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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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Ong SS, Ho PJ, Liow JJK, Tan QT, Goh SSN, Li J, Hartman M. A meta-analysis of idiopathic granulomatous mastitis treatments for remission and recurrence prevention. Front Med (Lausanne) 2024; 11:1346790. [PMID: 38873201 PMCID: PMC11170159 DOI: 10.3389/fmed.2024.1346790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/10/2024] [Indexed: 06/15/2024] Open
Abstract
Purpose The major aim of our meta-analysis was to review the effectiveness of various treatment modalities for achieving successful remission and preventing recurrence for women with idiopathic granulomatous mastitis (IGM). This knowledge is instrumental in developing evidence-based guidelines for clinicians to improve management strategies and outcomes for patients with IGM. Methods A systematic literature search was performed on MEDLINE (Ovid), Embase (Elsevier), PubMed, Cochrane Library, Web of Science, and Google Scholar; studies published to 19 January 2022 were included. A meta-analysis of 57 observational studies was performed. The results of two randomized controlled trials were also examined. Results There were 3,035 IGM patients across the observational and randomised studies. Overall recurrence and remission rates across all treatment strategies in 59 studies are 87.9% (2,667/3035) and 13.5% (359/2667), respectively. The studies reported 19 different treatment strategies, comprising observation, medical monotherapies, surgery, and combinations involving medical therapies, with and without surgery. Among monotherapy treatment, surgical management had the highest pooled remission rate (0.99 [95% confidence interval (CI) = 0.97-1.00]); among combination therapy, this was steroids and surgery (0.99 [0.94-1.00]). Antibiotic monotherapy had the lowest remission rate (0.72 [0.37-0.96]). The highest recurrence rates belonged to treatments that combined antibiotics and surgery (0.54 [0.02-1.00]), and antibiotics, steroids, and surgery (0.57 [0.00-1.00]). Most successful for preventing recurrence were observation (0.03 [0.00-0.10]), methotrexate (0.08 [0.00-0.24]), and steroids and surgery (0.05 [0.01-0.12]). There is a significant association between longer follow-up duration and recurrence rate reported, p = 0.002. Conclusion Combination therapies, especially those incorporating antibiotics, steroids, and surgery, have demonstrated higher remission rates, challenging the use of antibiotic monotherapy. There is an increased emphasis on the need for personalised, multi-pronged approach for preventing IGM recurrence, with longer follow-up care. More prospective future work in IGM research, with standardised diagnostic criteria, treatment protocols, and reporting guidelines will be important for developing treatment protocols and guidelines clinicians can adhere to in the clinical management of IGM patients.Systematic review registration: PROSPERO (CRD42022301386).
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Affiliation(s)
- Seeu Si Ong
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Peh Joo Ho
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jonathan Jun Kit Liow
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Qing Ting Tan
- KK Breast Department, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Serene Si Ning Goh
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Jingmei Li
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mikael Hartman
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
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Li H, Zhang G, Wang H, Chen H, Liu X, Zheng C, Lin L, Li L. Ultrasound-guided microwave ablation for the treatment of idiopathic granulomatous mastitis: comparison with surgical excision. BMC Womens Health 2024; 24:248. [PMID: 38637788 PMCID: PMC11025156 DOI: 10.1186/s12905-024-03070-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 04/02/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) results in notable clinical symptoms and breast deformity. This study aimed to evaluate the clinical feasibility of microwave ablation (MWA) for the treatment of IGM through comparison with surgical excision. METHODS From June 2016 to December 2020, a total of 234 consecutive patients admitted to the hospital were retrospectively included in this study. IGM was pathologically confirmed via breast biopsy in all included patients. These patients were divided into the MWA group (n = 91) and surgical group (n = 143) based on the type of treatment. Patients in both groups received oral prednisone prior to intervention. The clinical remission rate, recurrence rate, operative pain, complications, and BREAST Q score were compared between the two groups. RESULTS There were 340 lesions in the MWA group, and 201 lesions in the surgical group were ultimately included. Significant differences in the complete remission rate (96.7% vs. 86.7%, p = 0.020), recurrence rate (3.3% vs. 13.3%, p = 0.020), operation time (48.7±14.6 min vs. 68.1±36.4 min, p < 0.001), postoperative pain (p < 0.001) and postoperative BREAST Q score (p < 0.001) were observed between the MWA and surgical groups. CONCLUSIONS Microwave ablation is feasible for the treatment of IGM, due to its high curative rate and low recurrence rate. Because of the minimal invasiveness of MWA and sufficient preservation of the gland and contour of the breast, patients are more satisfied with the appearance of the breast. Therefore, for patients with complex conditions requiring surgery, MWA is a good alternative treatment.
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Affiliation(s)
- Hang Li
- The School of Clinical Medicine, Fujian Medical University, Fujian, 350000, China
- Department of Breast Surgery, Affiliated Hospital of Putian University, Fujian, 351100, China
| | - Guoliang Zhang
- Department of Thyroid Surgery, Affiliated Hospital of Putian University, Fujian, 351100, China
| | - Hongling Wang
- Department of General Surgery, Xiamen Xinkaiyuan Hospital, Fujian, 361000, China
| | - Haiying Chen
- The School of Clinical Medicine, Fujian Medical University, Fujian, 350000, China
| | - Xiaoli Liu
- Department of Pathology, Affiliated Hospital of Putian University, Fujian, 351100, China
| | - Chuansheng Zheng
- The School of Clinical Medicine, Fujian Medical University, Fujian, 350000, China
| | - Lisheng Lin
- Department of Breast Surgery, Affiliated Hospital of Putian University, Fujian, 351100, China
| | - Lihong Li
- The School of Clinical Medicine, Fujian Medical University, Fujian, 350000, China.
- Department of Breast Surgery, Affiliated Hospital of Putian University, Fujian, 351100, China.
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Ammann AM, Pratt CG, Lewis JD, Ahmad SA, Shaughnessy E, Heelan AA. Breast infections: A review of current literature. Am J Surg 2024; 228:78-82. [PMID: 37949727 DOI: 10.1016/j.amjsurg.2023.10.040] [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: 09/15/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023]
Abstract
Breast infections are common, affect women of all ages, and are associated with significant morbidity. Despite overall prevalence, treatment varies significantly based on provider or institution and no central treatment guidelines exist to direct the management of breast infections. This article provides a summary of the current trends in management of breast infections. The etiology, epidemiology, risk factors, presentation, diagnosis, and treatment of mastitis and breast abscesses (and their relative subdivisions) are explored based on the current literature. Trends in microbiology are reviewed and an approach to antibiotic coverage is proposed. Overall, there is a lack of randomized-controlled trials focused on the treatment of breast infections. This has resulted in an absence of clinical practice guidelines for the management of breast abscesses and variable practice patterns. The development of best-care protocols or pathways could provide more uniformity in care of breast infections.
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Affiliation(s)
- Allison M Ammann
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA.
| | - Catherine G Pratt
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA.
| | - Jaime D Lewis
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA.
| | - Syed A Ahmad
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA.
| | - Elizabeth Shaughnessy
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA.
| | - Alicia A Heelan
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA.
