Ali Gulcelik
- Department of General Surgery, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
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Awomolo AM, Louis-Jacques A, Crowe S. Idiopathic granulomatous mastitis diagnosed during pregnancy associated with successful breastfeeding experience. BMJ Case Rep 2021; 14:e241232. [PMID: 34413030 PMCID: PMC8378369 DOI: 10.1136/bcr-2020-241232] [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] [Accepted: 08/12/2021] [Indexed: 11/04/2022] Open
Abstract
Idiopathic granulomatous mastitis (IGM) is a rare benign breast condition with a course that is often rapidly progressive and slow to resolve. There is no consensus on management, especially during pregnancy and lactation. A 30-year-old at 33 weeks presented with mastalgia, induration and galactorrhoea in the left breast. There was no improvement with antibiotics. Initial workup was negative, and a core needle biopsy showed findings consistent with the diagnosis of IGM. She was treated with steroids antepartum. She was co-managed by rheumatology and her obstetrician/breastfeeding medicine specialist postpartum. She was treated with azathioprine, breastfed exclusively for 6 months and continued breastfeeding through the first year. A multidisciplinary team approach is crucial in diagnosing, treating, and facilitating successful breastfeeding in patients with IGM.
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Affiliation(s)
- Adeola M Awomolo
- Obstetrics and Gynecology, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Adetola Louis-Jacques
- Obstetrics and Gynecology, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Susan Crowe
- Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
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Papila Kundaktepe B, Velidedeoğlu M, Mete B. The effect of methotrexate monotherapy on treatment-resistant idiopathic granulomatous mastitis patients. Surgeon 2021; 20:e13-e19. [PMID: 33836950 DOI: 10.1016/j.surge.2021.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/16/2021] [Accepted: 03/09/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) is a disease of unknown etiology, involving a chronic inflammatory process, characterized by noncaseating granuloma formation. IGM can mimic a tumor clinically and radiologically. Since we are a tertiary referral center, most of our patients (n = 56, 87.5%) are secondary admissions who have previously had antibiotics and steroid treatments; therefore, we accept these patients as resistant cases. Here, we aim to present our single-center series of 64 patients with resistant IGM who underwent methotrexate monotherapy. To the best of our knowledge, our study includes the highest number of patients described in the literature with IGM who have undergone this treatment. METHODS This study included 64 patients, 56 of which were resistant cases, diagnosed with IGM between January 2013 and January 2020 at Istanbul University Cerrahpasa, Cerrahpasa Medical Faculty, General Surgery Breast Outpatient Clinic that were followed-up at least once. These patients were administered oral methotrexate monotherapy 15 mg/week for 24 weeks, and in relapsed cases, the treatment was up to 20 mg/week for 1 year. Folic acid 10 mg/week was given as a supplement to all patients. RESULTS Complete recovery was observed in 52 (81.25%) of the 64 patients. Follow-up was discontinued by 4 patients. The dose was increased and the duration of treatment was extended up to 1 year when relapse was observed in 8 patients and complete response was then obtained in these cases. Only 3 patients (4.69%) experienced side effects and were switched to subcutaneous treatment due to nausea. CONCLUSION Considering the high patient compliance, low recurrence, minimal side effects, and overall success of the treatment, we believe that methotrexate monotherapy may be used in treatment-resistant IGM patients and may also be the first choice for first-line treatment in the future.
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Affiliation(s)
- Berrin Papila Kundaktepe
- Istanbul University-Cerrahpasa, Cerrahpaşa Faculty of Medicine, Department of General Surgery, Turkey.
| | - Mehmet Velidedeoğlu
- Istanbul University-Cerrahpasa, Cerrahpaşa Faculty of Medicine, Department of General Surgery, Turkey.
| | - Bilgül Mete
- Istanbul University-Cerrahpasa, Cerrahpaşa Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Turkey.
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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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12
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Ringsted S, Friedman M. A rheumatologic approach to granulomatous mastitis: A case series and review of the literature. Int J Rheum Dis 2021; 24:526-532. [PMID: 33523600 PMCID: PMC8152827 DOI: 10.1111/1756-185x.14065] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/01/2021] [Accepted: 01/04/2021] [Indexed: 12/01/2022]
Abstract
AIM Idiopathic granulomatous mastitis (IGM) is an enigmatic inflammatory breast disorder. IGM responds to immunomodulatory treatment and may be associated with systemic manifestations such as arthritis and erythema nodosum. These patients are increasingly referred to rheumatologists for management, but IGM is rarely discussed in the rheumatology literature. The objective of this report is to familiarize rheumatologists with the treatment and systemic manifestations of IGM. We report here a case series of IGM at our institution, and a literature review of IGM treated with methotrexate (MTX). METHOD Patients with IGM at our institution were identified and described using a retrospective chart review. A literature review of PubMed and Google Scholar identified studies of IGM patients treated with MTX. RESULTS We identified 28 IGM patients at our institution. Inflammatory arthritis/arthralgia were present in four patients (14%), and five patients (18%) had erythema nodosum. Patients treated with MTX had the highest rates of relapse-free remission; relapse-free remission occurred in four of the five (80%) MTX-treated patients, compared with 5 of 12 (42%) patients treated with steroids alone, and two or three (66%) patients treated with steroids and surgery. In the literature review, 116 patients treated with MTX were identified, and the rate of relapse-free remission ranged from 58% to 100%. Arthritis/arthralgia and erythema nodosum were more common at our institution than reported in the literature. CONCLUSION Methotrexate is a promising treatment for IGM. Arthritis/arthralgias and erythema nodosum may be under-recognized when IGM patients are managed outside rheumatology. Prospective studies are needed to characterize clinical features and optimum treatment of IGM.
