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Samsami M, Parsaeian F, Haghbin Toutounchi A, Khoshnoudi H, Tahmasbi H. The impact of cotrimoxazole in idiopathic granulomatous mastitis treatment. Int J Surg Case Rep 2024; 121:109959. [PMID: 38945013 DOI: 10.1016/j.ijscr.2024.109959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/22/2024] [Accepted: 06/25/2024] [Indexed: 07/02/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Idiopathic granulomatous mastitis (IGM) is a benign inflammatory breast disease, commonly presented with a sensitive breast lump and developing scars. Currently, there is no definitive treatment for IGM but Antibiotics, steroids, immunosuppressive drugs or a surgical treatments are the usual options. This case series aimed to evaluate the effectiveness of cotrimoxazole in treatment of IGM as there is no clinical consensus on the best and most widely acknowledged therapeutic management for IGM. CASE PRESENTATION All IGM patients were treated by Cotrimoxazole (800 mg BD for one week), and they were assessed at a month, 3 months, and 6 months after that. The primary outcome was an improvement in presenting complaints and symptoms such as palpable mass, bulging, pain, erythema and hypersensitivity of breast skin, breast discharge and fluctuation. The secondary outcome was the refractory rate within 6 months. Number of 20 patients were included. At the baseline, participants exhibited various symptoms such as bulging, pain and erythema (100 %), breast discharge (80 %), and fluctuation (30 %). After the intervention, there was a significant decrease in the prevalence of symptoms over the study period. The prevalence of bulging and pain, erythema, discharge, and fluctuation symptoms were decreasedto 5 %, 0 %, and 0 %, respectively. The refractory rate of IGM within six months of cotrimoxazole treatment was estimated 30 %. CLINICAL DISCUSSION In this study, the treatment approach did not involve corticosteroids and invasive procedures and the recurrence rate of IGM within the six months was lower than in similar studies that employed steroids alone or any more invasive treatments. Additionally, our study showed a high healing rate with resolution of inflammation, pain, discharge, and fluctuation. These results suggest that cotrimoxazole may be a more favorable option than high-dose corticosteroids and a comparable alternative to low-dose corticosteroids regarding recurrence rates. CONCLUSION Cotrimoxazole may be an effective treatment option for idiopathic granulomatous mastitis. However, further research is needed on different treatment options.
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Affiliation(s)
- Majid Samsami
- Department of General Surgery, Imam Hossein medical and educational center, Shahid Beheshti University of medical sciences, Tehran, Iran.
| | - Fatemeh Parsaeian
- Department of General Surgery, Imam Hossein medical and educational center, Shahid Beheshti University of medical sciences, Tehran, Iran.
| | - Alireza Haghbin Toutounchi
- Department of General Surgery, Imam Hossein medical and educational center, Shahid Beheshti University of medical sciences, Tehran, Iran.
| | - Hojatolah Khoshnoudi
- Department of General Surgery, Imam Hossein medical and educational center, Shahid Beheshti University of medical sciences, Tehran, Iran.
| | - Hamed Tahmasbi
- Department of General Surgery, Imam Hossein medical and educational center, Shahid Beheshti University of medical sciences, Tehran, Iran.
