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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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Muthuswamy K, Subesinghe M. 18 F-FDG PET/CT Imaging of Idiopathic Granulomatous Mastitis. Clin Nucl Med 2024; 49:173-174. [PMID: 38015638 DOI: 10.1097/rlu.0000000000004980] [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: 11/30/2023]
Abstract
ABSTRACT A 43-year-old woman, who presented with a suspected left breast abscess, underwent serial ultrasounds, which demonstrated inflammatory changes that were nonresponsive to antibiotics and which spread to the contralateral breast. 18 F-FDG PET/CT demonstrated diffuse heterogeneous intense FDG uptake in both breasts with reactive axillary nodes. Breast biopsy confirmed granulomatous inflammation, and overall findings were consistent with idiopathic granulomatous mastitis. In the absence of histological analysis, idiopathic granulomatous mastitis is an important differential diagnosis to consider for bilateral abnormal breast uptake, and early recognition can facilitate prompt commencement of treatment.
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Azzam MI, Alnaimat F, Al-Nazer MW, Awad H, Odeh G, Al-Najar M, Alsayed S, El-Asir L, Addasi R, Melhem JM, Sweiss NJ. Idiopathic granulomatous mastitis: clinical, histopathological, and radiological characteristics and management approaches. Rheumatol Int 2023; 43:1859-1869. [PMID: 37347273 DOI: 10.1007/s00296-023-05375-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/15/2023] [Indexed: 06/23/2023]
Abstract
Idiopathic Granulomatous Mastitis (IGM) is an infrequent, benign breast disease that primarily affects women during their childbearing years and can be mistaken for breast cancer. This study aimed to review the clinical, radiological, and histopathological findings of patients with IGM in addition to management and outcome. Retrospective cross-sectional study of biopsy-confirmed IGM at an academic medical center and a private hospital in Amman, Jordan. Fifty-four patients were included, with a mean age of 37.0 ± 9.04 years, mostly presenting with a breast lump (n = 52, 96.3%) and breast pain (n = 45 patients, 84.9%). Approximately half of the patients (51.9%) were parous, and 50% had breastfed for an average duration of 30.37 ± 22.38 months. Most of the patients had either solitary or multiple abscesses on breast ultrasound. Histopathological analysis (n = 35) showed mostly either moderate inflammation (n = 16, 45.7%) or severe inflammation (n = 14, 40%). Two-thirds of the patients underwent surgical interventions at the time of diagnosis, mostly incision and drainage (n = 16, 29%) or surgical excision (n = 7, 13%), and no mastectomies were performed. The most common medical treatment included a combination of antibiotics, corticosteroids, and methotrexate (n = 21, 38.8%). After follow-up, 31 patients remained in remission, 3 experienced relapses, and 3 had a chronic course. The use of corticosteroids was significantly associated with remission (p = 0.035). The presentation and demographics of IGM patients in Jordan were consistent with the existing literature. Prospective research is needed to explore different treatment options and disease outcomes.
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Affiliation(s)
- Muayad I Azzam
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Fatima Alnaimat
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, University of Jordan, Amman, 11942, Jordan.
| | | | - Heyam Awad
- Department of Pathology, School of Medicine, University of Jordan, Amman, 11942, Jordan
| | - Ghada Odeh
- Department of General Surgery, School of Medicine, University of Jordan, Amman, 11942, Jordan
| | - Mahasen Al-Najar
- Department of Radiology and Nuclear Medicine, School of Medicine, University of Jordan, Amman, 11942, Jordan
| | - Suzan Alsayed
- Department of Rheumatology, Abdali Hospital, Amman, Jordan
| | - Layal El-Asir
- Women's Health and Breast Center, Abdali Hospital, Amman, Jordan
| | - Rami Addasi
- Department of General Surgery, School of Medicine, University of Jordan, Amman, 11942, Jordan
| | - Jamal Masad Melhem
- Department of General Surgery, School of Medicine, University of Jordan, Amman, 11942, Jordan
| | - Nadera J Sweiss
- Division of Rheumatology, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
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Mohindra N, Jain N, Sabaretnam M, Agrawal V, Mishra P, Chaturvedi P, Mishra A, Agarwal G. Mammography and Digital Breast Tomosynthesis in Granulomatous and Nongranulomatous Mastitis. J Surg Res 2023; 281:13-21. [PMID: 36108534 DOI: 10.1016/j.jss.2022.08.009] [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: 04/05/2022] [Revised: 07/13/2022] [Accepted: 08/17/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Digital Mammography (DM) is extensively used for breast imaging however, lesion visibility is often limited by overlapping tissues, which affects lesion characterization. Digital breast tomosynthesis (DBT) reduces the effect of overlapping tissues and helps in revealing obscured findings. We aimed to describe the mammographic findings in granulomatous and non-granulomatous mastitis and assess the utility of adjunctive DBT in lesion characterization. MATERIALS AND METHODS DM and DBT images of histo-pathologically diagnosed cases of granulomatous (GM) and non-granulomatous mastitis (NGM) were reviewed according to the BI-RADS lexicon. Presence of contiguous/ interconnected lesions, tubular densities, interspersed hypodensities/fat densities within the involved areas were also assessed. The perceived utility of adjunct DBT was scored from 0-2. RESULTS Of 33 reviewed patients (24 GM, 9 NGM; median age 39 years, range 24-78); 13/33 (39.4%) were under 35 years of age. DBT detected masses in 24/33 (72.7%), whereas only 15/33 (45.4%) were visible on DM alone. Contiguous or inter-connected lesions were found in 10/33 (30.3%) cases. Tubular extensions were seen in 14 cases and interspersed hypodensities in 15. None of the enlarged lymph nodes had irregular shape or indistinct margins or loss of fatty hilum. DBT was able to categorize more lesions as BIRADS 4a or below, as compared to DM alone. CONCLUSIONS Mammographic presence of multiple contiguous iso-dense masses, reniform contour of axillary lymph nodes with preserved fatty hilum despite a large area of breast involvement favour a benign etiology; especially if DBT reveals tubular extensions or lesions with inhomogenous low density areas within.
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Affiliation(s)
- Namita Mohindra
- Department of Radio-Diagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India.
| | - Neeraj Jain
- Department of Radio-Diagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Mayilvaganan Sabaretnam
- Department of Endocrine & Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Vinita Agrawal
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Prabhakar Mishra
- Department of Biostatistics, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Pragya Chaturvedi
- Department of Radio-Diagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Anjali Mishra
- Department of Endocrine & Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Gaurav Agarwal
- Department of Endocrine & Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
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Alper F, Karadeniz E, Güven F, Çankaya BY, Yalcin A, Özden K, Eşdur V, Kaşali K, Akçay MN. Comparison of the Efficacy of Systemic Versus Local Steroid Treatment in Idiopathic Granulomatous Mastitis: A Cohort Study. J Surg Res 2022; 278:86-92. [PMID: 35594619 DOI: 10.1016/j.jss.2022.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 03/01/2022] [Accepted: 04/06/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Steroid therapy is known to be effective against granulomatous mastitis. We aimed to compare the efficacy of local versus systemic steroid administration in patients with idiopathic granulomatous mastitis. MATERIALS AND METHODS This prospective cohort study included 58 patients who had either local (n = 42) or systemic (n = 16) treatment due to granulomatous mastitis between 2015 and 2019. Recurrence rates were determined as per ultrasound and magnetic resonance imaging examinations and the rate of side effects was evaluated as per patient complaints and physical examinations at the end of a 2-year follow-up period. RESULTS Median doses of 140 mg and 3810 mg were administered to the local and systemic group, respectively. Six (14.3%) patients in the local treatment group and 13 (81.3%) in the systemic treatment group had steroid-related side effects. The local treatment group had significantly fewer side effects than the systemic treatment group (P < 0.001). The recurrence rates were similar in both groups (P > 0.05). CONCLUSIONS Local steroid injection was as effective as systemic steroid therapy. Compared to systemic therapy, local steroid administration can be considered as a new therapeutic protocol with a lower dose and side effect rate.