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5
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Liu G, McRitchie D, Russell E, Cates EC. Spontaneous, idiopathic granulomatous mastitis in a pregnant patient: A case report and review of the literature. Heliyon 2023; 9:e21619. [PMID: 37942147 PMCID: PMC10628709 DOI: 10.1016/j.heliyon.2023.e21619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/27/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023] Open
Abstract
Idiopathic granulomatous mastitis is a rare breast condition of unclear etiology. Its course is often rapidly progressive, slow to resolve, and can have a high rate of recurrence. Clinical presentation can mimic breast abscess, infectious mastitis, and carcinoma of the breast, generating a diagnostic challenge. Histopathological analysis is required to make the diagnosis after common conditions are excluded. There is no standard treatment, however surgical excision, steroid treatment, and observation are commonly reported approaches. Here, we describe a complex case of a multiparous patient presenting with idiopathic granulomatous mastitis at 32 weeks gestation. In this review, we highlight the importance of collaboration amongst a multidisciplinary team for effective diagnosis and treatment. We discuss the use of oral corticosteroids in the antenatal period and illustrate the patient support required to both facilitate successful breastfeeding in the postpartum period and promote recovery.
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Affiliation(s)
- Grace Liu
- Bachelor of Health Sciences (Honours) Program, McMaster University, Hamilton, Canada
| | - Donna McRitchie
- North York General Hospital, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
| | | | - Elizabeth C. Cates
- Bachelor of Health Sciences (Honours) Program, McMaster University, Hamilton, Canada
- North York General Hospital, Toronto, Canada
- McMaster Midwifery Research Centre, McMaster University, Hamilton, Canada
- Department of Pathology & Molecular Medicine, McMaster University, Hamilton, Canada
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Cabioglu N, Uras C, Mutlu H, Sezgin D, Emiroglu S, Dulgeroglu O, Yilmaz R, Tukenmez M, Arikan AE, Kara H, Muslumanoglu M. Local steroid injection in severe idiopathic granulomatous mastitis as a new first-line treatment modality with promising therapeutic efficacy. Front Med (Lausanne) 2023; 10:1251851. [PMID: 37859855 PMCID: PMC10582626 DOI: 10.3389/fmed.2023.1251851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/04/2023] [Indexed: 10/21/2023] Open
Abstract
Background Intralesional steroid injection has recently evolved as a novel treatment modality for localized idiopathic granulomatous mastitis (= IGM). We aimed to explore the therapeutic efficacy of local steroid injections (LSI) in patients with severe IGM. Methods Fifty-one patients diagnosed with severe IGM were included in the study and treated with either local steroid injection (LSI) alone (n = 25) or combined LSI with systemic oral steroid treatment (OST) (n = 26). The local steroid injection protocol included an intralesional triamcinolone acetonide injection into the palpable granulomas every 4-week, and topical administration of steroid-containing pomades twice a day on the affected surface of the breast. Patients with a combined LSI and OST received low-dose oral methylprednisolone (<16 mg). Results Patients with LSI alone required more LSI applications than those in the combined LSI with OST group (LSI: 5 ± 2.9; vs. LSI/OST: 3.5 ± 2.5; p = 0.080) to obtain an effective optimum therapeutic response. At a median of 12 months (range, 4-42), no difference was found in complete response rates between patients in the LSI group and the combined LSI group with OST (52 vs. 53.9%, p = 0.999). However, steroid-related systemic side effects were lower in the LSI alone group (p < 0.008). Conclusion Local steroid injection could be considered as the first-line treatment in patients with severe IGM until a therapeutic response has been obtained either as the sole treatment modality or combined with oral steroids. Compared with systemic oral steroid therapy, local steroid administration can be considered a new treatment modality with fewer side effects.
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Affiliation(s)
- Neslihan Cabioglu
- Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Cihan Uras
- Department of Surgery, School of Medicine, Acibadem University, Istanbul, Türkiye
| | - Halime Mutlu
- Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Derya Sezgin
- Department of Surgery, School of Medicine, Acibadem University, Istanbul, Türkiye
| | - Selman Emiroglu
- Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Onur Dulgeroglu
- Department of Surgery, School of Medicine, Acibadem University, Istanbul, Türkiye
| | - Ravza Yilmaz
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Mustafa Tukenmez
- Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Akif Enes Arikan
- Department of Surgery, School of Medicine, Acibadem University, Istanbul, Türkiye
| | - Halil Kara
- Department of Surgery, School of Medicine, Acibadem University, Istanbul, Türkiye
| | - Mahmut Muslumanoglu
- Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
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7
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Fattahi AS, Amini G, Sajedi F, Mehrad-Majd H. Factors Affecting Recurrence of Idiopathic Granulomatous Mastitis: A Systematic Review. Breast J 2023; 2023:9947797. [PMID: 37794976 PMCID: PMC10547579 DOI: 10.1155/2023/9947797] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 08/12/2023] [Accepted: 09/03/2023] [Indexed: 10/06/2023]
Abstract
Idiopathic granulomatous mastitis is a rare and benign disease that primarily affects young women of reproductive age. Various factors have been suggested as possible causes, including pregnancy, breastfeeding, history of taking birth control pills, hyperprolactinemia, smoking, and history of trauma. Due to unknown etiology, opinions on its treatment have varied, resulting in differing recurrence rates and side effects. Therefore, conducting a comprehensive systematic review and meta-analysis can aid in understanding the causes and recurrence of the disease, thereby assisting in the selection of effective treatment and improving the quality of life. A systematic literature review was conducted using predefined search terms to identify eligible studies related to risk factors and recurrence up to June 2022 from electronic databases. Data were extracted and subjected to meta-analysis when applicable. A total of 71 studies with 4735 patients were included. The mean age of the patients was 34.98 years, and the average mass size was 4.64 cm. About 3749 of these patients (79.17%) were Caucasian. Patients who mentioned a history of pregnancy were 92.65% with 76.57%, 22.7%, and 19.7% having a history of breastfeeding, taking contraceptive pills, and high prolactin levels, respectively. Around 5.6% of patients had previous trauma. The overall recurrence rate was 17.18%, with recurrence rates for treatments as follows: surgery (22.5%), immunosuppressive treatment (14.7%), combined treatment (14.9%), antibiotic treatment (6.74%), and observation (9.4%). Only antibiotic and expectant treatments had significant differences in recurrence rates compared to other treatments (p value = 0.023). In conclusion, factors such as Caucasian race, pregnancy and breastfeeding history, and use of contraceptive hormone are commonly associated with the disease recurrence. Treatment should be tailored based on symptom severity and patient preference, with surgery or immunosuppressive options for recurrence.
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Affiliation(s)
- Asieh Sadat Fattahi
- Endoscopic and Minimally Invasive Research Center, Department of Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ghasem Amini
- Endoscopic and Minimally Invasive Research Center, Department of Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Sajedi
- Department of Persian Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hassan Mehrad-Majd
- Clinical Research Development Unit, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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8
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Rosen-Carole C, Datta P, Palmiter K, Starks K, Hale TW. Transfer of Injected Triamcinolone into Human Milk of a Lactating Patient Suffering from Idiopathic Granulomatous Mastitis. Breastfeed Med 2023; 18:74-77. [PMID: 36638194 DOI: 10.1089/bfm.2022.0220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background: Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory condition of the mammary gland that presents as a painful mass, and it must be distinguished from both infectious mastitis and breast cancer. When diagnosed during lactation, it can result in significant distress and early weaning. Injection of triamcinolone has been used as a successful treatment method, but safety in breastfed infants has not been established. Methods: We present a case of a lactating patient who received a direct injection of triamcinolone (dosage 40 mg) in her breast to treat IGM after failure of oral corticosteroids. Breastmilk samples were expressed by the patient 0, 1, 4, and 24 hours after the procedure, and then daily for 1 week. All the samples were analyzed using liquid chromatography mass spectrometry. The patient was supported by a breastfeeding and lactation medicine clinic. Results: After injection of triamcinolone into the granulomatous mass, breast milk samples were collected and analyzed. No samples were found to contain triamcinolone. A temporary but significant decrease in milk production was noted after injection, though only a slight decrease had been noted with 6 weeks of systemic corticosteroids. With support, the patient rebuilt milk production and continued to breastfeed from both breasts. Conclusion: Triamcinolone was not found in any milk samples (≥0.78 ng/mL) following therapeutic injection of the affected breast. The patient was able to continue breastfeeding from the affected breast with intermittent symptoms.