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Affiliation(s)
- Sarah Ringsted
- Department of Medicine, Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland, OR 9723
| | - Marcia Friedman
- Department of Medicine, Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland, OR 9723
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Granulomatous mastitis, erythema nodosum and arthritis syndrome: case-based review. Rheumatol Int 2021; 41:1175-1181. [PMID: 33649961 DOI: 10.1007/s00296-021-04820-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/20/2021] [Indexed: 10/22/2022]
Abstract
Granulomatous mastitis (GM) is a rare form of inflammatory breast condition associated with unilateral or bilateral breast pain, swelling and mass formation. Although the disease pathogenesis remains unknown, several reports have associated GM with manifestations such as erythema nodosum and occasionally with arthritis, suggesting that GM might have an autoimmune disease component. We aim to describe two cases of coexistence of GM, erythema nodosum, and arthritis. We also conducted a literature review to comprehensively assess and describe the characteristics of patients with GM, erythema nodosum, and arthritis, and identify effective treatment options. A literature review was conducted using PubMed and EMBASE, and 14 case reports/series were retrieved, with a total number of 29 patients. All patients are women and unilateral breast involvement was evident in the majority of patients. Nine patients (31%) presented with arthritis, 6 patients (20.7%) had a fever, and 6 patients (20.7%) developed the symptoms during pregnancy. All patients had normal chest radiograph and tissue cultures were negative. In most of the cases (n = 25, 86.2%), symptom improvement was observed with glucocorticoids and four patients (13.8%) underwent surgical treatment for the GM. Given the clinical characteristics of patients with GM, with erythema nodosum, with or without arthritis, and the positive response to glucocorticoids, we propose that the described phenotype represents an underrecognized systemic autoimmune disease that could be designated by the acronym "GMENA" (granulomatous mastitis, erythema nodosum, arthritis) syndrome. Further studies are needed to elucidate the pathogenesis of the syndrome.
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Koksal H. What are the new findings with regard to the mysterious disease idiopathic granulomatous mastitis? Surg Today 2021; 51:1158-1168. [PMID: 33511459 DOI: 10.1007/s00595-020-02204-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/14/2020] [Indexed: 01/30/2023]
Abstract
PURPOSE To review the demographic and clinical features and the success rates of treatment approaches for idiopathic granulomatous mastitis (IGM). METHODS A total of 134 patients diagnosed with IGM pathologically and treated by a single breast surgeon were retrospectively analyzed. RESULTS The time between the occurrence of symptoms and the last delivery was < 24 months in 25 (23.1%), 24-48 months in 51 (38.1%), and > 48 months in 52 (38.8%). The difference was statistically significant (p = 0.002). Although there was no significant difference, seasonal fluctuations were noticed, with the incidence being slightly higher during late spring and summer. Bilateral disease was present in 10 (7.5%) patients. Seven patients (5.2%) had erythema nodosum. The treatment approaches were conservative in 42, surgical procedures in 48, steroid treatment in 18, and surgical procedure + steroid treatment in 24. The median recovery time with conservative approaches was lower than that with surgical procedure + steroid treatment (p < 0.0001). Recurrence developed in 10 patients (7.7%). CONCLUSION Clinical differences were detected among the patients with IGM, and classification of patients by severity is needed to plan the optimal treatment approach. Seasonal fluctuations suggest the possibility of an immunological disease rather than a surgical disease.
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Affiliation(s)
- Hande Koksal
- Department of General Surgery, Ministry of Health Konya City Hospital, Hamidiye Faculty of Medicine, Saglik Bilimleri University, 42040, Konya, Turkey.
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Koksal H. The Clinical Utility of Autoantibodies in Patients with Idiopathic Granulomatous Mastitis. J INVEST SURG 2020; 35:325-329. [PMID: 33327830 DOI: 10.1080/08941939.2020.1861666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although the etiopathogenesis of idiopathic granulomatous mastitis (IGM) is still controversial, recently autoimmunity and immune dysregulation have been emphasized. The aim of this study is to investigate the clinical utility of autoantibodies in IGM. MATERIAL AND METHODS Rheumatoid factor (RF), antinuclear antibody (ANA), anti-double stranded DNA antibody (anti-ds-DNA), anti-cyclic citrullinated peptides antibody (anti-CCP) and perinuclear anti-neutrophil cytoplasmic antibody (pANCA) levels were investigated in pathologically diagnosed IGM patients (Group IGM) and healthy women (Group C). IGM patients were divided into two groups as those with active symptoms and signs (Group IGMA) and those without clinical and radiological findings (Group IGMR). RESULTS While, in Group IGM, the positivity of RF, ANA, anti-ds-DNA, pANCA and anti-CCP was 13.1%, 3.3%, 1.6%, 0%, and 3.3%, respectively, in Group C, they were 13.3%, 0%, 0%, 0%, and 0%, respectively. The differences were not statistically significant (p > .05). In Groups IGMA, IGMR and C, RF positivity was 10%, 16.1%, and 13.3%, respectively. The ANA positivity of Groups IGMA, IGMR and C was 0%, 6.5%, and 0%, respectively. Groups IGMA, IGMR and C's anti-ds-DNA positivity were 0%, 3.2%, and 0%, respectively. In all groups, pANCA was negative. The anti-CCP positivity of Groups IGMA, IGMR and C was 6.7%, 0%, and 0%, respectively. CONCLUSION Our findings did not support the clinical utility of autoantibodies including RF, ANA, anti-ds-DNA, pANCA and anti-CCP in IGM.