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Affiliation(s)
- Fatih Alper
- Department of Radiology, Ataturk University, Erzurum, Turkey; Clinical Research, Development and Design Application and Research Center, Erzurum, Turkey
| | - Erdem Karadeniz
- Department of General Surgery, Ataturk University, Erzurum, Turkey
| | - Fadime Güven
- Department of Radiology, Ataturk University, Erzurum, Turkey
| | | | - Ahmet Yalcin
- Department of Radiology, Ataturk University, Erzurum, Turkey.
| | - Kemalettin Özden
- Department of Infectious Diseases and Clinical Microbiology, Atatürk University, Erzurum, Turkey
| | - Veysel Eşdur
- Department of Radiology, Ataturk University, Erzurum, Turkey
| | - Kamber Kaşali
- Department of Biostatistics, Atatürk University, Erzurum, Turkey
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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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Velidedeoglu M, Umman V, Kilic F, Celik V, Gazioglu E, Hatipoglu E, Ozturk T, Mete B. Idiopathic granulomatous mastitis: introducing a diagnostic algorithm based on 5 years of follow-up of 152 cases from Turkey and a review of the literature. Surg Today 2022; 52:668-680. [PMID: 34549317 DOI: 10.1007/s00595-021-02367-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 07/28/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE The goals of this study were to report our clinical experience in a single center at a high-volume tertiary university hospital in Istanbul and to introduce a diagnostic algorithm based on a 5-year follow-up of 152 women with biopsy-proven idiopathic granulomatous mastitis (IGM). IGM is an uncommon, non-malignant, chronic inflammatory disease of the mammary gland with an unknown etiology. The symptoms, clinical presentation, and radiologic findings of IGM may resemble carcinomas. To our knowledge, this study comprises the largest series of IGM, especially with a 5-year follow-up, yet reported in the English literature. METHODS The present study reported our single-center clinical experience at a tertiary university hospital in Istanbul, Turkey, and introduced a diagnostic algorithm using our treatment protocol based on a 5-year follow-up of 152 women with biopsy-proven IGM. Our database of 10 years' experience containing over 700 patients with IGM was evaluated. However, to assess recurrence and resistance to treatment, only the 152 patients with a long follow-up period of 5 years were included in the study group. The analysis included 152 women with biopsy-proven IGM who were treated between January 2009 and March 2014. The clinical data of the presentation, histopathology, and treatment modalities were analyzed by reviewing the medical records. RESULTS Of the 152 patients diagnosed with granulomatous mastitis, 32 (21%) recovered by expectant management, while 14 (9%) responded to antibiotics, 65 (43%) received corticosteroids, 20 (13%) had antituberculosis medication, 16 (11%) underwent excision, and 5 (3%) responded to non-steroidal anti-inflammatory drugs. Fifty-one patients (33%) had recurrence; of these, 30 achieved a cure with second-line treatment, 16 underwent excision, and 5 achieved a cure with observation. CONCLUSION IGM is a rare benign breast disorder, and clinicians need a high index of suspicion to diagnose it, as IGM can be mistaken for breast cancer. Unlike periductal mastitis, IGM does not evolve secondary to nicotine addiction and is typically seen in women of childbearing age with a recent history of pregnancy and lactation. The diagnosis can be challenging, and an evaluation with a multidisciplinary team is necessary. There is no consensus concerning the definitive treatment approach. We suggested a diagnostic algorithm in the present study, using our treatment protocol based on the 5 years' follow-up of 152 women.
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Affiliation(s)
- Mehmet Velidedeoglu
- Department of General Surgery, Cerrahpasa School of Medicine, Istanbul University, 34098, Fatih, İstanbul, Turkey
| | - Veysel Umman
- Department of General Surgery, Cerrahpasa School of Medicine, Istanbul University, 34098, Fatih, İstanbul, Turkey.
| | - Fahrettin Kilic
- Department of Radiology, Cerrahpasa School of Medicine, Istanbul University, İstanbul, Turkey
| | - Varol Celik
- Department of General Surgery, Cerrahpasa School of Medicine, Istanbul University, 34098, Fatih, İstanbul, Turkey
| | - Ertugrul Gazioglu
- Department of General Surgery, Cerrahpasa School of Medicine, Istanbul University, 34098, Fatih, İstanbul, Turkey
| | - Engin Hatipoglu
- Department of General Surgery, Cerrahpasa School of Medicine, Istanbul University, 34098, Fatih, İstanbul, Turkey
| | - Tulin Ozturk
- Department of Pathology, Cerrahpasa School of Medicine, Istanbul University, İstanbul, Turkey
| | - Birgul Mete
- Department of Infectious Diseases, Cerrahpasa School of Medicine, Istanbul University, İstanbul, Turkey
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Bacon DR, Ngeve SM, Jordan SG. Granulomatous mastitis: An underdiagnosed inflammatory disease afflicting minority women. Radiol Case Rep 2021; 16:3990-3994. [PMID: 34745405 PMCID: PMC8554342 DOI: 10.1016/j.radcr.2021.09.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/16/2021] [Accepted: 09/18/2021] [Indexed: 11/29/2022] Open
Abstract
Granulomatous mastitis (GM) is an underdiagnosed and understudied benign inflammatory disease of the breast whose accurate diagnosis is confounded by mimicry of other breast pathologies (infectious mastitis and abscess, malignancy) and limited clinician knowledge of the disease. GM disproportionately affects minority women, furthering health disparities for a demographic already disadvantaged in the care of breast diseases. The first step in diagnosis is ultrasound followed by core needle biopsy yielding granulomatous inflammation. To far lesser degree, mammography, and MRI may play a role in narrowing the differential. A high index of clinical suspicion and multidisciplinary approach is required. The presence of Corynebacterium kroppensteddti may indicate one subtype of granulomatous mastitis called cystic neutrophilic granulomatous mastitis; disease stratification, and individualized therapy are on the horizon.
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Affiliation(s)
- Daniel R Bacon
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Smith M Ngeve
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Sheryl G Jordan
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Faast A, Ikeda DM, Pittman S, DeMartini W, Kozlov A. FDG Avid Abnormalities in the Breast: Breast Cancer Mimics. CURRENT RADIOLOGY REPORTS 2021. [DOI: 10.1007/s40134-021-00383-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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10
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Guirguis MS, Adrada B, Santiago L, Candelaria R, Arribas E. Mimickers of breast malignancy: imaging findings, pathologic concordance and clinical management. Insights Imaging 2021; 12:53. [PMID: 33877461 PMCID: PMC8058137 DOI: 10.1186/s13244-021-00991-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/23/2021] [Indexed: 12/18/2022] Open
Abstract
Many benign breast entities have a clinical and imaging presentation that can mimic breast cancer. The purpose of this review is to illustrate the wide spectrum of imaging features that can be associated with benign breast diseases with an emphasis on the suspicious imaging findings associated with these benign conditions that can mimic cancer. As radiologic-pathologic correlation can be particularly challenging in these cases, the radiologist’s familiarity with these benign entities and their imaging features is essential to ensure that a benign pathology result is accepted as concordant when appropriate and that a suitable management plan is formulated.
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Affiliation(s)
- Mary S Guirguis
- Breast Imaging Department, MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX, 77030-4009, USA.
| | - Beatriz Adrada
- Breast Imaging Department, MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX, 77030-4009, USA
| | - Lumarie Santiago
- Breast Imaging Department, MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX, 77030-4009, USA
| | - Rosalind Candelaria
- Breast Imaging Department, MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX, 77030-4009, USA
| | - Elsa Arribas
- Breast Imaging Department, MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX, 77030-4009, USA
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11
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Yin Y, Liu X, Meng Q, Han X, Zhang H, Lv Y. Idiopathic Granulomatous Mastitis: Etiology, Clinical Manifestation, Diagnosis and Treatment. J INVEST SURG 2021; 35:709-720. [PMID: 33691563 DOI: 10.1080/08941939.2021.1894516] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Idiopathic granulomatous mastitis (IGM) is a rare form of chronic inflammatory breast disease. Although it is a benign breast lesion, it may be sometimes difficult to distinguish from breast cancer. The cause of IGM is unknown, but may be associated with autoimmunity, abnormal hormone levels and infection. While the clinical manifestations of IGM involve various manifestations of inflammation, the diagnosis is principally established by histopathology, characterized by non-caseating granulomas and microabscess formation centered on the breast lobules. Therapeutic options for IGM range from observation to various medical treatments, such as steroids, immunosuppressants, and antibiotics, to surgical intervention, particularly if secondarily infected. Given that the controversy on etiology and treatment choices, we accomplished the present review through reviewing IGM-related literature published in 'Pubmed' and 'Web of science' databases during 1997 to 2020, aiming to provide the basis for rational clinical diagnosis and treatment.