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Affiliation(s)
- Casey Rosen-Carole
- Division of Breastfeeding and Lactation Medicine, Departments of Pediatrics and OBGYN, University of Rochester, Rochester, New York, USA
| | - Palika Datta
- Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, Texas, USA
| | - Kathleen Palmiter
- Division of Breastfeeding and Lactation Medicine, Departments of Pediatrics and OBGYN, University of Rochester, Rochester, New York, USA
| | - Kerri Starks
- Division of Breastfeeding and Lactation Medicine, Departments of Pediatrics and OBGYN, University of Rochester, Rochester, New York, USA
| | - Thomas W Hale
- Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, Texas, USA
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9
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Sargent RE, Sener SF. Benign Breast Disease. Surg Clin North Am 2022; 102:1007-1016. [DOI: 10.1016/j.suc.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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10
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Tian C, Wang H, Liu Z, Han X, Ning P. Characteristics and Management of Granulomatous Lobular Mastitis Associated with Antipsychotics-Induced Hyperprolactinemia. Breastfeed Med 2022; 17:599-604. [PMID: 35447036 DOI: 10.1089/bfm.2021.0341] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: Granulomatous lobular mastitis (GM) is a rare inflammatory breast disease. Reports focusing on GM caused by antipsychotic-induced hyperprolactinemia (HPRL) are very rare. Aim: To report a study of GM associated with antipsychotic-induced HPRL and discuss the mechanism and management. Materials and Methods: A retrospective review of patients with GM and psychiatric disorders were carried out. The clinical characteristics, management and outcome were collected and analyzed. The relationship between antipsychotics and GM was evaluated using the Naranjo Adverse Drug Reaction Probability Scale (Naranjo scale). Results: Nineteen female GM patients with psychiatric diseases, aged 21-39 years, who had received antipsychotics for 0.5-10.2 years were included. Most patients took multiple antipsychotics, and 10 (52.6%) took risperidone-containing regimens. Increased prolactin (PRL) was detected in all patients (range 35.15-200 ng/mL). The scores of Naranjo scale were 7-8, indicated the antipsychotics probably induced GM. All patients received systemic therapy, and were prescribed bromocriptine. Seven patients (36.8%) decreased the dose of antipsychotics, six (31.6%) switched antipsychotics, three (15.8%) continued the primary antipsychotics, and three (15.8%) discontinued antipsychotics. In addition, 14 patients (73.7%) received corticosteroid, 4 (21.1%) received antimycobacterials. PRL decreased to normal in 1 month. Seven patients (36.8%) received excisional surgery. After 12 months' follow-up (range 9-56 months), only three patients (15.8%) had a recurrence. Conclusion: Long-term use of antipsychotics may increase PRL levels, and lead to GM. It is vital to assess PRL level and reduce PRL to normal in patients with GM.
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Affiliation(s)
- Chunxiang Tian
- Department of Breast Surgery and Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Han Wang
- Department of Pharmacy, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Zeyu Liu
- Department of Breast Surgery and Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaorong Han
- Department of Breast Surgery and Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Ping Ning
- Department of Breast Surgery and Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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11
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Deng Y, Xiong Y, Ning P, Wang X, Han XR, Tu GF, He PY. A case management model for patients with granulomatous mastitis: a prospective study. BMC Womens Health 2022; 22:143. [PMID: 35501850 PMCID: PMC9063211 DOI: 10.1186/s12905-022-01726-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/20/2022] [Indexed: 02/01/2024] Open
Abstract
Background Granulomatous mastitis (GM) is a chronic inflammatory mastitis disease that requires long-term treatment and has a high recurrence rate. Case management has been proven to be an effective mechanism in assisting patients with chronic illness to receive regular and targeted disease monitoring and health care service. The aim of this study was to investigate the application of a hospital-to-community model of case management for granulomatous mastitis and explore the related factors associated with its recurrence. Methods This was a prospective study on patients with granulomatous mastitis based on a case management model. Data on demographic, clinical and laboratory information, treatment methods, follow-up time, and recurrence were collected and analyzed. The eight-item Morisky Medication Adherence Scale (MMAS-8) was used to investigate patients' adherence to medications. Logistic regression models were built for analysis of risk factors for the recurrence of granulomatous mastitis. Results By October 2021, a total of 152 female patients with a mean age of 32 years had undergone the entire case management process. The mean total course of case management was 24.54 (range 15–45) months. Almost all the patients received medication treatment, except for one pregnant patient who received observation therapy, and approximately 53.9% of the patients received medication and surgery. The overall recurrence rate was 11.2%, and “high” medication adherence (RR = 0.428, 95% CI 0.224–0.867, P = 0.015) was significantly associated with a lower rate of recurrence, while the rate of recurrence with a surgical procedure + medication was higher than that with medication alone (RR = 4.128, 95% CI 1.026–16.610, P = 0.046). Conclusion A case management model for patients with granulomatous mastitis was applied to effectively monitor changes in the disease and to identify factors associated with disease recurrence. “Low” medication adherence was a significant risk factor for the recurrence of granulomatous mastitis. Patients treated with medication and surgery were more likely to experience recurrence than those treated with medication alone. The optimal treatment approach should be planned for granulomatous mastitis patients, and patient medication adherence should be of concern to medical staff.
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Affiliation(s)
- Yuan Deng
- Department of Breast, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Qingyang District, Chengdu, 611731, Sichuan Province, People's Republic of China.,Department of Nursing, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Qingyang District, Chengdu, 611731, Sichuan Province, People's Republic of China
| | - Ying Xiong
- Department of Breast, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Qingyang District, Chengdu, 611731, Sichuan Province, People's Republic of China
| | - Ping Ning
- Department of Breast, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Qingyang District, Chengdu, 611731, Sichuan Province, People's Republic of China.
| | - Xin Wang
- Department of Nursing, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Qingyang District, Chengdu, 611731, Sichuan Province, People's Republic of China.
| | - Xiao-Rong Han
- Department of Breast, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Qingyang District, Chengdu, 611731, Sichuan Province, People's Republic of China
| | - Guo-Fang Tu
- Department of Nursing, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Qingyang District, Chengdu, 611731, Sichuan Province, People's Republic of China
| | - Pei-Yu He
- Department of Breast, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Qingyang District, Chengdu, 611731, Sichuan Province, People's Republic of China
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12
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Ramadan R, Koryem IM, Fayed H. Idiopathic granulomatous mastitis: Risk factors and management. Breast Dis 2022; 41:413-420. [PMID: 36530069 DOI: 10.3233/bd-220047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND IGM has a diagnostic and treatment dilemma. The etiology of IGM is unknown but some conditions have been discussed as predisposing factors including Oral Contraceptive Pills, pregnancy, breast feeding, reproductive age, hyperprolactinemia, infectious and autoimmune diseases. The current study aimed to determine possible risk factors for IGM and to evaluate our experience in its management. PATIENTS AND METHODS The study included forty patients with IGM and forty females with normal breasts as a control group. CST treatment was initiated for all patients; patients who responded completely were followed up without surgical intervention. Failure to respond to medical therapy or incidence of corticosteroid-related complications were considered indications for surgical treatment. All patients were followed up for 6 months to detect recurrence. RESULTS IGM had a significant higher incidence rate in young females within 5 years from the last lactation, smokers, those with hypperprolactinaemia, who had a history of breast feeding and those who received OCP (P = <0.001, <0.001, 0.006, 0.001, 0.023 and 0.027 respectively). The central part of the breast was more affected (9 cases (22.5%)). Multicenteric disease affected 8 cases (20%). Breast Mass was the most common presenting sign. After CST; the mass disappeared in 5 cases (12.5%), mass size reduced in 26 cases (65%) and mass size not affected in 9 cases (22.5%). Surgery was done in whom the mass size was reduced or not affected (35 cases (87.5%)). Disease recurrence was reported in 2 cases (5.7%). CONCLUSION IGM usually affects females in their childbearing period with multiple risk factors mainly parity, smoking, OCP and breast feeding with wide variation regarding the presenting manifestations. We should start with CST as there is always a chance to avoid unnecessary surgery and combination of both modalities can reduce the incidence of recurrence.