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Affiliation(s)
- Hande Koksal
- Department of General Surgery, Saglik Bilimleri University, Hamidiye Faculty of Medicine, Ministry of Health Konya City Hospital, Konya, Turkey
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Choi EC, Wong SBJ, Ho SAJ. Idiopathic Granulomatous Mastitis and Erythema nodosum - A Unifying Pathophysiology? Australas J Dermatol 2020; 62:e149-e153. [PMID: 32935853 DOI: 10.1111/ajd.13463] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/29/2020] [Accepted: 08/07/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Ellie Ce Choi
- Division of Dermatology, Department of Medicine, National University Healthcare System, Singapore, Singapore
| | | | - Sue-Ann Je Ho
- Division of Dermatology, Department of Medicine, National University Healthcare System, Singapore, Singapore
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Goulabchand R, Hafidi A, Van de Perre P, Millet I, Maria ATJ, Morel J, Le Quellec A, Perrochia H, Guilpain P. Mastitis in Autoimmune Diseases: Review of the Literature, Diagnostic Pathway, and Pathophysiological Key Players. J Clin Med 2020; 9:jcm9040958. [PMID: 32235676 PMCID: PMC7231219 DOI: 10.3390/jcm9040958] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 12/13/2022] Open
Abstract
Mastitis frequently affects women of childbearing age. Of all the pathological breast conditions requiring specific management, autoimmune mastitis is in the third position after infection and breast cancer. The aim of this literature review was to make a comprehensive description of autoimmune diseases targeting the mammary gland. Four main histological patterns of autoimmune mastitis are described: (i) lymphocytic infiltrates; (ii) ductal ectasia; (iii) granulomatous mastitis; and (iv) vasculitis. Our literature search found that all types of autoimmune disease may target the mammary gland: organ-specific diseases (diabetes, thyroiditis); connective tissue diseases (such as systemic erythematosus lupus or Sjögren’s syndrome); vasculitides (granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, giant cell arteritis, polyarteritis nodosa, Behçet’s disease); granulomatous diseases (sarcoidosis, Crohn’s disease); and IgG4-related disease. Cases of breast-specific autoimmune diseases have also been reported, including idiopathic granulomatous mastitis. These breast-limited inflammatory diseases are sometimes the first symptom of a systemic autoimmune disease. Although autoimmune mastitis is rare, it is probably underdiagnosed or misdiagnosed. Early diagnosis may allow us to detect systemic diseases at an earlier stage, which could help to initiate a prompt, appropriate therapeutic strategy. In case of suspected autoimmune mastitis, we hereby propose a diagnostic pathway and discuss the potential pathophysiological pathways leading to autoimmune breast damage.
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Affiliation(s)
- Radjiv Goulabchand
- St Eloi Hospital, Department of Internal Medicine and Multi-Organic Diseases, Local Referral Center for Systemic and Autoimmune Diseases, 80 Avenue Augustin Fliche, F-34295 Montpellier, France; (R.G.); (A.T.J.M.); (A.L.Q.)
- Internal Medicine Department, Caremeau University Hospital, 30029 Nimes, France
- Montpellier School of Medicine, University of Montpellier, 34967 Montpellier, France (I.M.); (J.M.); (H.P.)
- Inserm U1183, Institute for Regenerative Medicine and Biotherapy, St Eloi Hospital, 80 Avenue Augustin Fliche, 34295 Montpellier, France
| | - Assia Hafidi
- Montpellier School of Medicine, University of Montpellier, 34967 Montpellier, France (I.M.); (J.M.); (H.P.)
- Gui de Chauliac Hospital, Pathology Department, 80 Avenue Augustin Fliche, 34295 Montpellier, France
| | - Philippe Van de Perre
- Pathogenesis and Control of Chronic Infections, Univ Montpellier, INSERM, EFS, Montpellier University Hospital, 34394 Montpellier, France;
| | - Ingrid Millet
- Montpellier School of Medicine, University of Montpellier, 34967 Montpellier, France (I.M.); (J.M.); (H.P.)
- Lapeyronie Hospital, Montpellier University, Medical Imaging Department, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France
| | - Alexandre Thibault Jacques Maria
- St Eloi Hospital, Department of Internal Medicine and Multi-Organic Diseases, Local Referral Center for Systemic and Autoimmune Diseases, 80 Avenue Augustin Fliche, F-34295 Montpellier, France; (R.G.); (A.T.J.M.); (A.L.Q.)
- Montpellier School of Medicine, University of Montpellier, 34967 Montpellier, France (I.M.); (J.M.); (H.P.)
- Inserm U1183, Institute for Regenerative Medicine and Biotherapy, St Eloi Hospital, 80 Avenue Augustin Fliche, 34295 Montpellier, France
| | - Jacques Morel
- Montpellier School of Medicine, University of Montpellier, 34967 Montpellier, France (I.M.); (J.M.); (H.P.)
- Department of Rheumatology, CHU and University of Montpellier, 34295 Montpellier, France
| | - Alain Le Quellec
- St Eloi Hospital, Department of Internal Medicine and Multi-Organic Diseases, Local Referral Center for Systemic and Autoimmune Diseases, 80 Avenue Augustin Fliche, F-34295 Montpellier, France; (R.G.); (A.T.J.M.); (A.L.Q.)
- Montpellier School of Medicine, University of Montpellier, 34967 Montpellier, France (I.M.); (J.M.); (H.P.)
| | - Hélène Perrochia
- Montpellier School of Medicine, University of Montpellier, 34967 Montpellier, France (I.M.); (J.M.); (H.P.)
- Gui de Chauliac Hospital, Pathology Department, 80 Avenue Augustin Fliche, 34295 Montpellier, France
| | - Philippe Guilpain
- St Eloi Hospital, Department of Internal Medicine and Multi-Organic Diseases, Local Referral Center for Systemic and Autoimmune Diseases, 80 Avenue Augustin Fliche, F-34295 Montpellier, France; (R.G.); (A.T.J.M.); (A.L.Q.)
- Montpellier School of Medicine, University of Montpellier, 34967 Montpellier, France (I.M.); (J.M.); (H.P.)