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Affiliation(s)
- Yulong Yin
- Department of Thyroid Breast Surgery, The Affiliated Hospital of Northwest University, Xi'an, Shaanxi Province, China
| | - Xianghua Liu
- Department of Thyroid Breast Surgery, The Affiliated Hospital of Northwest University, Xi'an, Shaanxi Province, China
| | - Qingjie Meng
- Department of Thyroid Breast Surgery, The Affiliated Hospital of Northwest University, Xi'an, Shaanxi Province, China
| | - Xiaogang Han
- Department of Thyroid Breast Surgery, The Affiliated Hospital of Northwest University, Xi'an, Shaanxi Province, China
| | - Haomeng Zhang
- Department of Thyroid Breast Surgery, The Affiliated Hospital of Northwest University, Xi'an, Shaanxi Province, China
| | - Yonggang Lv
- Department of Thyroid Breast Surgery, The Affiliated Hospital of Northwest University, Xi'an, Shaanxi Province, China
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12
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Kornfeld HW, Mitchell KB. Management of idiopathic granulomatous mastitis in lactation: case report and review of the literature. Int Breastfeed J 2021; 16:23. [PMID: 33663552 PMCID: PMC7934432 DOI: 10.1186/s13006-021-00370-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 02/23/2021] [Indexed: 12/19/2022] Open
Abstract
Background Idiopathic Granulomatous Mastitis (IGM) is a benign chronic inflammatory breast condition that mimics two common breast disorders: breast carcinoma and breast abscess. It can form breast masses, fistulae, and fluid collections, resulting in breast disfigurement with retraction and nipple areolar complex (NAC) inversion. IGM most often presents in women of childbearing age within a few years of pregnancy, and can significantly impact lactation. Despite the prevalence of this disease, no current literature describes an approach to managing IGM during breastfeeding. Case presentation A 28-year-old G3P2 patient of Native American origin presented to her obstetrician at 7 months pregnant with worsening left breast swelling and redness. She underwent a mammogram, ultrasound and core needle biopsy that confirmed the diagnosis of Idiopathic Granulomatous Mastitis. During the postpartum period, she underwent intralesional triamcinolone injections of her left breast. Due to the contraindication of breastfeeding after local steroid injection, the patient stopped breastfeeding from the affected breast and continued breastfeeding unilaterally. Conclusions Idiopathic Granulomatous Mastitis is a challenging chronic inflammatory breast disease that affects women primarily in the reproductive years, with a higher incidence in patients of Hispanic, Native American, Middle Eastern, and African descent. Treatment of IGM during pregnancy and lactation has thus far not been addressed. We review the literature on the treatment of IGM in the non-lactating population, and propose considerations for treating breastfeeding women affected by this disease. Traditional treatment has included systemic immunosuppression and surgery, but newer literature demonstrates that intralesional injection of steroid can provide significant symptomatic relief to patients. A diagnosis of IGM does not preclude breastfeeding, though patients may experience challenges with milk production and latch on the affected breast. Individualized care should be provided, with considerations given to the following: side effects of systemic steroids, the need to wean a breast being treated with intralesional steroids, and augmentation of milk production on the unaffected breast to promote continued breastfeeding.
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Affiliation(s)
- Hannah W Kornfeld
- Santa Barbara Cottage Hospital, 400 W. Pueblo Street, Santa Barbara, CA, 93105, USA.
| | - Katrina B Mitchell
- Santa Barbara Cottage Hospital, 400 W. Pueblo Street, Santa Barbara, CA, 93105, USA.,Ridley Tree Cancer Center at Sansum Clinic, 540 West Pueblo Street, Santa Barbara, CA, 93105, USA
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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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Manogna P, Dev B, Joseph LD, Ramakrishnan R. Idiopathic granulomatous mastitis—our experience. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-019-0126-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Abstract
Background
Idiopathic granulomatous mastitis (IGM) is a rare benign chronic inflammatory condition of the breast and is most commonly seen in women of childbearing age. The etiology is uncertain, and an autoimmune association has been suggested with the diagnosis usually made by exclusion. The clinical and radiological features often mimic that of breast cancer and hence confirmed early diagnosis is required to avoid misdiagnosis and unnecessary delay in the treatment.
Results
The most common clinical presentation of granulomatous mastitis is unilateral palpable breast lump with or without associated pain. The typical ultrasound finding is an ill-defined, irregular heterogeneous, predominantly hypoechoic lesion with multiple tentacles. Histologic features show a well-defined non-necrotizing epitheloid granulomas along with Langhans type giant cells.
Conclusion
Imaging features mimic that of breast cancer, and final diagnosis of granulomatous mastitis always requires specific pathologic findings while excluding other causes.
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Aksan H, Kundaktepe BP, Sayili U, Velidedeoglu M, Simsek G, Koksal S, Gelisgen R, Yaylim I, Uzun H. Circulating miR-155, let-7c, miR-21, and PTEN levels in differential diagnosis and prognosis of idiopathic granulomatous mastitis and breast cancer. Biofactors 2020; 46:955-962. [PMID: 32941675 DOI: 10.1002/biof.1676] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/06/2020] [Indexed: 12/13/2022]
Abstract
This study investigates whether the circulating miR-155, let-7c, miR-21, and PTEN levels to be used in the differential diagnosis of patients with idiopathic granulomatous mastitis (IGM) and breast cancer (BC). Forty-five patients with BC, 50 patients with IGM, and 48 healthy volunteers were included in the study. Serum miR-21 expression was significantly higher in BC (fold change = 2.42) and IGM group (fold change = 1.33) compared to control (p < .001). Serum miR-155 and let-7c expression levels were significantly lower in both groups compared to the control group (p < .001). miR-21 expression in BC was significantly higher than IGM (fold change = 1.976; p < .001). PTEN levels in BC were significantly higher than IGM (p < .001) and significantly lower than the control group (p < .001); the IGM group was significantly lower than the control group (p < .001). In addition to radiological data, serum miR-21 and PTEN levels may be noninvasive biomarkers that can help differentiate IGM from BC. The results of the study will lead to future studies in the differential diagnosis of IGM and BC.
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Affiliation(s)
- Hulya Aksan
- Department of Molecular Medicine, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
- Department of Medical Biochemistry, Faculty of Medicine, Haliç University, Istanbul, Turkey
| | - Berrin Papila Kundaktepe
- Department of General Surgery, Cerrahpasa Faculty of Medicine, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Ugurcan Sayili
- Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Mehmet Velidedeoglu
- Department of General Surgery, Cerrahpasa Faculty of Medicine, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Gonul Simsek
- Department of Physiology, Cerrahpasa Faculty of Medicine, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Selcuk Koksal
- Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Remise Gelisgen
- Department of Medical Biochemistry, Cerrahpasa Faculty of Medicine, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Ilhan Yaylim
- Department of Molecular Medicine, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Hafize Uzun
- Department of Medical Biochemistry, Cerrahpasa Faculty of Medicine, Istanbul University - Cerrahpasa, Istanbul, Turkey
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16
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Tekin L, Dinç Elibol F. Is There any Relationship Between Granulomatous Mastitis and Seasons? An Analysis of Seasonal Frequency, Clinical, and Radiologic Findings. Eur J Breast Health 2020; 16:235-243. [PMID: 33062962 DOI: 10.5152/ejbh.2020.5897] [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: 06/24/2020] [Accepted: 08/18/2020] [Indexed: 11/22/2022]
Abstract
Objective Idiopathic granulomatous mastitis (IGM) is a rare, resistant, and recurrent benign disease of the breast. IGM can be clinically and radiologically confused with breast carcinoma, and core needle biopsy is needed to diagnose. The etiology and pathogenesis of IGM have not been fully explained. This premenopausal disease may be associated with pregnancy, breastfeeding, autoimmune processes, inflammation, and oral contraceptives. However, there is no study on whether there is a seasonal relationship. Materials and Methods From January 2015 to January 2020, the seasonal relationship of IGM was evaluated in 37 females aged between 25-49. Results Although all cases were distributed between September and May, there was no statistically significant result in the relationship with the season. US is the main modality in the diagnosis of this condition which only provides an accurate pre-diagnosis approach with the typical USG appearance features. Some MRI features may help us to distinguish IGM from breast malignities. Conclusion IGM is a rare chronic non-specific inflammatory lesion of the breast, which can be confused with benign and malignant breast diseases in both clinical and radiologic aspects. To understand the etiology of this condition better, the seasonal connection needs to be evaluated in larger patient groups.