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Affiliation(s)
- Rabie Ramadan
- Department of Surgery, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Islam M Koryem
- Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Haytham Fayed
- Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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13
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Dokcu Ş, Başçeken Sİ. Plastic and reconstructive breast surgery techniques in the surgical treatment of idiopathic granulomatous mastitis: a single-center experience. Ann Surg Treat Res 2022; 103:253-263. [DOI: 10.4174/astr.2022.103.5.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/29/2022] [Accepted: 09/01/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Şeref Dokcu
- Department of Surgical Oncology, Health Sciences University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Salim İlksen Başçeken
- Department of Surgical Oncology, Health Sciences University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
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14
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Godazandeh G, Shojaee L, Alizadeh-Navaei R, Hessami A. Corticosteroids in idiopathic granulomatous mastitis: a systematic review and meta-analysis. Surg Today 2021; 51:1897-1905. [PMID: 33590327 DOI: 10.1007/s00595-021-02234-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/16/2020] [Indexed: 02/05/2023]
Abstract
Idiopathic granulomatous mastitis (IGM) is an inflammatory disease of the breasts with an unknown etiology. Corticosteroids are one the primary options for treating this disease, but the results of previous studies concerning their efficacy have been controversial. We, therefore, decided to assess the effectiveness of corticosteroids on IGM using a systematic review and meta-analysis. We conducted a systematic search using MeSH terms and all relevant keywords in PubMed, EMBASE, Cochrane Library and Web of Science until May 21, 2019. Data were analyzed using the Comprehensive Meta-Analysis (CMA) V.2 software program and presented as the event rate, risk ratio (RR) and risk difference (RD). Twelve studies including 559 IGM patients were entered into the meta-analysis. Our analysis showed that the RR and RD of recurrence in the steroid-only group compared with the surgery-only group were 2.99 (95% confidence interval [CI] 0.28-31.33) and 0.14 (95% CI - 0.01-0.30), respectively, showing no statistical significance. The meta-analysis of the steroid-only group and steroid + surgery group showed that the RR of recurrence was 6.13 (95% CI 0.41-81.62) with no significance. However, the meta-analysis of the RD showed that the risk of recurrence in the steroid group was significantly higher than that in the steroids + surgery group (RD: 0.28, 95% CI 0.11-0.44). This meta-analysis showed that managing IGM with only steroids may be less effective than the combination of steroids and surgery. This combination approach may result in a lower rate of recurrence and side effects in these patients.
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Affiliation(s)
- Gholamali Godazandeh
- Department of Surgery, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Leyla Shojaee
- Department of Surgery, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Reza Alizadeh-Navaei
- Gastrointestinal Cancer Research Center, Non-Communicable Disease Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Amirhossein Hessami
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
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15
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16
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Can FK, Güven F, Karadeniz E. Granulomatous Mastitis. Rev Soc Bras Med Trop 2021; 54:e0452. [PMID: 34787268 PMCID: PMC8582968 DOI: 10.1590/0037-8682-0452-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/08/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Fatma Kesmez Can
- Ataturk University, Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, Erzurum, Turkey
| | - Fadime Güven
- Ataturk University, Medical Faculty, Department of Radiology, Erzurum, Turkey
| | - Erdem Karadeniz
- Ataturk University, Medical Faculty, Department of General Surgery, Erzurum, Turkey
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17
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Kafadar MT, Bahadır MV, Girgin S. Low-Dose Methotrexate Use in Idiopathic Granulomatous Mastitis: An Alternative Treatment Method. Breast Care (Basel) 2021; 16:402-407. [PMID: 34602947 DOI: 10.1159/000513879] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/18/2020] [Indexed: 01/20/2023] Open
Abstract
Background Idiopathic granulomatous mastitis (IGM) is a rare, recurrent and progressive breast disease with an unknown etiology. Patients with IGM will probably face stressful, time-consuming treatment procedures with side effects due to medications. There are different treatment modalities in clinical use including medical and surgical interventions. Objective The aim of this study was to present the results of using the combination therapy of low-dose methotrexate (MTX) and steroid in IGM. Methods Seventeen patients diagnosed with IGM and treated with MTX were included into the study. Low-dose MTX at 5 mg/week and 8 mg/day prednisone were given for 2-3 months. Results After 2-3 months of treatment, 10 patients exhibited (58.5%) complete, 3 patients (17.6%) partial recovery, and no response to the treatment process was observed in 4 patients (23.5%). No side effects of MTX and recurrent events were noted in any of the patients. Conclusion Low-dose MTX and prednisone treatment for IGM patients, who did not respond to steroids alone, should be considered as an alternative treatment method instead of surgical intervention.
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Affiliation(s)
- Mehmet Tolga Kafadar
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Mehmet Veysi Bahadır
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Sadullah Girgin
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
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18
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Awomolo AM, Louis-Jacques A, Crowe S. Idiopathic granulomatous mastitis diagnosed during pregnancy associated with successful breastfeeding experience. BMJ Case Rep 2021; 14:e241232. [PMID: 34413030 PMCID: PMC8378369 DOI: 10.1136/bcr-2020-241232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 11/04/2022] Open
Abstract
Idiopathic granulomatous mastitis (IGM) is a rare benign breast condition with a course that is often rapidly progressive and slow to resolve. There is no consensus on management, especially during pregnancy and lactation. A 30-year-old at 33 weeks presented with mastalgia, induration and galactorrhoea in the left breast. There was no improvement with antibiotics. Initial workup was negative, and a core needle biopsy showed findings consistent with the diagnosis of IGM. She was treated with steroids antepartum. She was co-managed by rheumatology and her obstetrician/breastfeeding medicine specialist postpartum. She was treated with azathioprine, breastfed exclusively for 6 months and continued breastfeeding through the first year. A multidisciplinary team approach is crucial in diagnosing, treating, and facilitating successful breastfeeding in patients with IGM.
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Affiliation(s)
- Adeola M Awomolo
- Obstetrics and Gynecology, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Adetola Louis-Jacques
- Obstetrics and Gynecology, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Susan Crowe
- Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
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19
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Bell S, Villasmil R, Lattanzio N, Abdelal Q, King A, Farhangi V. Idiopathic Granulomatous Mastitis Presenting in a Patient With Hypothyroidism and Recent Hospitalization for Myxedema Coma: A Rare Case Report and Review of Literature. J Investig Med High Impact Case Rep 2021; 8:2324709620949325. [PMID: 32779533 PMCID: PMC7425251 DOI: 10.1177/2324709620949325] [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] [Indexed: 11/15/2022] Open
Abstract
Idiopathic granulomatous mastitis (IGM) is a rare, benign inflammatory disorder of the breast. Clinical features may include painful breasts, erythema, subcutaneous nodules, and ulcerative lesions. It can mimic various other breast pathologies, and it is a diagnosis of exclusion after infection, malignancy, and other inflammatory conditions have been ruled out. In this article, we present a case of IGM developing in a 40-year-old female 3 months after hospitalization for myxedema coma. A contrast-enhanced magnetic resonance imaging of the breasts showed bilateral edema, and a biopsy was negative for malignancy or infection. She was started on prednisone and had noticeable improvement of ulcerations within several weeks. IGM is a rare condition that requires a multimodal treatment approach. Often recalcitrant disease is encountered and requires surgical intervention, immunosuppression, and antimicrobial therapy. The diagnosis should be entertained in patients with bilateral breast inflammation to avoid unnecessary surgical resection early on.
