La mastite granulomateuse idiopathique

Idiopathic granulomatous mastitis: A challenging case report and comprehensive review of the literature

INTRODUCTION AND IMPORTANCE

Idiopathic granulomatous mastitis is an uncommon, long-lasting inflammatory condition of the female breast. It is characterized by the development of a painful breast mass that gradually increases in size. This condition is benign and its cause is unknown. It primarily affects women of childbearing age who have a history of pregnancy and breastfeeding. The main feature of idiopathic granulomatous mastitis is the presence of chronic inflammation in the breast.

CASE PRESENTATION

We report a 36-year-old woman with a history of pregnancy and breastfeeding presented with pain and swelling of the right breast. Physical examination revealed a mass with redness and retraction of the nipple. Imaging revealed localized density and hypoechoic areas with collection, suggesting granulomatous mastitis. A biopsy confirmed the diagnosis. The abscess was drained through a small incision performed under local anesthesia. Treatment with corticosteroids resulted in significant improvement, with complete resolution after one month.

CLINICAL DISCUSSION

A comprehensive evaluation of potential causes is necessary to confirm the diagnosis of idiopathic granulomatous mastitis. Histologically, it is distinguished by the predominant presence of neutrophils and the absence of caseous necrosis. Treatment remains controversial, with recent literature supporting the efficacy of conservative management with steroid and immunosuppressive therapy, leaving surgical excision for complicated and refractory cases.

CONCLUSIONS

Idiopathic granulomatous mastitis is an uncommon breast condition where the exact causes and recommended treatment approaches are not well-defined. It is important to consider this condition in women who are in their reproductive years.

Granulomatous mastitis: A case report

Idiopathic granulomatous mastitis is a rare chronic benign inflammatory mastopathy occurring mainly in young women. With a non-specific imagery, it is considered as a diagnosis by exclusion and has a challenging treatment. Histologically, it is characterized by the predominance of polynuclear neutrophils and the absence of caseous necrosis. The breast carcinoma is the main differential diagnosis at the clinical stage, and imagery plays an essential role in its diagnostic approach. Its treatment combines antibiotics, anti-inflammatories, corticosteroid therapy, and surgery. We report a 42-year-old woman who presented a breast lesion diagnosis as granulomatous mastitis based on magnetic resonance imaging, ultrasound, and histology examinations. She received a treatment with different drugs (antibiotics, anti-inflammatories). The outcome treatment was successful with a good healing of breast lesions.

Granulomatous mastitis: A case report

Idiopathic granulomatous mastitis is a rare chronic benign inflammatory mastopathy occurring mainly in young women. With a non-specific imagery, it is considered as a diagnosis by exclusion and has a challenging treatment. Histologically, it is characterized by the predominance of polynuclear neutrophils and the absence of caseous necrosis. The breast carcinoma is the main differential diagnosis at the clinical stage, and imagery plays an essential role in its diagnostic approach. Its treatment combines antibiotics, anti-inflammatories, corticosteroid therapy, and surgery. We report a 42-year-old woman who presented a breast lesion diagnosis as granulomatous mastitis based on magnetic resonance imaging, ultrasound, and histology examinations. She received a treatment with different drugs (antibiotics, anti-inflammatories). The outcome treatment was successful with a good healing of breast lesions.

Granulomatous mastitis: A case report

Idiopathic granulomatous mastitis is a rare chronic benign inflammatory mastopathy occurring mainly in young women. With a non-specific imagery, it is considered as a diagnosis by exclusion and has a challenging treatment. Histologically, it is characterized by the predominance of polynuclear neutrophils and the absence of caseous necrosis. The breast carcinoma is the main differential diagnosis at the clinical stage, and imagery plays an essential role in its diagnostic approach. Its treatment combines antibiotics, anti-inflammatories, corticosteroid therapy, and surgery. We report a 42-year-old woman who presented a breast lesion diagnosis as granulomatous mastitis based on magnetic resonance imaging, ultrasound, and histology examinations. She received a treatment with different drugs (antibiotics, anti-inflammatories). The outcome treatment was successful with a good healing of breast lesions.