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Affiliation(s)
- Leyla Tekin
- Department of Pathology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Funda Dinç Elibol
- Department of Radiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
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Gupta N, Vats M, Garg M, Dahiya DS. Bilateral idiopathic granulomatous mastitis. BMJ Case Rep 2020; 13:13/8/e234979. [PMID: 32868320 DOI: 10.1136/bcr-2020-234979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
A 35-year-old woman presented to the surgery outpatient department with a lump in her right breast for 2 months and pain for 1 month. After clinical examination and relevant investigations, we kept a working diagnosis of antibioma. The lump was excised under local anaesthesia and biopsy was sent. However, histopathological examination reported multiple non-caseating granulomas without acid-fast bacilli. Two months later, she developed a sinus with serous discharge at the scar site. At the same time, she developed pain in the left upper breast, which subsequently progressed to an abscess. Incision and drainage of the abscess was done, but the wound did not heal, and a discharging sinus appeared at the site. Finally, a diagnosis of idiopathic granulomatous mastitis was made, after excluding all other causes, and the patient was prescribed oral steroids. She recovered fully after 8 months and there is no recurrence till date.
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Affiliation(s)
- Nikhil Gupta
- Department of Surgery, PGIMER, Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Manu Vats
- Department of Surgery, PGIMER, Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Mradul Garg
- Department of Minimal Invasive, GI and Bariatric Surgery, Metro Heart Institute with Multispeciality, Faridabad, India
| | - Davinder Singh Dahiya
- Department of Advanced Laparoscopy, Gastrointestinal and Bariatric Surgery, Noble Heart Super Speciality Hospital, Rohtak, India
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[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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Zhao Q, Xie T, Fu C, Chen L, Bai Q, Grimm R, Peng W, Wang S. Differentiation between idiopathic granulomatous mastitis and invasive breast carcinoma, both presenting with non-mass enhancement without rim-enhanced masses: The value of whole-lesion histogram and texture analysis using apparent diffusion coefficient. Eur J Radiol 2019; 123:108782. [PMID: 31864142 DOI: 10.1016/j.ejrad.2019.108782] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 11/28/2019] [Accepted: 12/04/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE The aim of this study was to investigate whether whole-lesion histogram and texture analysis using apparent diffusion coefficient can discriminate between idiopathic granulomatous mastitis (IGM) and invasive breast carcinoma (IBC), both of which appeared as non-mass enhancement lesions without rim-enhanced masses. METHOD This retrospective study included 58 pathology-proven female patients at two independent study sites (27 IGM patients and 31 IBC patients). Diffusion-weighted imaging (3b values, 50, 400 or 500, and 800 s/mm2) was performed using 1.5 T or 3 T MR scanners from the same vendor. Whole-lesions were segmented and 11 features were extracted. Univariate analysis and multivariate logistic regression analysis were performed to identify significant variables for differentiating IGM from IBC. Receiver operating characteristic curve was assessed. The interobserver reliability between two observers for the histogram and texture measurement was also reported. RESULTS The 5th percentile, difference entropy and entropy of apparent diffusion coefficient showed significant differences between the two groups. An area under the curve of 0.778 (95 % CI: 0.648, 0.908), accuracy of 79.3 %, and sensitivity of 87.1 % was achieved using these three significant features. No significant feature was found with the multivariate analysis. For the interobserver reliability, all apparent diffusion coefficient parameters except skewness and kurtosis indicated good or excellent agreement, while these two features showed moderate agreement. CONCLUSIONS Whole-lesion histogram and texture analysis using apparent diffusion coefficient provide a non-invasive analytical approach to the differentiation between IGM and IBC, both presenting with non-mass enhancement without rim-enhanced masses.
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Affiliation(s)
- Qiufeng Zhao
- Department of Radiology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Tianwen Xie
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Caixia Fu
- MR Application Development, Siemens Shenzhen Magnetic Resonance, Shenzhen, China
| | - Ling Chen
- Department of Pathology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qianming Bai
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Robert Grimm
- MR Application Predevelopment, Siemens Healthcare, Erlangen, Germany
| | - Weijun Peng
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
| | - Song Wang
- Department of Radiology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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20
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Alper F, Karadeniz E, Güven F, Yılmaz Çankaya B, Özden K, Akçay MN. The evaluation of the efficacy of local steroid administration in idiopathic granulomatous mastitis: The preliminary results. Breast J 2019; 26:309-311. [PMID: 31495032 DOI: 10.1111/tbj.13588] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/13/2019] [Accepted: 06/13/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Fatih Alper
- Department of Radiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Erdem Karadeniz
- Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Fadime Güven
- Department of Radiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Bahar Yılmaz Çankaya
- Department of Radiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Kemalettin Özden
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Müfide Nuran Akçay
- Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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Maione C, Palumbo VD, Maffongelli A, Damiano G, Buscemi S, Spinelli G, Fazzotta S, Gulotta E, Buscemi G, Lo Monte AI. Diagnostic techniques and multidisciplinary approach in idiopathic granulomatous mastitis: a revision of the literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:11-15. [PMID: 30889150 PMCID: PMC6502167 DOI: 10.23750/abm.v90i1.6607] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 04/10/2018] [Indexed: 12/23/2022]
Abstract
Idiopathic granulomatous mastitis (IGM) is a chronic benign inflammatory disease of the breast that may mimic breast cancer. It is most common in parous young fertile women, although it can occur in nulliparous women and in men. IGM is an idiopathic disease due to the influence of some environmental factors in genetically predisposed subjects. Several pathogenic hypothesis have been proposed in the last years (autoimmune, hormonal, infective genesis). IGM presents as a painful palpable mass located in one of the two udders. The skin is usually normal but could present signs of inflammation with or without lymph nodes involvement. Ultrasonography, mammography, magnetic resonance can be diagnosed an IGM, but pathognomonic radiological signs has not yet reported in literature. Biopsy findings show granulomatous lesion centered on the breast lobule, as in granulomatous mastitis induced by tuberculosis or sarcoidosis. The aim of this review of literature is to verify the development of new advanced diagnostic techniques and multidisciplinary approach for this condition. In the last years innovative approaches have modified IGM diagnosis and therapy, avoiding surgery in most of cases, introducing a more conservative medical approach based on recent etiopathological hypothesis. (www.actabiomedica.it)
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22
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Barreto DS, Sedgwick EL, Nagi CS, Benveniste AP. Granulomatous mastitis: etiology, imaging, pathology, treatment, and clinical findings. Breast Cancer Res Treat 2018; 171:527-534. [PMID: 29971624 DOI: 10.1007/s10549-018-4870-3] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 06/26/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To outline the demographics, clinical presentation, imaging features, and treatment modalities observed among a series of patients diagnosed with biopsy-proven granulomatous mastitis (GM). METHOD Following approval by institutional review board, retrospective chart review was performed on patients with biopsy-proven granulomatous mastitis at our institution in the period from January 2013 until October 2017. RESULTS A total of 90 patients were identified: 87 women and 3 men. The mean age was 35 years, mostly women in their reproductive age. In our study, patients with GM were more likely to be Hispanic compared to the general population. Sixty-three percent of patients were within 5 years of previous pregnancy. Painful palpable mass-like lesion was the most common physical finding. Breast ultrasound (US) was performed in all patients, and most commonly showed a hypoechoic irregular-shaped mass. Mammography (MG) showed asymmetry or irregular mass as the main finding. Definitive diagnosis was obtained by imaging-guided core needle biopsies in 94.4%. Conservative management was preferred, and only one patient underwent surgery. CONCLUSION Although clinical and radiological findings of patients with GM may mimic those of breast carcinoma, our study showed that women of childbearing age, especially among Hispanic ethnicity with a recent history of pregnancy or high prolactin level and newly tender mass-like lesion, in addition to new focal asymmetry on mammogram and heterogeneous hypoechoic irregular-shaped mass on ultrasound exam, should raise concern for GM. Non-invasive approach and clinical follow-up were the preferred treatment method.