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Affiliation(s)
| | | | | | | | - Alan King
- Florida State University, Sarasota, FL, USA
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20
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Smith E, Moore DA, Jordan SG. You'll see it when you know it: granulomatous mastitis. Emerg Radiol 2021; 28:1213-1223. [PMID: 34292441 DOI: 10.1007/s10140-021-01931-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/07/2021] [Indexed: 01/24/2023]
Abstract
Granulomatous mastitis (GM) is an under-recognized and under-diagnosed disease. Patients with GM often present to the emergency room with a painful breast mass, nipple retraction, and skin changes. This pictorial essay will review the clinical presentation and imaging appearance of GM, BI-RADS reporting parameters, differential diagnoses, and diagnostic challenges posed by this disease. Early and accurate diagnosis is essential, as misdiagnosis can result in repeated core biopsies, leading to fistulae and sinus tract formation. A classic history and typical sonographic appearance allow the emergency radiologist to confidently make this diagnosis.
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Affiliation(s)
- Elana Smith
- Department of Radiology, University of Maryland Medical Center, 22 S. Greene St., Baltimore, MD, 21201, USA.
| | - Dan A Moore
- 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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21
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Williams MS, McClintock AH, Bourassa L, Laya MB. Treatment of Granulomatous Mastitis: Is There a Role for Antibiotics? Eur J Breast Health 2021; 17:239-246. [PMID: 34263151 PMCID: PMC8246047 DOI: 10.4274/ejbh.galenos.2021.2021-3-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/01/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To perform a retrospective review of the clinical characteristics, microbiological data, and clinical outcomes in patients with granulomatous mastitis (GM) who were treated at our institution with a unique strategy of prolonged antibiotic therapy as the primary treatment modality. MATERIALS AND METHODS A retrospective case series was performed on patients (n = 42) with GM seen at the breast specialty clinic of our institution between the years 2004 and 2014. Patients were primarily treated with lipophilic antibiotics, and steroids and surgery were reserved for refractory cases. RESULTS Bacteria were identified in 34 samples from 22/42 patients (52.3%). Diphtheroids (presumptive Corynebacterium spp.) were most commonly identified, followed by Corynebacterium spp. and Propionibacterium acnes (now Cutibacterium acnes). Antibiotics were our preferred first-line medical therapy and were used in 33/36 (91.7%) patients. The mean duration of antibiotic therapy was 7.0±4.5 months. Clarithromycin was our antibiotic of choice and was the initial antibiotic used in 15 of the 33 patients (45.5%) treated with antibiotics. Eleven patients required adjunctive therapy with prednisone. The mean duration of steroid therapy was 4.3±2.5 months. Surgery for therapeutic purposes included incision and drainage in seven patients, fine needle aspiration in eight patients, and excision of the fistulous tract in one patient. No patients had large-volume excisions. The average time from the first breast clinic visit to clinical resolution was 8.0±4.6 months. CONCLUSION GM may be the result of a bacterial process that induces a unique form of inflammatory response. Clinicians should consider special requests to microbiology laboratories to attempt to isolate Corynebacterium spp. in the evaluation of samples sent to the laboratory for analysis. An extended course of a lipophilic antibiotic is a largely unexplored but potentially effective treatment option with low associated morbidity. More research is needed in this area.
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Affiliation(s)
- Meagan S. Williams
- Department of Medicine, Division of General Internal Medicine, University of Washington, Washington, USA
| | - Adelaide H. McClintock
- Department of Medicine, Division of General Internal Medicine, University of Washington, Washington, USA
| | - Lori Bourassa
- Department of Laboratory Medicine and Pathology, Division of Clinical Microbiology, University of Washington, Washington, USA
| | - Mary B. Laya
- Department of Medicine, Division of General Internal Medicine, Breast Care Program, University of Washington, Washington, USA
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22
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Dağ A, Edizsoy A, Berkeşoğlu M. Oncoplastic Breast Surgery Techniques When Surgery is Essential for the Management of the Idiopatic Granulomatous Mastitis. J INVEST SURG 2021; 35:653-658. [PMID: 34180771 DOI: 10.1080/08941939.2021.1922552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Immunosuppressive agents are the main treatment options for idiopathic granulomatous mastitis (IGM). However, in some patients, the remaining large pouch and seroma may cause recurrence and severe deformity. Oncoplastic breast surgery (OBS) techniques can be used when surgery is required. MATERIAL AND METHODS In this study, surgical results of the patients histopathologically diagnosed with IGM who underwent any of the OBS techniques between 2016 and 2020 were evaluated. Patient characteristics, surgical indications, and technical details of the surgery were recorded. RESULTS Eighteen patients who underwent wide excision combined with the OBS technique were included in the study. Surgery was performed owning to persistent disease (n = 12), recurrence (n = 3), and patient preference (n = 3). No major complications occurred after the OBS technique. None of the patients had recurrence at the surgical site. CONCLUSIONS When surgery is indicated in patients with IGM, successful results can be obtained with acceptable complication rates by using the simplest and easiest applicable OBS techniques, including volume displacement technique.
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Affiliation(s)
- Ahmet Dağ
- Faculty of Medicine, Clinic of General Surgery, Mersin University, Mersin, Turkey
| | - Akay Edizsoy
- Clinic of Surgical Oncology, Isparta City Hospital, Isparta, Turkey
| | - Mustafa Berkeşoğlu
- Faculty of Medicine, Clinic of General Surgery, Mersin University, Mersin, Turkey
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23
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An Integrative Approach for Idiopathic Granulomatous Mastitis. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02170-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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24
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Serum C-Reactive Protein and Interleukin-6 Levels as Biomarkers for Disease Severity and Clinical Outcomes in Patients with Idiopathic Granulomatous Mastitis. J Clin Med 2021; 10:jcm10102077. [PMID: 34066203 PMCID: PMC8150275 DOI: 10.3390/jcm10102077] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/07/2021] [Accepted: 05/07/2021] [Indexed: 12/12/2022] Open
Abstract
Idiopathic granulomatous mastitis (IGM) is a rare inflammatory breast disease mimicking breast cancer. Limited research has been conducted on the application of serum biomarkers. This study aims to investigate the association of serum biomarkers with disease severity in patients with IGM. From November 2011 to March 2020, medical records of patients with IGM were reviewed. Serum cytokine levels were measured in patients and healthy controls between July 2018 and March 2020. A total of 41 patients with histologically proven IGM were found. Serum interleukin (IL)-6 level was significantly higher in patients with IGM (n = 11) than healthy controls (n = 7). Serum IL-6 and C-reactive protein (CRP) levels were significantly higher in patients with severe disease than mild and moderate disease. Serum IL-6 (Spearman’s ρ = 0.855; p < 0.001) and CRP (Spearman’s ρ = 0.838; p = 0.001) levels were associated with time to resolution. A higher serum CRP level was associated with a longer time to resolution (B = 0.322; p < 0.001) in multiple linear regression analysis. Serum IL-6 and CRP levels can be used as biomarkers for the evaluation of disease severity in IGM. IL-6 may play a crucial role in the immunopathology of IGM.