Granulomatous mastitis: A case report

Idiopathic granulomatous mastitis is a rare chronic benign inflammatory mastopathy occurring mainly in young women. With a non-specific imagery, it is considered as a diagnosis by exclusion and has a challenging treatment. Histologically, it is characterized by the predominance of polynuclear neutrophils and the absence of caseous necrosis. The breast carcinoma is the main differential diagnosis at the clinical stage, and imagery plays an essential role in its diagnostic approach. Its treatment combines antibiotics, anti-inflammatories, corticosteroid therapy, and surgery. We report a 42-year-old woman who presented a breast lesion diagnosis as granulomatous mastitis based on magnetic resonance imaging, ultrasound, and histology examinations. She received a treatment with different drugs (antibiotics, anti-inflammatories). The outcome treatment was successful with a good healing of breast lesions.

Oncoplastic breast surgery to treat recurrent granulomatous abscess: A new approach

Introduction and importance

Granulomatous mastitis is a rare chronic and benign inflammatory breast disease with challenging diagnosis and management. No commonly recognized recommendations are established. Despite of medical and surgical approaches, relapse rate remains high.

Case presentation

A 43-year-old patient with a history of granulomatous mastitis presented recurrent breast abscess associated with skin fistula. She underwent Racquet mammoplasty procedure inspired from oncoplastic techniques. Medical and cosmetic outcomes were satisfactory.

Clinical discussion

Granulomatous mastitis is challenging to diagnose and can be confused with inflammatory breast malignancies. It's associated with high relapse rate. Management of granulomatous mastitis is complex. Its treatment varies from medical management based on steroid therapy and immunosuppressants to surgical approach. In case of recurrent breast abscess, surgical techniques inspired from oncoplastic breast surgery, can be used to improve cosmetic outcome.

Conclusion

Oncoplastic surgical technic may be considered as an efficient procedure to manage recurrent breast granulomatous abscess.

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Granulomatous mastitis is a rare challenging condition.

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Up to now, there isn’t a commonly recommended therapeutic strategy.

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Relapse rate is high with an unsatisfactory cosmetic outcome.

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Oncoplastic surgery may provide cosmetic result with low relapse rate.

[Exploration of breast inflammation excluding pregnancy and breastfeeding: Guidelines]

Breast inflammation, excluding breast-feeding and pregnancy, is a rare breast pathology. We conducted a PubMed database search of all studies focusing on mastitis or breast inflammation exploration. While the most frequent aetiologies are infectious and inflammatory, inflammatory breast cancer can be diagnosed (LE2). Aetiologic diagnostic is difficult due to the absence of any clinical and imaging specific signs (LE3). The presence of mass, suspect lymph nodes or skin thickening in a woman older than 40 years old should orient toward inflammatory breast cancer (LE3). A suspect lesion must lead to perform a biopsy under sonography (grade A). In the absence of evidence for a malignant pathology after initial evaluation, we recommend starting an antibiotic treatment (grade C) with a clinical follow-up at the end of the treatment (grade B). If the symptoms persist, we recommend a new imaging (± MRI) (grade C) and a biopsy (grade C). Benign inflammatory pathologies may require a biopsy to exclude an inflammatory breast cancer and precise the diagnosis. Their specific management and treatment are presented in detail in the following chapters and may involve steroids.

[Granulomatosis with polyangiitis (previously Wegener's granulomatosis) mimicking malingering]

INTRODUCTION

ANCA vasculitis may involve the skin and develop slowly without specific histology, and without autoantibodies.

CASE REPORT

We report a 50-year-old woman who experienced bilateral mastectomy because of ulcero-necrotic, non-specific inflammatory cutaneous lesions of the breasts. First considered by others as a malinger patient, she developed oto-neurological lesions leading to the diagnosis of Wegener's granulomatosis. Five years later, specific antibodies of the disease were present.

CONCLUSION

Cutaneous involvement by ANCA vasculitis can be isolated for a long time. Physicians must have a high degree of suspicion to avoid diagnostic delay of ANCA vasculitis.