- Inserm U1183, Institute for Regenerative Medicine and Biotherapy, St Eloi Hospital, 80 Avenue Augustin Fliche, 34295 Montpellier, France
- Correspondence: ; Tel.: +33-467-337332
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[Idiopathic granulomatous mastitis associated with erythema nodosum]. Ann Dermatol Venereol 2020; 146:571-576. [PMID: 31151772 DOI: 10.1016/j.annder.2019.04.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 12/24/2018] [Accepted: 04/08/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) is a rare, chronic, granulomatous, inflammatory disorder with potentially misleading clinical and radiological features. IGM is diagnosed after exclusion of infectious or tumoral diseases. Herein we report a case of erythema nodosum associated with IGM, which serves as a reminder that erythema nodosum may constitute an extra-mammary sign of IGM. PATIENTS AND METHODS A 36-year-old nulliparous woman presented with fever and skin rash at our dermatology clinic at the North Franche-Comté hospital in July 2017. Symptoms had occurred 2 days previously. The patient had a fever of 38.8°C and typical erythema nodosum on the limbs. Physical examination showed an irregular, inflammatory, abscessed mass measuring 20cm with multiple shrinkage zones that had been developing for 4 weeks and for which breast examinations were being performed. Laboratory tests showed an inflammatory state (CRP 155mg/mL, WBC 14.6×109/L), other tests (serum electrolytes and calcium, hepatic and renal tests, Streptotest, T-spot, HIV, HBV, HCV serology, anti-streptolysin, anti-streptodornase, local microbiology samples, antinuclear antibodies, soluble antigens antibodies, hemocultures, angiotensin-converting-enzyme and chest x-rays) were normal. Microbiology investigations were negative. Mammography revealed invasive mastitis. Breast sample biopsies showed giant cell granulomas without caseous necrosis or tumor cells, and histochemical staining (PAS, Ziehl, Grocott, Gram) was negative. The final diagnosis was of IGM associated with erythema nodosum. Symptoms rapidly improved with oral steroids. DISCUSSION As reported herein, erythema nodosum may be associated with IGM and support the diagnosis thereof. This association is rare, with fewer than 30 case reports described in the literature. IGM is an uncommon benign disorder of the breast that can mimic two frequent breast disorders: breast carcinoma and breast abscess. It usually occurs in young sexually active women. It appears as a tumor with an inflammatory solid painful mass, with nipple and skin retraction, occasionally with abscesses and accompanied by homolateral axillary lymphadenopathies. Radiologic findings are usually not specific for or suggestive of cancer. The histopathological picture of IGM is characterized by the presence of multinucleated giant cells and epithelioid histiocytes forming non-caseating granulomas around lobules. Minor ductal and periductal inflammation is usually present. IGM is rarely associated with autoimmune system manifestations, especially erythema nodosum, arthritis, episcleritis or hidradenitis suppurativa. Although the physiopathology of IGM remains unclear, this case serves as additional evidence that the etiology of IGM is of autoimmune origin. While there is no recommendation for the treatment of IGM, oral steroids remain the cornerstone of therapy. CONCLUSION We report a case of IGM associated with erythema nodosum. Dermatologists must be aware of this association.
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Koksal H, Vatansev H, Artac H, Kadoglou N. The clinical value of interleukins-8, -10, and -17 in idiopathic granulomatous mastitis. Clin Rheumatol 2020; 39:1671-1677. [PMID: 31916110 DOI: 10.1007/s10067-020-04925-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 12/20/2019] [Accepted: 01/01/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Idiopathic granulomatous mastitis (IGM) is a rare, chronic inflammatory benign breast disease. Although the etiology of this disease is unknown, it has been suggested that hormonal disorders, autoimmunity, smoking, and α1-antitrypsin deficiency may play a role in the etiopathogenesis. The aim is to investigate the changes in cytokine profiles including interleukin (IL)-4, -8, -10, -17, and tumor necrosis factor (TNF)-alpha in patients with IGM. METHODS Forty-seven patients with pathologically diagnosed IGM and 30 healthy women were included. The cytokines including IL-4, -8, 10, -17, and TNF-alpha were measured by human enzyme-linked immunosorbent assay. RESULTS The IL-8, IL-10, and IL-17 levels were higher in IGM patients than control group (p = .002; p = .008; and p = .018, respectively). The IL-8 levels of patients with active lesions and in remission were statistically higher than the control group (p = .027 and p = .015, respectively). IL-10 levels of patients in remission were higher than the control group (p = .024). There was no difference in IL-4 and TNF-ɑ levels between all groups. CONCLUSION These results showed that proinflammatory cytokines including IL-8 and IL-17 have role in pathogenesis of IGM. However, the increased levels of IL-10 in especially patients in remission suggest that it reduces the release of proinflamatory cytokines as well as suppressing their function and activation for controlling IGM. Although IGM is thought to be a surgical disease, these cytokine changes indicate the presence of serious immune dysregulation. This suggests that in the treatment of IGM, treatment needs to evolve from surgery to medical treatment.Key points• The IL-8, IL-10, and IL-17 levels were higher in IGM patients than in control group.• The IL-8 levels of both patients with active lesions and in remission were high.• There was no difference in IL-4 and TNF-ɑ levels between all groups.
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Affiliation(s)
- Hande Koksal
- Department of General Surgery, Hamidiye Faculty of Medicine, Konya Education and Research Hospital, Saglik Bilimleri University, Konya, Turkey.
| | - Husamettin Vatansev
- Department of Biochemistry, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Hasibe Artac
- Department of Pediatric Immunology and Allergy, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Naim Kadoglou
- Department of General Surgery, London North West Healthcare NHS Trust, Northwick Park Hospital, Middlesex, London, UK
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20
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Gümüş M, Akkurt ZM, Gümüş H. Is erythema nodosum coexisting with lesions of the breast a suggestive sign for idiopathic granulomatous mastitis? Turk J Surg 2018; 34:71-73. [PMID: 29756114 DOI: 10.5152/turkjsurg.2017.3161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 05/14/2015] [Indexed: 12/30/2022]
Abstract
Coexistence of idiopathic granulomatous mastitis and erythema nodosum is very unusual. In this paper, we present a patient with idiopathic granulomatous mastitis accompanied by erythema nodosum to highlight the diagnostic importance of erythema nodosum and its relationship with treatment response of breast lesion. A 39-year-old female with a breast lesion and erythema nodosum was started on treatment with corticosteroids before the results of her histopathological evaluation were obtained. The response to treatment was very quick. Erythema nodosum totally disappeared and the breast lesion regressed noticeably within a week. We think that erythema nodosum associated with a breast lesion may be a sign suggestive of idiopathic granulomatous mastitis and can be used for the evaluation of the response to corticosteroid treatment. More case reports are needed to justify the use of erythema nodosum as a sign suggestive of idiopathic granulomatous mastitis.