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25
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Coombe RF, Hamed H. An update on granulomatous mastitis: a rare and complex condition. Br J Hosp Med (Lond) 2021; 82:1-7. [PMID: 34076525 DOI: 10.12968/hmed.2020.0718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Granulomatous mastitis is a rare inflammatory condition of the breast affecting women of child-bearing age. The disease is characterised by chronic and relapsing inflammation, resulting in scarring and discharging sinuses. Granulomatous mastitis is considered to be idiopathic and the pathogenesis is poorly understood. An amplified immune response has been proposed as a likely cause and there is evidence linking Corynebacterium to some cases of granulomatous mastitis. The presentation is similar to bacterial mastitis or abscess and antibiotics are commonly commenced empirically. The cornerstone of diagnosis is histopathological evaluation on core biopsy; an index of suspicion based on demographic assessment can avoid delays in diagnosis. Management is difficult and there is no consensus on best treatment. Various treatment regimens are described, with high relapse rates relating to the nature of the condition. Watchful waiting is appropriate for mild presentations and steroids are the mainstay of treatment for more severe cases. This article reviews the emerging evidence on granulomatous mastitis and describes an updated approach to management.
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Affiliation(s)
- Robyn F Coombe
- Guy's Hospital Breast Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.,School of Medicine, Griffith University, Queensland, Australia
| | - Hisham Hamed
- Guy's Hospital Breast Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.,School of Medicine, Kings College, London, UK
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26
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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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Çetinkaya G, Kozan R, Emral AC, Tezel E. Granulomatous mastitis, watch and wait is a good option. Ir J Med Sci 2020; 190:1117-1122. [PMID: 33078264 DOI: 10.1007/s11845-020-02406-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 10/15/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) is a benign and rare chronic inflammatory disease of the breast with unknown etiology. While there is no consensus regarding its post-diagnosis management, there are different treatment alternatives. AIMS In this study, it was aimed to question the effectiveness of follow-up strategy without administering any treatment. METHODS One hundred eighteen female patients diagnosed with IGM were retrospectively evaluated. Patients with histopathologically confirmed IGM were included in the study. Medical treatment was given only to patients who did not accept the follow-up option without treatment. The protocol used in steroid therapy was 16 mg prednisolone twice daily for 2 weeks, and then the dose was gradually reduced, and the treatment was stopped after 2 months. Patients were followed up with a physical examination every 3 months. The effectiveness of the systemic corticosteroid treatment and the follow-up approach without any treatment was compared. The recurrence rates and pre-treatment and post-treatment methods of the patients were examined. RESULTS While 30.5% of the patients recovered with corticosteroid treatment, 42.4% recovered under observation without any treatment. The mean recovery period of the patients in these two groups was calculated as 3.9 months and 5.6 months, respectively. However, no statistically significant difference was found in terms of recovery period (p = 0.064). The recurrence rate was 11.9%. CONCLUSION For IGM, the "watch and wait" approach is an effective option. A chance should be given to the self-limiting nature of the disease with the addition of drainage when necessary.
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Affiliation(s)
- Gökay Çetinkaya
- Department of General Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ramazan Kozan
- Department of General Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey.
| | - Ahmet Cihangir Emral
- Department of General Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ekmel Tezel
- Department of General Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey
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Dağ A, Edizsoy A. Challenges in management of idiopathic granulomatous mastitis during the pandemic of COVID-19. Breast J 2020; 27:87-88. [PMID: 33073462 DOI: 10.1111/tbj.14092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Ahmet Dağ
- General Surgery, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Akay Edizsoy
- General Surgery, Mersin University Faculty of Medicine, Mersin, Turkey
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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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Shin K, Ruiz-Flores L, Schopp J, Whitman GJ. Granulomatous Mastitis: What Radiologists Should Know With Imaging Examples of Biopsy Proven Cases. Ultrasound Q 2020; 37:34-42. [PMID: 32956245 DOI: 10.1097/ruq.0000000000000534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
ABSTRACT Granulomatous mastitis is a rare benign inflammatory disease of the breast, predominantly affecting women of childbearing age. Because of its low prevalence, the literature is limited, and its treatment algorithm is unclear. However, it is important to understand this disease for timely diagnosis and treatment. Our overview with imaging examples of biopsy-proven cases aims to improve our knowledge and to determine when it would be appropriate to include it in the differential diagnosis.
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Affiliation(s)
- Kyungmin Shin
- Division of Diagnostic Imaging, Department of Breast Imaging, The University of Texas MD Anderson Cancer, Houston
| | - Lorell Ruiz-Flores
- Division of Diagnostic Imaging, Department of Breast Imaging, The University of Texas MD Anderson Cancer, Houston
| | - Jennifer Schopp
- Department of Radiology, Division of Breast Imaging, The University of Texas Southwestern, Dallas, TX
| | - Gary J Whitman
- Division of Diagnostic Imaging, Department of Breast Imaging, The University of Texas MD Anderson Cancer, Houston
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Stachs A, Stubert J, Reimer T, Hartmann S. Benign Breast Disease in Women. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 116:565-574. [PMID: 31554551 DOI: 10.3238/arztebl.2019.0565] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/02/2019] [Accepted: 07/02/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Most clinical breast changes in women are benign; in only 3% to 6% of cases are they due to breast cancer. How- ever, there is a lack of up-to-date, evidence-based treatment recommendations for the various benign differential diagnoses. METHODS Selective literature search of PubMed from 1985 to May 2019, including current national (AWMF, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften [Association of Scientific Medical Societies in Germany]) and inter- national guidelines. RESULTS Mastalgia and fibrocystic changes are common (around 50% of all women over the age of 30). Fibroadenomas occur in 25% of women; they are the most common benign tumors of the breast and do not require treatment. With most benign breast changes the risk of dedifferentiation is very low. However, it is important in the differential diagnosis to distinguish between such benign changes and breast cancer or changes that carry a risk of malignancy. Complex cysts, for example, carry a risk of malig- nancy of 23% to 31%, papillary lesions 16% , and radial scars 7%. Where there is doubt, histological confirmation should be sought by means of percutaneous biopsy. CONCLUSION Benign breast changes can be definitively distinguished from malignant lesions through the selective use of avail- able diagnostic investigations and interdisciplinary collaboration. When lesions of uncertain malignant potential are found (B3 in the biopsy classification), complete excision is indicated. Prospective studies on the early diagnosis of breast cancer in lesions carrying a risk of malignancy are desirable.
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Affiliation(s)
- Angrit Stachs
- Department of Obstetrics and Gynecology, University of Rostock
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Ip KHK, Koch K, Lamont D. Granulomatosis with polyangiitis: a life-threatening cause of granulomatous mastitis. ANZ J Surg 2020; 91:E59-E60. [PMID: 32614984 DOI: 10.1111/ans.16106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Ken Hiu-Kan Ip
- Dermatology Department, Waikato District Health Board, Hamilton, New Zealand
| | - Karen Koch
- Dermatology Department, Waikato District Health Board, Hamilton, New Zealand
| | - Duncan Lamont
- Anatomical Pathology Department, Waikato District Health Board, Hamilton, New Zealand
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Tomita M, Oura S, Nishiguchi H, Makimoto S. A case of bilateral methotrexate-associated diffuse large B-cell lymphomas of the breasts with unique clinical presentation and outcome. Breast Cancer 2020; 27:1038-1043. [PMID: 32361905 DOI: 10.1007/s12282-020-01102-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/22/2020] [Indexed: 11/29/2022]
Abstract
A 54-year-old woman on methotrexate (MTX) treatment developed reddish skin change in her right breast. Mammography and ultrasound showed no masses in the breasts but bilateral mammary glands presented diffuse lower-level echoes. Only 19 days later, the patient developed bilateral breast masses. Histological examination showed that diffuse large B-cell lymphoma cells spread widely and sparsely in the bilateral breasts in addition to the tumor cell conglomerate, leading to the diagnosis of MTX-associated lympho-proliferative disorders (MTX-LPDs). Withdrawal of MTX resulted in complete disappearance of the left MTX-LPD in 2 months but no regression of the right MTX-LPD. Chemotherapy led to a partial response followed by re-growth of the right MTX-LPD. Re-biopsy of the right MTX-LPD revealed double/triple hit lymphoma. Second-line and later-line chemotherapies caused no regression of the right MTX-LPD. The patient died in a year after the diagnosis of MTX-LPDs. Breast oncologists should note the presence, biology, and diagnostic images of MTX-LPD.