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Affiliation(s)
- David S Barreto
- Department of Breast Radiology, Baylor College of Medicine, One Baylor Plaza, MS: BCM360, Houston, TX, 77030, USA.
| | - Emily L Sedgwick
- Department of Breast Radiology, Baylor College of Medicine, One Baylor Plaza, MS: BCM360, Houston, TX, 77030, USA
| | - Chandandeep S Nagi
- Department of Pathology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Ana P Benveniste
- Department of Breast Radiology, Baylor College of Medicine, One Baylor Plaza, MS: BCM360, Houston, TX, 77030, USA
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23
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Pluguez-Turull CW, Nanyes JE, Quintero CJ, Alizai H, Mais DD, Kist KA, Dornbluth NC. Idiopathic Granulomatous Mastitis: Manifestations at Multimodality Imaging and Pitfalls. Radiographics 2018. [DOI: 10.1148/rg.2018170095] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Cedric W. Pluguez-Turull
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Jennifer E. Nanyes
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Cristina J. Quintero
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Hamza Alizai
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Daniel D. Mais
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Kenneth A. Kist
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Nella C. Dornbluth
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
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Granulomatous diseases of the breast and axilla: radiological findings with pathological correlation. Insights Imaging 2018; 9:59-71. [PMID: 29404980 PMCID: PMC5825314 DOI: 10.1007/s13244-017-0587-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 12/05/2017] [Accepted: 12/13/2017] [Indexed: 12/04/2022] Open
Abstract
Objectives This article reviews our experience and describes the literature findings of granulomatous diseases of the breast and axilla. Methods After approval of the Institutional Review Board was obtained, the surgical pathological records from January 2000 to January 2017 were searched for the keyword granulomatous. Clinical, imaging and histology findings were reviewed by both a fellowship-trained radiologist and a breast-imaging consultant radiologist, reviewing 127 patients (age range, 32–86 years; 126 women and 1 man). Results Most common causes of granulomatous lesions of the breast and axilla included silicone granulomas 33% (n = 42), fat necrosis 29% (n = 37) and suture granulomas 11% (n = 14). In 16% (n = 20), no cause could be found and clinical history was consistent with idiopathic granulomatous mastitis. Other granulomatous aetiologies included granulomatous infections, sarcoidosis and Sjögren’s syndrome. Causes of axillary granulomatous disease were similar to the breast; however, a case of cat-scratch disease was found that only involved the axillary lymph nodes. They can have a variable appearance on imaging and may mimic malignancy with irregular masses seen on mammography, ultrasound and magnetic resonance imaging. Fistulas to the skin and nipple retraction can suggest chronicity and a granulomatous aetiology. Combination of clinical history, laboratory and imaging findings can be diagnostic. Conclusions Granulomatous processes of the breast are rare. The diagnosis can, however, be made if there is relevant history (prior trauma, silicone breast implants, lactation), laboratory (systemic or infectious processes) and imaging findings (fistula, nipple retraction). Recognising these entities is important for establishing pathological concordance after biopsy and for preventing unnecessary treatment. Teaching points Breast granulomatous are rare but can mimic breast carcinoma on imaging Imaging with clinical and laboratory findings can correctly diagnosis specific granulomatous breast diseases Recognition of the imaging findings allows appropriate pathological concordance and treatment
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25
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Management of granulomatous mastitis: a series of 13 patients who were evaluated for treatment without corticosteroids. Int Surg 2016; 100:774-82. [PMID: 26011195 PMCID: PMC4452962 DOI: 10.9738/intsurg-d-14-00231.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Granulomatous mastitis (GM) is a rare chronic inflammatory breast condition with unknown etiology. There is still no generally accepted optimal treatment for GM. Corticosteroid treatment and/or wide excision is most commonly reported in the literature. Incision and drainage or limited excision alone has little benefit because of a strong tendency of recurrence. Corticosteroids also have a high failure rate and possible side effects. In the current series, we treated GM patients without corticosteroids, except for one patient. We also devised multidirectional deep drainage for advanced and complicated abscesses, which are characteristic of GM. This retrospective study included 13 women who met the required histologic criteria of GM. The mean age of the patients was 41 years. All of the patients were premenopausal. Six patients had breast-fed in the last 5 years. Five patients were under medication with antidepressants. A total of 11 patients developed abscesses during the clinical course, and the abscesses penetrated the retromammary space in 4 patients. We treated 2 of these 4 patients with multidirectional deep drainage and obtained complete remission in 5 and 6.5 months, respectively. These times were much shorter than those in the other 2 patients. The time to resolution in 11 patients was 4 to 28 months. This overall outcome was comparable with that of corticosteroid treatment reported in the literature. Because the natural history of GM is thought to be self-limiting, close observation and minimally required drainage of abscesses without corticosteroid administration remain the treatment modality of choice.
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Fazzio RT, Shah SS, Sandhu NP, Glazebrook KN. Idiopathic granulomatous mastitis: imaging update and review. Insights Imaging 2016; 7:531-9. [PMID: 27221974 PMCID: PMC4956627 DOI: 10.1007/s13244-016-0499-0] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 04/02/2016] [Accepted: 05/03/2016] [Indexed: 12/15/2022] Open
Abstract
Objectives The purpose of this study was to review the imaging features of idiopathic granulomatous mastitis (IGM) with clinical and pathology correlation. Methods With institutional review board (IRB) approval, a retrospective search of the surgical pathology database from January 2000 to July 2015 was performed. Clinical, imaging and histology findings were reviewed. Cases of granulomatous mastitis without a known source, diagnosed with percutaneous or surgical biopsy, were included in our analysis. Results Seventeen cases of IGM were identified with imaging available for review. The majority of patients presented with a palpable abnormality, whereas a minority were asymptomatic with an abnormal screening mammogram. At imaging, IGM most often demonstrated a focal asymmetry at mammography, a hypoechoic mass with irregular or angular margins at ultrasound, and robust enhancement with mixed progressive and plateau kinetics at magnetic resonance imaging (MRI). Axillary lymph nodes were reactive in appearance at ultrasound. Molecular breast imaging performed in one case showed mild focal asymmetric radiotracer uptake. Conclusion IGM is a rapidly progressive rare inflammatory condition of the breast resulting in non-necrotizing granuloma formation. Imaging features mimic breast carcinoma and diagnosis can be difficult. Radiologists’ awareness of this condition is essential to prevent delayed or unnecessary treatment. Teaching points • Idiopathic granulomatous mastitis is rapidly progressive inflammatory condition. • Imaging features may mimic breast carcinoma or infection. • Ultrasound shows irregular hypoechoic masses with increased vascularity and sinus tracts. • MRI shows irregular, enhancing masses or non-mass enhancement with microabscesses. • MRI is useful for assessment of breast involvement and response to treatment.
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Affiliation(s)
- Robert T Fazzio
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
| | - Sejal S Shah
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Nicole P Sandhu
- Department of Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Katrina N Glazebrook
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
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Sripathi S, Ayachit A, Bala A, Kadavigere R, Kumar S. Idiopathic granulomatous mastitis: a diagnostic dilemma for the breast radiologist. Insights Imaging 2016; 7:523-9. [PMID: 27164916 PMCID: PMC4956625 DOI: 10.1007/s13244-016-0497-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 04/12/2016] [Accepted: 04/22/2016] [Indexed: 02/07/2023] Open
Abstract
Background Idiopathic granulomatous mastitis is a chronic inflammatory disease of the breast, which is often difficult to differentiate both clinically and radiologically from infectious aetiologies such as tuberculosis, fungal infections, and also from malignancy, thus posing a diagnostic dilemma. We present a pictorial review of the commonly encountered imaging findings in idiopathic granulomatous mastitis on mammography and ultrasound. Materials and methods Mammographic and ultrasound findings of histopathologically proven cases of granulomatous mastitis are discussed. Conclusion Idiopathic granulomatous mastitis has varied and non-specific appearances on ultrasound and mammography. Histopathology is essential to establish diagnosis. Teaching Points • Idiopathic granulomatous mastitis often poses a diagnostic dilemma for the radiologist by mimicking malignancy. • It has varied and non-specific appearances on mammography and ultrasound. • Histopathology is mandatory to establish the diagnosis and decide management.