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Affiliation(s)
- Metehan Gümüş
- Department of General Surgery, Dicle Üniversitesi School of Medicine, Diyarbakır, Turkey
| | - Zeynep Meltem Akkurt
- Department of Dermatology, Dicle Üniversitesi School of Medicine, Diyarbakır, Turkey
| | - Hatice Gümüş
- Department of Radiology, Dicle Üniversitesi School of Medicine, Diyarbakır, Turkey
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21
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An Unusual Cause of Oligoarthritis and Erythema Nodosum: Idiopathic Granulomatous Mastitis. Arch Rheumatol 2017; 32:71-75. [PMID: 30375541 DOI: 10.5606/archrheumatol.2017.5952] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 05/05/2016] [Indexed: 01/29/2023] Open
Abstract
Idiopathic granulomatous mastitis (IGM) is an unusual benign inflammatory disease of breast. Breast cancer mimics IGM both radiologically and clinically. However, IGM is a benign disease and awareness of such an entity prevents unnecessary surgical procedures. Although its etiology is unknown, it may be an autoimmune disease. There are few patients reported in the literature presenting with reactive arthritis and/or erythema nodosum accompanying IGM of breast. Granulomatous mastitis should be considered as a possible underlying cause of arthritis and erythema nodosum. In this article, we report this interesting association of IGM as an underlying cause of arthritis and generalized erythema nodosum in a 32-year-old female patient. Comprehensive examination for granulomatous mastitis showed no apparent underlying cause. Indomethacin was beneficial in treatment of arthritis and erythema nodosum. Resistant IGM was responsive to colchicine treatment. Clinical management and therapeutic approach have been discussed in detail.
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22
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Al Manasra ARA, Al-Hurani MF. Granulomatous Mastitis: A Rare Cause of Male Breast Lump. Case Rep Oncol 2016; 9:516-519. [PMID: 27721777 PMCID: PMC5043282 DOI: 10.1159/000448990] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 08/09/2016] [Indexed: 11/21/2022] Open
Abstract
Background Mastitis is a common benign disorder of the female breast. It is frequently associated with tenderness, swelling and nipple discharge. We are describing an extremely rare case of an idiopathic granulomatous mastitis in the male breast. Only 1 previous case was reported. Case Report A 29-year-old male patient presented with a hard, painless lump in the right breast of 2 weeks duration. The patient underwent surgical excision with margin. The histopathologic findings were consistent with granulomatous mastitis. The case was reported as idiopathic granulomatous mastitis after exclusion of all known causes of the disease. Conclusion Granulomatous mastitis is rare in females and extremely rare in male breast tissue. Since this disease mimics breast cancer in its clinical picture and radiologic findings are usually not conclusive, surgical excision is recommended in all cases.
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Affiliation(s)
- Abdel Rahman A Al Manasra
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad F Al-Hurani
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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23
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Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) is a rare, benign, and chronic disease of the breast. Despite the various treatment approaches described for this disease, a gold standard treatment modality has not yet been defined. In this study, the effect of topical steroids was reviewed and assessed in patients with IGM. METHODS The records of patients with IGM who were treated only with topical steroids were retrospectively reviewed. Patients were grouped as "completely healed," "inadequately healed," "stable," "worsened," or "recurred" if they had once healed but their symptoms returned. Patients whose skin changes were completely ameliorated were considered "completely healed." RESULTS All of the patients were women, and the average patient age was 35.7 years (range 24-48 years). During the average follow-up of 37.2 months (range 12-72 months) in patients who received only topical steroid treatment, recurrence was observed in three patients (3/28, 10.7 %), and no side effects or steroid-related complications occurred. CONCLUSIONS Topical steroids seem to be effective in the treatment of IGM characterized by skin changes. Prospective clinical studies would be useful in determining the clinical efficacy of topical steroids in the treatment of IGM.
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24
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Sheybani F, Naderi HR, Gharib M, Sarvghad M, Mirfeizi Z. Idiopathic granulomatous mastitis: Long-discussed but yet-to-be-known. Autoimmunity 2016; 49:236-9. [PMID: 26829298 DOI: 10.3109/08916934.2016.1138221] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Idiopathic granulomatous mastitis (IGM) is a chronic benign inflammatory disease of the breast with unknown etiology. It is an important diagnostic and therapeutic challenge, as most patients were initially misdiagnosed by their primary care physicians, leading to diagnostic confusion and heightened anxiety. Although several triggers have been proposed for development of IGM, the etiologic association of neither of them has been documented. Three main hypotheses about the possible causes of IGM have been suggested, including autoimmune response, infectious disease, and hormonal disruption. Here, we discuss a hypothetical perspective of IGM to explain the possible role of autoinflammation in the pathogenesis of the disease. We also reviewed the previously published literature on pathogenesis of IGM.
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Affiliation(s)
| | | | | | | | - Zahra Mirfeizi
- c Rheumatic Diseases Research Center, School of Medicine, Mashhad University of Medical Sciences , Mashhad , Iran
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25
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Abstract
OBJECTIVE To describe the clinical and paraclinical characteristics of idiopathic granulomatous mastitis, the management of our patients, and review the literature on this topic. METHODS Patients referred to our clinic with a presumptive diagnosis of infectious mastitis were only included in the study if they had histopathologic confirmation of granulomatous mastitis. A systemic or infectious etiology was excluded by the testing of tissues and fluids by staining, culture, and polymerase chain reaction methods. Those patients with no reported etiology were categorized as idiopathic granulomatous mastitis and treated with antiinflammatory drugs. All were monitored for signs of recurrence. RESULTS All 22 patients with a final diagnosis of idiopathic granulomatous mastitis were women with a mean age (± standard deviation) of 32.8 ± 6.2 years. Initial treatment with a prednisone regimen was given in 15 (68.2%) patients, prednisone plus methotrexate (MTX) in six (27.3%), and MTX alone in one (4.5%). Among the total of 22 patients with idiopathic granulomatous mastitis, 12 (54.5%) received MTX either as an initial treatment or as an alternative regimen. Of the 22 patients, three (13.6%) had disease recurrence and four (18.2%) experienced adverse drug reactions. Sixteen (72.7%) patients discontinued the initial treatment regimen with acceptable control of disease activity and without recurrence or adverse drug reactions during the follow-up period. CONCLUSION Idiopathic granulomatous mastitis is a distinct benign breast condition of unknown etiology but several triggers are suspected, including inflammatory, infectious, and hormonal factors. Corticosteroids and MTX, with or without surgery, are the treatment of choice in these patients.