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Affiliation(s)
- Masafumi Tomita
- Department of Surgery, Kishiwada Tokushukai Hospital, 4-27-1, Kamori-cho, Kishiwada, Osaka, 596-8522, Japan
| | - Shoji Oura
- Division of Breast Surgery, Kishiwada Tokushukai Hospital, 4-27-1, Kamori-cho, Kishiwada, Osaka, 596-8522, Japan.
| | - Haruka Nishiguchi
- Breast Surgery, Wakaura Chuo Hospital, 6-2-70, Shioya, Wakayama, Wakayama, 641-0055, Japan
| | - Shinichirou Makimoto
- Department of Surgery, Kishiwada Tokushukai Hospital, 4-27-1, Kamori-cho, Kishiwada, Osaka, 596-8522, Japan
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Tsai MJ, Huang WC, Wang JT, Wang MY, Lee YH, Lin SW, Pan SC, Chang SC. Factors associated with treatment duration and recurrence rate of complicated mastitis. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2020; 53:875-881. [PMID: 32327329 DOI: 10.1016/j.jmii.2020.03.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 03/27/2020] [Accepted: 03/29/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The incidence of mastitis has increased, and this disease can lead to long antibiotic courses and complications. Here, we aimed to identify the factors associated with antibiotic duration and recurrence of complicated mastitis. MATERIALS AND METHODS This retrospective cohort study was conducted in a tertiary hospital in Taiwan. All hospitalized patients diagnosed with mastitis (ICD-9 code 611.0) from Jan. 1, 2012, to Dec. 31, 2016, were enrolled. Patient characteristics and clinical data were obtained from the medical charts. Recurrence was defined as mastitis within the first year after the discontinuation of antibiotics for at least 7 days. RESULTS In total, 214 females with a median age of 37 years old (IQR 33-45) were enrolled. A total of 148 patients (69.2%) underwent debridement, and 122 (57.0%) underwent biopsy. Histopathological examinations revealed granulation tissue in 44.6% (62/139) of the patients. Positive cultures were obtained in 65.9% (141/214) of the patients. Coagulase-negative staphylococci (64/141, 45.4%) was the most common pathogen, followed by Corynebacterium species (42/141, 29.8%). The median hospitalization length and antibiotic course were 7 (IQR 4-13) and 37 days (IQR 22-77), respectively. Three patients died of breast cancer during treatment. The recurrence rate was 18.5% (39/211). Younger age, corynebacterial infection, and pregnancy were associated with longer treatment durations (P < 0.001, 0.003, <0.001). Corynebacterial infection was associated with a 2.16-fold (95% CI: 1.11-4.20) increase in recurrence after adjusting for age. CONCLUSION Corynebacterial infection is associated with longer treatment courses and an increased recurrence rate of complicated mastitis. Therefore, specific treatments should be considered.
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Affiliation(s)
- Ming-Jui Tsai
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Chia Huang
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Jann-Tay Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Yang Wang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Hsuan Lee
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Wen Lin
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Sung-Ching Pan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Shan-Chwen Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan
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Zhang X, Li Y, Zhou Y, Liu D, Chen L, Niu K, Sun Q, Huang H. A systematic surgical approach for the treatment of idiopathic granulomatous mastitis: a case series. Gland Surg 2020; 9:261-270. [PMID: 32420250 DOI: 10.21037/gs.2020.02.06] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Surgical resection can be performed for idiopathic granulomatous mastitis (IGM), but recurrence and tissue defects remain issues. Here we report our 6-year experience with a four-pattern surgical approach for IGM that involves the use of a random breast dermo-glandular flap (BDGF). Methods Sixty-eight consecutive patients with IGM were prospectively enrolled from 01/2012 and 03/2017. Based on the extent, shape, and location of the lesions, four different patterns of surgery based on BDGF were used to remove the lesion and repair the defect. Operative data (time, blood loss, and intraoperative complications), primary healing time, recurrence, and patient-reported outcomes (cosmetic outcome, and improvement in dressing change and bathing) at 2 years were evaluated. Results Patients' median age was 35 (range, 22-55) years. Duration of IGM was 3-22 months, with a median lesion size of 3.5 (range, 0.9-9.1) cm. The operative time was significantly longer, and blood loss was more important with the increasing lesion size (both P<0.05). No significant intraoperative complications occurred. All wounds healed by primary intention. IGM relapsed in three patients (3/68, 4.4%); they were treated successfully with a second operation. The self-evaluated cosmetic outcome was "much better" in 45 patients (66.2%), "a little better" in 18 (26.5%), and "same or worse" in five (7.3%). The self-evaluated improvement in dressing change and bathing was "improved a lot" in 51 patients (75.0%), "improved a little" in 11 (16.2%), and "not improved or getting worse" in six (8.8%). Conclusions The BDGF-based systematic four-pattern surgical approach is effective in the treatment of IGM. Recurrence rate is low, there are no complications, and the cosmetic results and improvement in dressing change and bathing are generally favourable.
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Affiliation(s)
- Xiaohui Zhang
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science (CAMS) and Peking Union Medical College, Beijing 100730, China
| | - Yan Li
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science (CAMS) and Peking Union Medical College, Beijing 100730, China
| | - Yidong Zhou
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science (CAMS) and Peking Union Medical College, Beijing 100730, China
| | - Deshun Liu
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science (CAMS) and Peking Union Medical College, Beijing 100730, China
| | - Linlin Chen
- Department of Breast Surgery, Beijing Dangdai Hospital, Beijing 100010, China
| | - Kunying Niu
- Department of Breast Surgery, Beijing Dangdai Hospital, Beijing 100010, China
| | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science (CAMS) and Peking Union Medical College, Beijing 100730, China
| | - Hanyuan Huang
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science (CAMS) and Peking Union Medical College, Beijing 100730, China
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Wang Y, Song J, Tu Y, Chen C, Sun S. Minimally invasive comprehensive treatment for granulomatous lobular mastitis. BMC Surg 2020; 20:34. [PMID: 32087717 PMCID: PMC7035639 DOI: 10.1186/s12893-020-00696-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/11/2020] [Indexed: 12/22/2022] Open
Abstract
Objective To describe a minimally invasive comprehensive treatment for granulomatous lobular mastitis (GLM) and compare its effect with the existing methods, particularly in terms of its recurrence rate and esthetic outcomes. Methods This retrospective study reviewed 69 GLM patients receiving the minimally invasive comprehensive treatment. Patients’ information, including age, clinical features, image characteristics, histopathological findings, mastitis history, treatment process, operative technique, recurrence, and esthetic effect, was evaluated. Results All patients were female with a median age of 32 (range 17–55) years. Hospital stays ranged from 2 to 34 days, with a median of 6 days. The shortest time for complete rehabilitation was 2 days and the longest time was 365 days, with a median of 30 days. After a median follow-up of 391 days (range 162–690), 7 patients (10.14%) relapsed. The average cosmetic score was 2.62 ± 0.57 points and was mainly related to the past treatment, especially the surgical history. Conclusion Minimally invasive comprehensive treatment is a new method for the treatment of GLM, ensuring a therapeutic effect while maintaining breast beauty.