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Affiliation(s)
- Smiti Sripathi
- Department of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal, Karnataka, India.
| | - Anurag Ayachit
- Department of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal, Karnataka, India
| | - Archana Bala
- Department of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal, Karnataka, India
| | - Rajagopal Kadavigere
- Department of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal, Karnataka, India
| | - Sandeep Kumar
- Department of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal, Karnataka, India
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Bilal A, Badar Albadar F, Bashir Barlas N. Granulomatous Mastitis: Imaging of Temporal Evolution. SCIENTIFICA 2016; 2016:3737528. [PMID: 27051554 PMCID: PMC4802017 DOI: 10.1155/2016/3737528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 02/08/2016] [Indexed: 06/05/2023]
Abstract
Aim. To assess the temporal imaging evolution of granulomatous mastitis and to review imaging findings. Material and Methods. Retrospective review of imaging data of 10 patients with biopsy proven granulomatous mastitis. The patients were divided into 3 groups according to their initial imaging presentation. Temporal evolution of imaging findings was observed separately for each group. Ratios, proportions, and percentages were used for data analysis. Results. Upon initial presentation, 75% of women who underwent mammogram showed an area of mass like architectural distortion. 25% demonstrated focal asymmetry. Complex cystic lesion was seen 40%. Multiple abscesses with sinus tract formation tracking into surrounding tissues were seen in 2 cases. Four out of 10 patients presented as edematous changes. Three out of this group progressed to develop complex cystic lesions/abscess formation. 25% presenting with complex cystic lesions or abscess at presentation showed spontaneous resolution. The remainder needed surgical treatment. The patients with abscess formation and sinus tract formation needed surgical management. Conclusion. Initial imaging findings in granulomatous mastitis can be variable but the eventual course and outcome is similar in most patients with surgical management required in most cases.
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Affiliation(s)
- Ahmed Bilal
- Department of Medical Imaging, King Khalid University Hospital, Riyadh 61421, Saudi Arabia
| | - Fahad Badar Albadar
- Department of Medical Imaging, King Khalid University Hospital, Riyadh 61421, Saudi Arabia
| | - Nauman Bashir Barlas
- Northumbria HealthCare NHS Foundation Trust, Wansbeck General Hospital, Ashington NE63 9JJ, UK
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Aghajanzadeh M, Hassanzadeh R, Alizadeh Sefat S, Alavi A, Hemmati H, Esmaeili Delshad MS, Emir Alavi C, Rimaz S, Geranmayeh S, Najafi Ashtiani M, Habibzadeh SM, Rasam K, Massahniya S. Granulomatous mastitis: Presentations, diagnosis, treatment and outcome in 206 patients from the north of Iran. Breast 2015; 24:456-60. [DOI: 10.1016/j.breast.2015.04.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 03/31/2015] [Accepted: 04/08/2015] [Indexed: 02/08/2023] Open
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Velidedeoglu M, Kilic F, Mete B, Yemisen M, Celik V, Gazioglu E, Ferahman M, Ozaras R, Yilmaz MH, Aydogan F. Bilateral idiopathic granulomatous mastitis. Asian J Surg 2015; 39:12-20. [PMID: 25944108 DOI: 10.1016/j.asjsur.2015.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 02/24/2015] [Accepted: 02/25/2015] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Idiopathic granulomatous mastitis (IGM) is a benign rare inflammatory pseudotumor. Bilateral involvement of IGM has been reported in a few cases. To our knowledge, this study is the largest series of bilateral cases to date. The goals of this study were to present clinical features of bilateral IGM and to evaluate the results of treatments. MATERIALS AND METHODS We performed a retrospective review of the idiopathic granulomatous mastitis database from 2010 to 2013. Ten female patients who met required histologic and clinical criteria of IGM in both breasts were included in study. Demographic data, clinical findings, medication history, and radiologic findings are presented. RESULTS The mean age at onset of the disease was 38.4 ± 8.3 years (range: 29-52 years). Nine patients had no recurrence during a mean follow-up period of 21 months (range: 11-26 months). Additionally, the median time to second breast involvement was 15.6 months. CONCLUSION Bilateral IGMs have a higher rate of more relapse and greater resistance to medical therapies than do unilateral IGMs. Surgical management should be avoided unless all medical treatment options have been exhausted. Nevertheless, expectant management seems a rational option for the treatment of bilateral IGM.
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Affiliation(s)
- Mehmet Velidedeoglu
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Fahrettin Kilic
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Birgul Mete
- Department of Infectious Diseases, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Mucahit Yemisen
- Department of Infectious Diseases, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Varol Celik
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ertugrul Gazioglu
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Mehmet Ferahman
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Resat Ozaras
- Department of Infectious Diseases, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Mehmet Halit Yilmaz
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Fatih Aydogan
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
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Gunduz Y, Altintoprak F, Tatli Ayhan L, Kivilcim T, Celebi F. Effect of topical steroid treatment on idiopathic granulomatous mastitis: clinical and radiologic evaluation. Breast J 2014; 20:586-91. [PMID: 25228089 DOI: 10.1111/tbj.12335] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Idiopathic granulomatous mastitis (IGM) is a rare inflammatory, noncaseating, chronic granulomatous benign disease. The etiology of IGM is still unknown. It is postulated to be an autoimmune localized response. The use of a course of oral steroids provides an important regression of breast mass and skin lesions. Topical corticosteroids are used to treat many skin diseases, but no study is available on the sole use of topical steroids for treating IGM. Eleven women with IGM were treated with topical steroid and evaluated using mammography, ultrasonography, and dynamic MRI. At the end of the 12th week, patients were clinically and radiologically evaluated for the regression of breast and skin lesions. Pre- and post-treatment time-intensity curve patterns (TICs) were also compared. During the topical steroid treatment, the inflammation signs in the affected breast had markedly disappeared, the fistulas had become inactive, and the fistula orifices and/or skin erosions had closed in nine patients. The median follow-up period was 17 months (range: 12-48 months). Recurrence was observed in two patients (2/11) at 5 and 8 months, which were treated again topically. The inflammatory findings of the breast skin completely resolved after 8 weeks of treatment, and no side effects or steroid-related complications occurred. In the pretreatment period, TICs from enhancing areas showed a Type 1 pattern in three cases, a Type 2 pattern in five cases, and a Type 3 pattern in three cases. After topical steroid treatment, TIC was not changed only in one patient (Type 2). Type 1 patterns were determined in seven cases and Type 2 patterns in two cases. In addition, in two patients, TICs were not determined due to complete healing. Our MRI findings showed that topical steroid therapy may be useful because it affects mammary parenchyma as well as mammary skin. Further studies with a greater number of patients are needed to determine the topical steroid therapy dosing and duration, and to better understand the efficacy for treating IGM.
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Affiliation(s)
- Yasemin Gunduz
- Department of Radiology, Sakarya University Medical Faculty, Sakarya, Turkey
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Corticosteroid treatment in the management of idiopathic granulomatous mastitis to avoid unnecessary surgery. Surg Today 2014; 45:457-65. [PMID: 24993812 DOI: 10.1007/s00595-014-0966-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 04/01/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory disease of the breast. It can mimic breast carcinoma clinically and radiologically, and usually affects females of childbearing age. There is no commonly accepted optimal treatment for IGM. In this study, we present the clinical and histopathological features and outcomes of the therapeutic management of IGM, as well as the clinical course of the disease when patients were treated with oral corticosteroids. METHODS This retrospective study included 49 of 87 patients who met the required histological criteria for IGM who were followed up between January 2009 and December 2011. All patients had a disease-free follow-up period of at least 6 months. The data regarding the clinical features at presentation, laboratory values and the treatment modalities were obtained from the medical records of the patients. RESULTS The mean age of the patients was 34.3 ± 4.37 years. Forty patients were treated with prednisolone, five were started on antituberculosis treatment, two received non-steroidal anti-inflammatory drugs, one received antibiotics and one underwent wide excision. All patients who received steroids responded well to the therapy. CONCLUSION Systemic therapy with corticosteroids is an effective and appropriate treatment option for IGM. It can provide complete disease resolution and prevent recurrence in the long term. A multidisciplinary approach including specialists in the fields of both general surgery and infectious diseases is essential for the diagnosis, treatment and follow-up of IGM.