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26
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Uslukaya Ö, Yılmaz E, Türkoğlu A, Gümüş H, Gümüş M. A rare case of idiopathic granulomatous mastitis associated with erythema nodosum. JOURNAL OF CLINICAL AND EXPERIMENTAL INVESTIGATIONS 2015. [DOI: 10.5799/jcei.122641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Altintoprak F, Kivilcim T, Ozkan OV. Aetiology of idiopathic granulomatous mastitis. World J Clin Cases 2014; 2:852-858. [PMID: 25516860 PMCID: PMC4266833 DOI: 10.12998/wjcc.v2.i12.852] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 07/07/2014] [Accepted: 10/10/2014] [Indexed: 02/05/2023] Open
Abstract
Idiopathic granulomatous mastitis is a rare chronic inflammatory lesion of the breast that can clinically and radiographically mimic breast carcinoma. The most common clinical presentation is an unilateral, discrete breast mass, nipple retraction and even a sinus formation often associated with an inflammation of the overlying skin. The etiology of idiopathic granulomatous mastitis is still obscure. Its treatment remains controversial. The cause may be the autoimmune process, infection, a chemical reaction associated with oral contraceptive pills, or even lactation. Various factors, including hormonal imbalance, autoimmunity, unknown microbiological agents, smoking and α 1-antitrypsin deficiency have been suggested to play a role in disease aetiology. In this review, causing factors in the aetiology of idiopathic granulomatous mastitis are reviewed in detail.
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28
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Fahmy J, Halabi-Tawil M, Bagot M, Tournant B, Petit A. [Erythema nodosum during the course of idiopathic granulomatous mastitis]. Ann Dermatol Venereol 2014; 142:46-9. [PMID: 25600795 DOI: 10.1016/j.annder.2014.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 07/14/2014] [Accepted: 09/01/2014] [Indexed: 01/29/2023]
Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) is a benign, aseptic inflammatory disease of unknown origin, which must be distinguished from tumoral and infectious processes that affect the breast, including tuberculosis. IGM is a rare cause of erythema nodosum, but it is useful for dermatologists to be aware of this association. PATIENTS AND METHODS A 32-year-old nulliparous woman presented with erythema nodosum, arthralgia and fever. On examination, she had a firm and painful mass of 5cm in the right breast with retraction and axillary adenopathy. The breast lump developed gradually over the preceding 4 months. Although two biopsies showed no evidence of atypical cells, inflammatory areas and a granulomatous process were seen. Culture of breast tissue for mycobacteria was negative. A diagnostic of idiopathic granulomatous mastitis was made. Systemic corticosteroids led to a reduction in size of the mass, but relapse occurred in the contralateral breast on dose-reduction of the corticosteroids. DISCUSSION IGM is a rare disease of unknown aetiology. Diagnosis is based on characteristic histological features and exclusion of other granulomatous diseases. Extra-mammary signs are rare and include erythema nodosum, arthralgia and episcleritis. Management is poorly codified.
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Affiliation(s)
- J Fahmy
- Service de dermatologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France.
| | - M Halabi-Tawil
- Service de dermatologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - M Bagot
- Service de dermatologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - B Tournant
- Centre des maladies du sein, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - A Petit
- Service de dermatologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France
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29
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Brouwer A, Degrieck N, Rasschaert M, Lockefeer F, Huizing M, Tjalma W. Tuberculous mastitis presenting as a lump: a mimicking disease in a pregnant woman case report and review of literature. Acta Clin Belg 2014; 69:389-94. [PMID: 25056489 DOI: 10.1179/2295333714y.0000000048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Tuberculosis (TB) of the breast is a rare entity, and can be confused with many other breast disorders, like mamma carcinoma or inflammatory breast cancer. When finding granulomatous mastitis (GM) on histology, it is important to make a differential diagnosis and seek actively for clues on the presence of tuberculosis, sarcoidosis, Wegener's granulomatosis, or idiopathic granulomatous mastitis, since treatment strategies differ and maltreatment has major implications on morbidity and mortality. An extensive clinical evaluation, laboratory work up, and imaging will lead in most cases to the right diagnosis. Anti-tuberculous therapy is the core treatment for breast TB, and surgery is indicated for extensive or persistent residual disease. Here we present a case of tuberculous mastitis and a review of literature on GM.