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Affiliation(s)
- Yaohuai Wang
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, No.99 Zhang Road, Wuchang District, Wuhan, 430060, China
| | - Junlong Song
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, No.99 Zhang Road, Wuchang District, Wuhan, 430060, China
| | - Yi Tu
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, No.99 Zhang Road, Wuchang District, Wuhan, 430060, China
| | - Chuang Chen
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, No.99 Zhang Road, Wuchang District, Wuhan, 430060, China
| | - Shengrong Sun
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, No.99 Zhang Road, Wuchang District, Wuhan, 430060, China.
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Hashmi D, Al Samaraee A, Marks B, Fasih T. Idiopathic granulomatous mastitis: a diagnostic dilemma. Br J Hosp Med (Lond) 2020; 81:1-4. [PMID: 32097077 DOI: 10.12968/hmed.2019.0287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Dua Hashmi
- Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Ahmad Al Samaraee
- Department of General Surgery, Gateshead Health NHS Foundation Trust, Gateshead, UK
| | - Bertram Marks
- Department of General Surgery, Gateshead Health NHS Foundation Trust, Gateshead, UK
| | - Tarannum Fasih
- Department of General Surgery, Gateshead Health NHS Foundation Trust, Gateshead, UK
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Vorburger D, Frauchiger-Heuer H, Dedes KJ. [Rare Forms of Mastitis]. PRAXIS 2020; 109:1055-1062. [PMID: 33050811 DOI: 10.1024/1661-8157/a003509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Rare Forms of Mastitis Abstract. Inflammatory breast diseases caused by bacterial infections represent the main cause for mastitis in breastfeeding and non-breastfeeding women. The clinical appearance and a standardized evaluation can indicate rare inflammatory breast diseases. An underlying comorbidity or the evidence of rare pathogens could be suggestive. However, core needle biopsy is the main step in diagnostics. Malignancy, e.g. an inflammatory breast cancer must consistently be excluded. This mini review outlines a few rare inflammatory breast diseases, their initial presentation, and how to diagnose them accurately.
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Altunkeser A, Arslan FZ, Eryılmaz MA. Magnetic resonance imaging findings of idiopathic granulomatous mastitis: can it be an indirect sign of treatment success or fail? BMC Med Imaging 2019; 19:94. [PMID: 31842782 PMCID: PMC6916024 DOI: 10.1186/s12880-019-0397-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 12/03/2019] [Indexed: 02/01/2023] Open
Affiliation(s)
- Ayşegül Altunkeser
- Department of Radiology, University of Health Science, Konya Trainning and Research Hospital, Konya, Turkey
| | - Fatma Zeynep Arslan
- Department of Radiology, University of Health Science, Konya Trainning and Research Hospital, Konya, Turkey.
| | - Mehmet Ali Eryılmaz
- Department of General Surgery, University of Health Science, Konya Trainning and Research Hospital, Konya, Turkey
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40
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Marshall L, Cleaver D, Cleaver L, Cleaver J. Mastitis to mastectomy: a rare, unresponsive postpartum eruption. Int J Dermatol 2019; 59:e92-e95. [PMID: 31498886 DOI: 10.1111/ijd.14640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 07/31/2019] [Accepted: 08/09/2019] [Indexed: 12/01/2022]
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Alrayes A, Almarzooq R, Abdulla HA. Surgical treatment of granulomatous mastitis: Our experience in Bahrain. Breast J 2019; 25:958-962. [DOI: 10.1111/tbj.13378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/08/2019] [Accepted: 02/11/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Amal Alrayes
- Department of Surgery Salmaniya Medical Complex Manama Bahrain
| | - Raed Almarzooq
- Department of Surgery Salmaniya Medical Complex Manama Bahrain
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Haliloglu N, Ustuner E, Ozkavukcu E. Breast Ultrasound during Lactation: Benign and Malignant Lesions. Breast Care (Basel) 2019; 14:30-34. [PMID: 31019440 DOI: 10.1159/000491781] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Structural changes during lactation make breast physical examination difficult. When breast problems occur, patients are often referred for an ultrasound (US) scan. Most breast lesions diagnosed in these patients are benign, but the diagnosis of breast cancer is a challenge. We aim to demonstrate the spectrum of US imaging findings in lactating women. Methods 77 breastfeeding patients who underwent breast US in our department between February 2012 and March 2017 were evaluated. Patients' electronic medical records were reviewed for the presenting complaint, US reports, pathology results if available, and clinical/radiologic follow-up. All examinations were performed by 2 radiologists. Results 28 of the 77 patients had normal US findings. Cysts were seen in 16 patients. 4 patients had stable fibroadenomas. 6 patients had US imaging findings suggestive of mastitis, 5 patients had galactoceles, 1 patient had an abscess, and 1 patient had unilateral hypertrophy without any accompanying lesion. In 13 patients, BI-RADS 3 solid masses were diagnosed. Invasive breast cancer was diagnosed in 3 patients. Conclusion US can demonstrate or exclude a true mass against the background of a nodular breast parenchyma. Radiologists must be aware of malignant US features to avoid delays in the diagnosis of pregnancy-associated breast cancer.
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Affiliation(s)
- Nuray Haliloglu
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Evren Ustuner
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Esra Ozkavukcu
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
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Wolfrum A, Kümmel S, Theuerkauf I, Pelz E, Reinisch M. Granulomatous Mastitis: A Therapeutic and Diagnostic Challenge. Breast Care (Basel) 2018; 13:413-418. [PMID: 30800035 DOI: 10.1159/000495146] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Granulomatous mastitis (GM) is a rare benign inflammatory breast disease that affects mostly women of childbearing age with a history of breastfeeding. The etiopathogenesis is still unknown; however, inflammation as the result of a reaction to trauma, metabolic or hormonal processes, autoimmunity, and an infection with Corynebacterium kroppenstedtii have all been implicated. Clinical findings are pain, mass, hyperemia, and inflammation. Because the clinical presentation can mimic infectious mastitis or inflammatory carcinoma, the disease course is often protracted. The diagnosis is made by histopathology. Biopsies show a granulomatous formation in combination with a localized infiltration of multi-nucleated giant cells, epithelioid histiocytes, and plasma cells. Ultrasound, mammography, and magnetic resonance imaging are not specific; however, ultrasound and mammography should be done to exclude other pathologies. Due to the lack of data including randomized controlled studies, the management of GM is controversial. In Western industrialized countries, most authors use a therapy regimen starting with antibiotics and corticosteroids, followed by continuous steroid therapy and surgery in patients with persisting symptoms. More data are needed to define the best therapy. The role of immunotherapy has not yet been ascertained. The implementation of a registry to collect more information on this rare disease is highly recommended.
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Affiliation(s)
- Angelika Wolfrum
- Breast Unit, Evangelische Huyssens-Stiftung, Kliniken Essen-Mitte, Essen, Germany
| | - Sherko Kümmel
- Breast Unit, Evangelische Huyssens-Stiftung, Kliniken Essen-Mitte, Essen, Germany
| | | | - Enrico Pelz
- Institute for Pathology Viersen, Viersen, Germany
| | - Mattea Reinisch
- Breast Unit, Evangelische Huyssens-Stiftung, Kliniken Essen-Mitte, Essen, Germany
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Irkorucu O. Granulomatous mastitis: We need a useful classification system. Am J Surg 2018; 216:642. [DOI: 10.1016/j.amjsurg.2017.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 08/10/2017] [Indexed: 11/26/2022]
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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: 79] [Impact Index Per Article: 13.2] [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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