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Breast diseases during pregnancy and lactation. Obstet Gynecol Sci 2013; 56:143-59. [PMID: 24327995 PMCID: PMC3784111 DOI: 10.5468/ogs.2013.56.3.143] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 04/15/2013] [Accepted: 04/17/2013] [Indexed: 11/26/2022] Open
Abstract
Breast is a typical female sexual physiologic organ that is influenced by steroid hormone from menarche until menopause. Therefore various diseases can be developed by continuous action of estrogen and progesterone. Breast diseases are mainly categorized as benign and malignant. It is very important to distinguish the malignancy from breast diseases. However, it is very difficult to diagnose malignancy in pregnant and lactating women even though the same breast diseases took place. Therefore, we will review breast diseases such as breast carcinoma during pregnancy and lactation.
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Al-Jarrah A, Taranikanti V, Lakhtakia R, Al-Jabri A, Sawhney S. Idiopathic Granulomatous Mastitis: Diagnostic strategy and therapeutic implications in Omani patients. Sultan Qaboos Univ Med J 2013; 13:241-7. [PMID: 23862029 PMCID: PMC3706113 DOI: 10.12816/0003229] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 12/09/2012] [Accepted: 12/30/2012] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES Idiopathic granulomatous mastitis (IGM) is a rare benign disorder of the breast whose aetiology is controversial, and is often misdiagnosed clinically and radiologically as mammary malignancy; as a result, it may be incorrectly treated. Although no standard treatment is available for this chronic disease, surgery with or without corticosteroids has been tried with controversial results. This study discusses the clinical presentation, diagnosis, management, recurrence, and follow-up data of IGM with a review of relevant literature. METHODS From 2009-2012, the Breast Unit at Sultan Qaboos University Hospital, Oman, conducted a clinical study on 20 patients with breast lumps. Their clinical and radiological examinations were indeterminate, and a diagnosis of granulomatous mastitis was established only by histopathology. RESULTS The majority of the patients were cases of unknown aetiology, who presented with a unilateral breast mass. A few patients had a mass with an abscess, along with axillary lymphadenopathy. A total of 4 patients were suspected of malignancy using radiology. In all patients, sterilised pus was sent for culture and sensitivity. Microscopy showed the characteristic pattern of granulomatous inflammation. All patients were treated with antibiotics for 6 weeks, and the mean follow-up period was 15 months (11-33 months). All patients had complete remission with no further recurrence. CONCLUSION This single largest study of cases of IGM in Oman highlights the pitfalls in diagnosing this non-neoplastic disease of unknown aetiology and uncertain pathogenesis. It emphasises IGM's excellent response to antibiotics, which is crucial, as IGM is a disease which is notoriously difficult and controversial to treat.
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Affiliation(s)
- Adil Al-Jarrah
- Departments of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Varna Taranikanti
- Departments of Human & Clinical Anatomy, Sultan Qaboos University, Muscat, Oman
| | - Ritu Lakhtakia
- Pathology, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Asma Al-Jabri
- Departments of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Sukhpal Sawhney
- Radiology & Molecular Imaging, Sultan Qaboos University Hospital, Muscat, Oman
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Tan H, Li R, Peng W, Liu H, Gu Y, Shen X. Radiological and clinical features of adult non-puerperal mastitis. Br J Radiol 2013; 86:20120657. [PMID: 23392197 DOI: 10.1259/bjr.20120657] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To describe the radiological and clinical features of adult non-puerperal mastitis and to determine the most accurate method of preventing unnecessary surgical procedures. METHODS Clinical and imaging findings were retrospectively reviewed in 51 females with non-puerperal mastitis, which was confirmed by biopsy/surgical pathology. All 51 patients had pre-operative MRI; 45 patients also had sonograms and 25 also had mammograms, pre-operatively. RESULTS Of the 51 cases with non-puerperal mastitis, 94.1% (48/51) were confirmed as having acute or chronic inflammation, and the other 3 had plasma cell mastitis; areola papillaris inflammation was found in 39.2% (20/51) of the cases. Overall, 6 of the 25 cases that were examined with mammography and 2 of the 45 cases that were examined with sonography appeared normal, but all 51 lesions were positively identified on MRI. Asymmetrical density (12/25) on mammograms and solitary or separated/contiguous, clustered, hypoechoic mass-like lesions (31/45) on ultrasound were the most common signs of non-puerperal mastitis. On enhanced MRI, 90.2% (46/51) of patients showed non-mass-like enhanced lesions. Multiple regional enhancements in the pattern of distribution (32/46) and separated or contiguous, clustered, rim-like enhancements in the pattern of internal enhancement (29/46) were the most common manifestations in non-mass-like enhanced lesions. Of the 51 patients, mastitis Type 1 and Type 2 in the time-signal intensity curve were detected in 47.1% and 51.0% of the patients, respectively. The breast imaging reporting and data system categories with the highest number of patients were Category 0 (9/25) on mammography, Category 4a on sonography (18/45) and Category 4a on MRI (29/51). CONCLUSION The findings from mammography and ultrasound are non-specific; therefore, using MR can be helpful in the diagnosis, especially in the presence of non-mass-like enhancements that are multiple, regional, separated, or contiguous, clustered and rim-like. ADVANCES IN KNOWLEDGE Mastitis is often neglected because of the lack of typical clinical signs and symptoms. This study has assessed and described the clinical features and imaging findings of adult non-puerperal mastitis on mammograms, sonograms and MRI and found that MRI is more specific in the diagnosis of disease.
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Affiliation(s)
- H Tan
- Department of Radiology, Cancer Hospital/Institute & Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Lo G, Dessauvagie B, Sterrett G, Bourke AG. Squamous metaplasia of lactiferous ducts (SMOLD). Clin Radiol 2012; 67:e42-6. [PMID: 22964367 DOI: 10.1016/j.crad.2012.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 07/01/2012] [Accepted: 07/12/2012] [Indexed: 10/27/2022]
Abstract
The aim of this review is to illustrate the mammographic and sonographic appearances of squamous metaplasia of the lactiferous ducts (SMOLD) and to discuss the disease processes of this uncommon breast disease, which shows a strong correlation with smoking. The most common mammographic appearance is of a retro-areolar asymmetrical density. Ultrasonography of the symptomatic breast typically shows a retro-areolar, predominately medial, ill-defined, hypoechoic lesion with either abscess or sinus/fistula formation. Duct dilatation and continuity with lactiferous ducts is commonly seen. Increased vascularity is occasionally seen on colour Doppler ultrasound. Pathology tissue confirmation is always required and this can be by histology of a core biopsy or excision specimen, or fine-needle aspiration (FNA) cytology. Occasionally smears of an associated abundant nipple or sinus discharge may be of value.
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Affiliation(s)
- G Lo
- Department of Radiology, Sir Charles Gairdner Hospital, Nedlands, Australia.
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Boufettal H, Essodegui F, Noun M, Hermas S, Samouh N. Idiopathic granulomatous mastitis: a report of twenty cases. Diagn Interv Imaging 2012; 93:586-96. [PMID: 22677299 DOI: 10.1016/j.diii.2012.04.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Idiopathic granulomatous mastitis is a benign lesion of the mammary gland characterised by the presence of non-infectious inflammatory breast lesions limited to the lobules. OBJECTIVE We report twenty cases of idiopathic granulomatous mastitis (IGM) with a discussion of epidemiology, clinical and diagnostic features, treatment and progress of this pathological entity. MATERIALS AND METHODS A retrospective study of twenty cases compiled from a ten-year period, from 952 pathological anatomy examinations carried out to investigate various breast pathologies. RESULTS The patients had a mean age of 45.5 years. Clinical examinations revealed a tumefaction measuring between 2.5 and 18 cm in diameter. The mean size was 5.5 cm. Mammography showed nodular lesions and sonography demonstrated hypoechoic nodules. On histological examination there was a granulomatous inflammatory infiltrate of epithelioid and giant cells, without caseation necrosis, made up of lymphocytes, plasma cells and neutrophils. Microbiology investigations were negative. Lesion involvement was principally lobulocentric. Surgical excision of the lesions was combined with corticosteroid therapy in twelve cases, with non-steroidal anti-inflammatory drugs in another four and with antibiotic therapy in four cases. The patients made good progress in the short-term. DISCUSSION AND CONCLUSION IGM is a rare entity. It poses a problem of differential diagnosis because it clinically resembles other forms of mastitis. The diagnosis can be made with certainty on histological studies. The treatment is medical alongside surgical excision. The prognosis of this disease remains favourable.