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30
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Hida T, Minami M, Kawaguchi H, Oshiro Y, Kubo Y. Case of erythema nodosum associated with granulomatous mastitis probably due toCorynebacteriuminfection. J Dermatol 2014; 41:821-3. [DOI: 10.1111/1346-8138.12604] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 07/18/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Tetsuya Hida
- Divisions of Dermatology; Matsuyama Red Cross Hospital; Matsuyama Japan
| | - Mitsuyoshi Minami
- Divisions of Dermatology; Matsuyama Red Cross Hospital; Matsuyama Japan
| | | | - Yumi Oshiro
- Divisions of Diagnostic Pathology; Matsuyama Red Cross Hospital; Matsuyama Japan
| | - Yoshiaki Kubo
- Department of Dermatology; Institute of Health Biosciences; The University of Tokushima Graduate School; Tokushima Japan
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31
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Nakamura Y, Yamaguchi M, Nakamura A, Muto M. Tender, red nodules and arthralgia in a young woman with mastitis. Clin Exp Dermatol 2014; 39:410-2. [PMID: 24635090 DOI: 10.1111/ced.12276] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Y Nakamura
- Department of Dermatology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
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32
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Zhang LN, Shi TY, Yang YJ, Zhang FC. An SLE patient with prolactinoma and recurrent granulomatous mastitis successfully treated with hydroxychloroquine and bromocriptine. Lupus 2014; 23:417-20. [PMID: 24446305 DOI: 10.1177/0961203313520059] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Granulomatous mastitis (GM) is a rare benign mammary lesion in which autoimmunity and hyperprolactinemia are considered possible etiological factors. GM has a high frequency of relapse and may lead to chronic ulceration and fistula if not treated properly. Here we report a case of a 22-year-old systemic lupus erythematosus (SLE) patient with three years' disease duration, stable on prednisone and hydroxychloroquine, who was found to have prolactinoma and recurrent GM after she discontinued medication on her own accord. The patient subsequently recovered and remained free of GM relapse under treatment of prednisone, hydroxychloroquine and bromocriptine. Though autoimmune disorders and prolactinoma were reported in GM, a coexisting condition of SLE, prolactinoma, and granulomatous mastitis has rarely been observed in one patient. We suggest our case as an illustrative example of the complex interaction between autoimmunity, neuroendocrine dysfunction, and manifestations in the breast: Immunological disturbances in the background of SLE, coupled with elevated prolactin levels secondary to a prolactinoma, may have predisposed the patient to the development of GM. The mammary lesion recovered and maintained free of relapse under immunosuppressive and antiprolactinemic therapy.
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Affiliation(s)
- L-N Zhang
- Department of Rheumatology and Clinical Immunology, Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
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33
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Lucas R, Gussman D, Polis RL, Rattigan MI, Matulewicz TJ. Idiopathic granulomatous mastitis with erythema nodosum simulating breast abscess in pregnancy: A case report. Obstet Med 2013; 7:37-9. [PMID: 27512418 DOI: 10.1177/1753495x13502474] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Granulomatous mastitis is a rare benign inflammatory condition of the breast and is known to be associated with pregnancy. A 25-year-old Hispanic G2P1 at 17 weeks gestation presented to the emergency department with findings consistent of a breast abscess. The abscess failed to resolve with incision and drainage followed by multiple courses of antibiotic therapy. A biopsy was then obtained and yielded a diagnosis of granulomatous lobulitis. The patient was treated with steroids and her symptoms resolved. Granulomatous lobulitis may present with characteristics of various clinical entities including neoplasm or, as in this case, abscess. Clinicians should consider a diagnosis of granulomatous mastitis in cases of recalcitrant breast abscess.
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Affiliation(s)
- Romeo Lucas
- Departments of Obstetrics and Gynecology and Pathology, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Debra Gussman
- Departments of Obstetrics and Gynecology and Pathology, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Rachael L Polis
- Departments of Obstetrics and Gynecology and Pathology, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Meghan I Rattigan
- Departments of Obstetrics and Gynecology and Pathology, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Theodore J Matulewicz
- Departments of Obstetrics and Gynecology and Pathology, Jersey Shore University Medical Center, Neptune, NJ, USA
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34
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La mastite granulomateuse idiopathique. Rev Med Interne 2013; 34:358-62. [DOI: 10.1016/j.revmed.2012.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 07/31/2012] [Indexed: 01/14/2023]
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35
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Néel A, Hello M, Cottereau A, Graveleau J, De Faucal P, Costedoat-Chalumeau N, Rondeau-Lutz M, Lavigne C, Chiche L, Hachulla E, Seiberras S, Cabane J, Tournemaine N, Hamidou M. Long-term outcome in idiopathic granulomatous mastitis: a western multicentre study. QJM 2013; 106:433-41. [PMID: 23407345 DOI: 10.1093/qjmed/hct040] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
AIM To investigate the presentation, disease course and long-term outcome of a western cohort of idiopathic granulomatous mastitis (IGM) and to analyse the impact of different therapeutic strategies. METHODS Multicentre retrospective study of 23 women followed over an extended period. Patients were recruited in nine French internal medicine departments. RESULTS The median follow-up was 6 years. IGM presented commonly as a single inflammatory unilateral extra-areolar lump of varying size. Clinical course was heterogeneous and frequently remitting/relapsing. Most patients had at least one recurrence (18/23, 78%). The mean number of recurrences was 1.3 ± 1.5. Seven women had a bilateral evolution. Twelve women received steroids (corticosteroids). Only two of these did not respond to corticosteroids, whereas six relapsed when dose was tapered off. Nine patients received colchicine and/or hydroxychloroquine. First-line treatment consisted of excisional surgery in eight cases. At the date of last interview, 91% of the patients declared to be healed, 15 being free of treatment. However, 12/21 (57%) reported significant sequelae (unsightly scars: eight and/or lasting pain: six). Unsightly scars were not more prevalent in patients who had received steroids whereas they tended to be more frequent after breast excisional surgery. In addition, we found that excisional surgery did not prevent recurrences more successfully than a conservative approach. CONCLUSIONS Despite its retrospective nature, this Caucasian series provides novel information regarding long-term outcomes in IGM and argues in favour of conservative approaches. The value of immunomodulatory drugs such as colchicine or hydroxychloroquine deserves further investigation.
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Affiliation(s)
- A Néel
- Department of Internal Medicine, Centre Hospitalo-Universitaire Hôtel-Dieu, Nantes, France
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Binesh F, Shiryazdi M, Bagher Owlia M, Azimi S. Idiopathic granulomatous mastitis, erythema nodosum and bilateral ankle arthritis in an Iranian woman. BMJ Case Rep 2013; 2013:bcr2012007636. [PMID: 23355571 PMCID: PMC3604348 DOI: 10.1136/bcr-2012-007636] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Here we report a case of idiopathic granulomatous mastitis (IGM) associated with erythema nodosum (EN) and ankle arthritis. The skin, joint and mammary symptoms improved with corticosteroid. Coincidence of granulomatous mastitis, EN and arthritis is a rare feature.