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Azouz E, Aloui H, Omri A, Abouda HS. Unknown Case: Chronic Progressive Breast Mass With Fistula. JOURNAL OF BREAST IMAGING 2024:wbad100. [PMID: 38603521 DOI: 10.1093/jbi/wbad100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Indexed: 04/13/2024]
Affiliation(s)
- Eya Azouz
- Department of Radiology, University of Medicine of Tunis, La Rabta Hospital of Tunis, Tunis, Tunisia
| | - Haithem Aloui
- Maternity and Neonatology Center of Tunis Department C, University of Medicine of Tunis, Tunis, Tunisia
| | - Ahlem Omri
- Department of Radiology, University of Medicine of Tunis, La Rabta Hospital of Tunis, Tunis, Tunisia
| | - Hassine Saber Abouda
- Maternity and Neonatology Center of Tunis Department C, University of Medicine of Tunis, Tunis, Tunisia
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Azzam MI, Alnaimat F, Al-Nazer MW, Awad H, Odeh G, Al-Najar M, Alsayed S, El-Asir L, Addasi R, Melhem JM, Sweiss NJ. Idiopathic granulomatous mastitis: clinical, histopathological, and radiological characteristics and management approaches. Rheumatol Int 2023; 43:1859-1869. [PMID: 37347273 DOI: 10.1007/s00296-023-05375-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/15/2023] [Indexed: 06/23/2023]
Abstract
Idiopathic Granulomatous Mastitis (IGM) is an infrequent, benign breast disease that primarily affects women during their childbearing years and can be mistaken for breast cancer. This study aimed to review the clinical, radiological, and histopathological findings of patients with IGM in addition to management and outcome. Retrospective cross-sectional study of biopsy-confirmed IGM at an academic medical center and a private hospital in Amman, Jordan. Fifty-four patients were included, with a mean age of 37.0 ± 9.04 years, mostly presenting with a breast lump (n = 52, 96.3%) and breast pain (n = 45 patients, 84.9%). Approximately half of the patients (51.9%) were parous, and 50% had breastfed for an average duration of 30.37 ± 22.38 months. Most of the patients had either solitary or multiple abscesses on breast ultrasound. Histopathological analysis (n = 35) showed mostly either moderate inflammation (n = 16, 45.7%) or severe inflammation (n = 14, 40%). Two-thirds of the patients underwent surgical interventions at the time of diagnosis, mostly incision and drainage (n = 16, 29%) or surgical excision (n = 7, 13%), and no mastectomies were performed. The most common medical treatment included a combination of antibiotics, corticosteroids, and methotrexate (n = 21, 38.8%). After follow-up, 31 patients remained in remission, 3 experienced relapses, and 3 had a chronic course. The use of corticosteroids was significantly associated with remission (p = 0.035). The presentation and demographics of IGM patients in Jordan were consistent with the existing literature. Prospective research is needed to explore different treatment options and disease outcomes.
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Affiliation(s)
- Muayad I Azzam
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Fatima Alnaimat
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, University of Jordan, Amman, 11942, Jordan.
| | | | - Heyam Awad
- Department of Pathology, School of Medicine, University of Jordan, Amman, 11942, Jordan
| | - Ghada Odeh
- Department of General Surgery, School of Medicine, University of Jordan, Amman, 11942, Jordan
| | - Mahasen Al-Najar
- Department of Radiology and Nuclear Medicine, School of Medicine, University of Jordan, Amman, 11942, Jordan
| | - Suzan Alsayed
- Department of Rheumatology, Abdali Hospital, Amman, Jordan
| | - Layal El-Asir
- Women's Health and Breast Center, Abdali Hospital, Amman, Jordan
| | - Rami Addasi
- Department of General Surgery, School of Medicine, University of Jordan, Amman, 11942, Jordan
| | - Jamal Masad Melhem
- Department of General Surgery, School of Medicine, University of Jordan, Amman, 11942, Jordan
| | - Nadera J Sweiss
- Division of Rheumatology, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
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Houlihan E, Ryan K, Mannion J, Hennessy G, Dunne B, Connolly E, O'Connell B. Idiopathic granulomatous mastitis: a 5-year retrospective review of cases in a tertiary centre in Dublin, Ireland. J Clin Pathol 2023:jcp-2023-209028. [PMID: 37699697 DOI: 10.1136/jcp-2023-209028] [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: 06/30/2023] [Accepted: 08/28/2023] [Indexed: 09/14/2023]
Abstract
AIMS Idiopathic granulomatous mastitis (IGM) is a rare, benign, inflammatory breast disorder of unknown aetiology usually affecting women of reproductive age. It classically presents as a unilateral painful breast mass. It is frequently mistaken for carcinoma or other inflammatory breast diseases. Diagnostic investigations include clinical examination, appropriate imaging and tissue sampling. A link between IGM and infection with the Corynebacterium species in particular Corynebacterium kroppenstedtii has been described. METHODS A retrospective single-centre cohort study was conducted over a 5-year period (2017-2022); all cases of IGM were identified. RESULTS Forty-one patients were diagnosed with IGM. Breast lump was the most common presenting complaint (n=29). The average age was 45 years. Eighteen patients had samples sent for culture and sensitivity, 11 of which had positive microbiology results indicative of Corynebacterium spp infection.An 82% resolution rate (27 of 33) was recorded in those who received either a short-antibiotic course or none at all. Eight patients reported persistent disease at 3 months, five of which had evidence of Corynebacterium spp. DISCUSSION This 5-year review highlights the impact of IGM in a tertiary centre in Dublin, Ireland. Although no treatment guidelines exist, options include antibiotics, immunomodulators and surgery. Due to risk of fistulae and unfavourable cosmetic outcomes, surgery should be reserved for refractory IGM. We suspect that there may be a subset of patients where prolonged antibiotic therapy should be considered. Defining this subgroup requires further study, but likely includes those with cystic neutrophilic granulomatous mastitis, relapsing disease and in whom Corynebacterium spp is recovered.