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Affiliation(s)
- Houssine Boufettal
- Department of Obstetrics and Gynaecology C, Ibn Rochd University Hospital, School of Medicine and Pharmacy, Aïn Chok University, Casablanca, Morocco.
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Sakurai K, Fujisaki S, Enomoto K, Amano S, Sugitani M. Evaluation of follow-up strategies for corticosteroid therapy of idiopathic granulomatous mastitis. Surg Today 2011; 41:333-7. [PMID: 21365412 DOI: 10.1007/s00595-009-4292-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Accepted: 11/16/2009] [Indexed: 02/06/2023]
Abstract
PURPOSE Idiopathic granulomatous mastitis (IGM) is a rare inflammatory pseudotumor. No therapeutic modality has been established because of the rareness of this disease. The aim of this study was to investigate the clinical course of IGM treated with corticosteroid, and to evaluate the optimal methods of observation during corticosteroid therapy of IGM. METHODS The retrospective study included eight women who met the required histological criteria of IGM. The clinical data of the presentation, histopathology, and management were analyzed by reviewing the medical records. RESULTS The mean age of the patients was 44.8 years (range, 28-75 years) and all patients complained of a breast mass. Seven of them had pain. All of them underwent a core needle biopsy and were diagnosed as having IGM. Five took prednisolone orally and three received prednisolone plus antibiotics; one patient of the latter group underwent a resection due to severe pain. Seven patients healed without surgery and it took from 4 to 10 months to achieve a cure. The period until confirmation of the disappearance of a mass was the shortest by palpation, followed by contrast magnetic resonance imaging and ultrasonography in that order. CONCLUSION Steroid therapy was effective for the treatment of IGM, which was cured without surgery in seven of eight cases. Ultrasonography was considered an excellent method for evaluating the treatment outcomes.
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Affiliation(s)
- Kenichi Sakurai
- Division of Breast and Endocrine Surgery, Department of Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
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Hwang MJ, Rogers A, Vidya R. Idiopathic granulomatous mastitis: rare but important. BMJ Case Rep 2010; 2010:2010/sep10_1/bcr1020092334. [PMID: 22778243 DOI: 10.1136/bcr.10.2009.2334] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 61-year-old woman attended the breast clinic with unresolving mastitis and an associated mass, following failed treatment with antibiotics. Triple assessment confirmed idiopathic granulomatous mastitis. Unresponsive to further conservative management and steroid therapy, she underwent surgical excision and made uneventful recovery. No evidence of recurrence was detected at 18 months follow-up.
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Affiliation(s)
- M J Hwang
- Department of General Surgery, Stafford Hospital, Kings Norton, Birmingham, UK.
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Erozgen F, Ersoy YE, Akaydin M, Memmi N, Celik AS, Celebi F, Guzey D, Kaplan R. Corticosteroid treatment and timing of surgery in idiopathic granulomatous mastitis confusing with breast carcinoma. Breast Cancer Res Treat 2010; 123:447-52. [PMID: 20625813 DOI: 10.1007/s10549-010-1041-6] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 07/02/2010] [Indexed: 11/26/2022]
Abstract
Idiopathic granulomatous mastitis (IGM) is an uncommon chronic inflammatory lesion of the breast with an uncertain optimal treatment regimen, the physical examination, and radiologic features of which may be confused with breast carcinoma. In this study, we aimed to describe the clinicopathologic characteristics of 33 patients who admitted to our breast policlinic and took the diagnosis of granulomatous (idiopathic and non-idiopathic) mastitis, and report the place of corticosteroids and the timing of surgery in the treatment of patients with IGM. The clinical features of 33 patients who presented to our breast policlinic with the complaint of breast mass and reached the final diagnosis of GM between March 2005 and October 2009 were reported. The most common symptoms were mass (n: 27) and pain (n: 11). Ultrasonography (USG) and biopsy were performed in all of the patients. Mammography (MMG) was performed in 9, and magnetic resonance imaging (MRI) in 10 patients. The diagnosis of idiopathic lobular granulomatous mastitis (ILGM) was made in 25 patients and tuberculous mastitis (non-idiopathic GM) in the remaining 8 patients. Twenty-four patients received steroid treatment except one who was pregnant. After giving birth, she also received steroids. One of the patients who developed recurrence after 11 months repeated the steroid therapy. Eight patients with tuberculous mastitis were placed on a regimen of antituberculosis therapy for 6 months. In the diagnosis of IGM, physical examination, USG, MMG, and even MRI alone may sometimes not be enough. They should be discussed altogether and the treatment should begin after definitive histopathologic result. Fine needle aspiration biopsy for cytology will result in a high level of diagnostic accuracy, however, core biopsy will reinforce the exact result. Corticosteroid therapy has been shown to be efficacious for IGM, but in the existence of complications such as abscess formation, fistulae, and persistent wound infection, surgical treatment has been the first method of choice.
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Affiliation(s)
- Fazilet Erozgen
- II. General Surgery Department, Vakif Gureba Training and Research Hospital, Istanbul, Turkey
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A case of granulomatous mastitis with erythema nodosum and arthritis. Rheumatol Int 2009; 31:1093-5. [PMID: 20012050 DOI: 10.1007/s00296-009-1273-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 11/29/2009] [Indexed: 02/06/2023]
Abstract
Idiopathic granulomatous mastitis is an inflammatory mass in the breast. Patients typically present with a firm breast mass, often associated with inflammation of the overlying skin. Nipple retraction, peau d'orange-like changes, and axillary adenopathy may be present. We describe a 23-year-old pregnant woman with arthritis, erythema nodosum, and mastitis.
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Abstract
OBJECTIVE Granulomatous lobular mastitis is a rare chronic inflammatory disease that has clinical and radiologic findings similar to those of breast cancer. We performed a retrospective analysis of clinical, imaging, and treatment findings in 54 women diagnosed with granulomatous lobular mastitis between January 2000 and April 2008. CONCLUSION The imaging findings of granulomatous lobular mastitis overlap with those of malignancy. The most common presentation is a focal asymmetric density on mammography and an irregular hypoechoic mass with tubular extensions on ultrasound. Core biopsy is typically diagnostic. Once the diagnosis is established by tissue sampling, corticosteroids are the first line of treatment.
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Vacuum-assisted biopsy and steroid therapy for granulomatous lobular mastitis: Report of three cases. Surg Today 2009; 39:695-9. [DOI: 10.1007/s00595-008-3891-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Accepted: 07/08/2008] [Indexed: 10/20/2022]
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Renz DM, Baltzer PAT, Böttcher J, Thaher F, Gajda M, Camara O, Runnebaum IB, Kaiser WA. Magnetic resonance imaging of inflammatory breast carcinoma and acute mastitis. A comparative study. Eur Radiol 2008; 18:2370-80. [DOI: 10.1007/s00330-008-1029-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Revised: 03/10/2008] [Accepted: 03/30/2008] [Indexed: 10/22/2022]
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Salem A, Bennaceur R, Driss M, Mehiri S, Mrad K, Rajhi H, Hamza R, Ben Romdhane K, Mnif N. Imagerie des mastites granulomateuses idiopathiques. IMAGERIE DE LA FEMME 2008. [DOI: 10.1016/s1776-9817(08)71701-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sabate JM, Clotet M, Torrubia S, Gomez A, Guerrero R, de Las Heras P, Lerma E. Radiologic Evaluation of Breast Disorders Related to Pregnancy and Lactation. Radiographics 2007; 27 Suppl 1:S101-24. [DOI: 10.1148/rg.27si075505] [Citation(s) in RCA: 161] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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