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Affiliation(s)
- Fariba Binesh
- Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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37
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Abstract
Idiopathic granulomatous lobular mastitis (IGLM) is a rare breast condition with prominent skin findings. It is typically seen in young parous women. Painful breast masses, draining sinuses, scarring, and breast atrophy are the main clinical manifestations. IGLM can resemble a variety of other inflammatory and neoplastic processes of the breast. It is thought to result from obstruction and rupture of breast lobules. Extravasated breast secretions then induce an inflammatory reaction. Corynebacteria have also been implicated in the pathogenesis. Treatment is surgical, but systemic corticosteroids, methotrexate, and antibiotics also play a role.
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38
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Ozel L, Unal A, Unal E, Kara M, Erdoğdu E, Krand O, Güneş P, Karagül H, Demiral S, Titiz MI. Granulomatous mastitis: is it an autoimmune disease? Diagnostic and therapeutic dilemmas. Surg Today 2011; 42:729-33. [PMID: 22068681 DOI: 10.1007/s00595-011-0046-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 06/17/2011] [Indexed: 02/06/2023]
Abstract
PURPOSE Granulomatous mastitis (GM) is a rare benign inflammatory breast disease. The clinical presentation of granulomatous mastitis usually mimics malignancy or infection. The aim of this study was to review the clinical and diagnostic features of GM and discuss the medical and surgical treatment of our series of eight GM patients. METHODS Between 2008 and 2010, eight patients were diagnosed with GM and underwent surgery. Patients were evaluated clinically and radiologically. The diagnosis of GM was confirmed in all cases by core needle or excisional biopsies. Serological tests were performed for rheumatoid factor (RF), antinuclear antibody (ANA), and anti-double-stranded DNA (anti-dsDNA). RESULTS The mean patient age was 37 years. Common presenting symptoms were a hard mass, pain, inflamed hyperemic skin, and sinus formation. Serological tests for RF were positive in 6 patients, and ANA and anti-dsDNA antibodies were detected in 2 patients. All patients underwent antibiotic therapy before surgery, and were treated with wide surgical excision with negative margins. Methylprednisolone (16 mg/day for 3 months) therapy was used in 3 patients (all RF and 2 ANA/anti-dsDNA positive) following a wide excisional biopsy after a postoperative recurrence mimicking skin lesions was seen. These patients responded well to steroid therapy. CONCLUSIONS The diagnosis of GM should be made carefully to avoid a misdiagnosis. Steroid therapy should be considered based on the idea that this is an autoimmune disease.
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Affiliation(s)
- Leyla Ozel
- Department of 1st General Surgery and Transplantation, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
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Akbulut S, Yilmaz D, Bakir S. Methotrexate in the management of idiopathic granulomatous mastitis: review of 108 published cases and report of four cases. Breast J 2011; 17:661-8. [PMID: 21951547 DOI: 10.1111/j.1524-4741.2011.01162.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This study aimed to discuss the role of agents, such as steroids and methotrexate (MTX), in the treatment of patients with idiopathic granulomatous mastitis (IGM). Using Pubmed and Google Scholar data bases, a retrospective study was carried out on IGM cases treated with steroids and/or MTX between 1972 and 2010. Four IGM cases treated with MTX at our clinic were also summarized in this study. A total of 541 IGM cases since 1972, including ours, were retrospectively analyzed. Steroid treatment 5-85 mg was administered over 5 days-22 months to 112 patients aged 21-48 years. Recurrence occurred in 22 patients, steroid-induced diabetes mellitus in 5 patients, no response to treatment was observed in 4 patients, in 2 patients, the mass decreased in size, and static disease was observed in one. The steroid treatment was changed to MTX treatment in 4 patients who had recurrence, 5 with steroid-induced DM and in 4 who were nonrespondents. Three patients were started on steroid together with MTX as a primary treatment. Of the patients treated with MTX, a satisfactory result was obtained in 14 cases and in 2, mastectomy was performed because of recurrence despite the treatment with MTX. IGM is a troublesome condition that presents management problems due to the side effects of steroids. Our study demonstrates that the use of MTX in IGM cases has been effective in preventing complications, in resolving the inflammatory process, and in limiting side effects of corticosteroids.
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Affiliation(s)
- Sami Akbulut
- Department of Surgery Department of Pathology, Diyarbakir Education and Research Hospital, Dagkapi, Diyarbakir, Turkey.
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Akbulut S, Arikanoglu Z, Senol A, Sogutcu N, Basbug M, Yeniaras E, Yagmur Y. Is methotrexate an acceptable treatment in the management of idiopathic granulomatous mastitis? Arch Gynecol Obstet 2011; 284:1189-95. [PMID: 21207047 DOI: 10.1007/s00404-010-1825-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 12/20/2010] [Indexed: 02/07/2023]
Abstract
PURPOSE The treatment of choice for idiopathic granulomatous mastitis (IGM) has not yet been established. There are limited data on the use of methotrexate (MTX) in the treatment of IGM. Herein, we investigated the role of MTX in the treatment of IGM patients. METHODS We present four new cases of IGM treated with MTX and a review of the English language literature concerning the use of MTX in the treatment of IGM. RESULTS We prospectively investigated the clinicopathological features of four female patients (aged 28-37 years) who were multiparous and had used oral contraceptives. The patients were administered 7.5-15 mg MTX over 2-6 months. No recurrence was detected during the follow-up period of 4-8 months. In five published studies on MTX use in IGM, data were available for 12 patients aged 21-40 years. In nine patients, treatment was changed to MTX because of a lack of response to steroids, recurrence or steroid-induced diabetes mellitus. Steroids were used in combination with MTX as an initial treatment choice in three patients. Satisfactory results were achieved in ten patients treated with MTX, and only two demonstrated recurrence despite the treatment and underwent mastectomy. CONCLUSION MTX in the present cases of IGM was effective, prevented complications and limited corticosteroid side effects.
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Affiliation(s)
- Sami Akbulut
- Department of Surgery, Diyarbakir Education and Research Hospital, 21400 Diyarbakir, Turkey.
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