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Affiliation(s)
- Elaine Houlihan
- Microbiology Department, St James's Hospital, Dublin, Ireland
| | - Katherine Ryan
- Department of Histopathology, St James's Hospital, Dublin, Ireland
| | - Jennifer Mannion
- Breast/General Surgery Department, St James's Hospital, Dublin, Ireland
| | - Grace Hennessy
- Department of Histopathology, St James's Hospital, Dublin, Ireland
| | - Barbara Dunne
- Department of Histopathology, St James's Hospital, Dublin, Ireland
| | | | - Brian O'Connell
- Microbiology Department, St James's Hospital, Dublin, Ireland
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Esmaeil NK, Salih AM, Pshtiwan LR, Muhialdeen AS, Abdullah AM, Hama JI, Hammood ZD, Kakamad FH, Tahir SH, Abdalla BA, Salih KM, Mohammed SH. Management of Idiopathic Granulomatous Mastitis: A Single Institution Experience. Breast Care (Basel) 2023; 18:231-238. [PMID: 37766742 PMCID: PMC10521250 DOI: 10.1159/000529647] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 02/08/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction There are multiple management modalities for idiopathic granulomatous mastitis, but the treatment of choice is still under debate. This study aims to evaluate the diagnosis and outcomes of different management modalities in patients with idiopathic granulomatous mastitis and to identify the risk factors associated with recurrence. Method This is a single-group cohort study that included those patients who had idiopathic granulomatous mastitis. Ultrasonography was conducted for all of the cases using LOGIQ E9 with an ML6-15 transducer (5-15 MHz). A core needle biopsy was conducted to take samples from the cases for histopathological examination. The patients were put on steroid therapy. Whenever the cases did not respond to the steroid therapy, treatment with a combination of low-dose steroids and methotrexate was started. In the lack of response to conservative treatments, surgical interventions were started. Results Sixty-three cases with a confirmed histopathological diagnosis of granulomatous mastitis were included. The mean age of patients was 35.7 years. The history of more than one childbirth was positive in a large portion of the cases (82.5%). The lesion side was unilateral in 58.7% of the cases. A large proportion of the lesions were classified as BIRADS category 2. The best treatment outcome was yielded by a combination of low-dose steroids and incision and drainage. The factors of age, lesion area (cm2), skin thickening, and white blood cell count enhanced the chance of recurrence. Conclusion Incision and drainage in combination with a low dose of steroids can give an acceptable outcome with a low rate of recurrence.
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Affiliation(s)
- Nawzad Khaleil Esmaeil
- Department of Medical Laboratory Technology, Kalar Technical College, Sulaimani Polytechnic University, Sulaimani, Iraq
| | - Abdulwahid M. Salih
- Smart Health Tower, Sulaimani, Iraq
- Department of Surgery, College of Medicine, University of Sulaimani, Sulaimani, Iraq
| | | | - Aso S. Muhialdeen
- Smart Health Tower, Sulaimani, Iraq
- Kscien Organization, Azadi Mall, Sulaimani, Iraq
| | | | - Jihad Ibrahim Hama
- Department of Scientific Affairs, Research Center, University of Halabja, Halabja, Iraq
| | | | - Fahmi H. Kakamad
- Smart Health Tower, Sulaimani, Iraq
- Department of Surgery, College of Medicine, University of Sulaimani, Sulaimani, Iraq
- Kscien Organization, Azadi Mall, Sulaimani, Iraq
| | - Soran H. Tahir
- Smart Health Tower, Sulaimani, Iraq
- Department of Surgery, College of Medicine, University of Sulaimani, Sulaimani, Iraq
| | - Berun A. Abdalla
- Smart Health Tower, Sulaimani, Iraq
- Kscien Organization, Azadi Mall, Sulaimani, Iraq
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Alhalaseh S, Smith J, Alziadin N, Gandrabur L. Challenging Management of a Breast Mass: Case Report and Literature Review. Cureus 2023; 15:e41855. [PMID: 37583723 PMCID: PMC10423851 DOI: 10.7759/cureus.41855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/13/2023] [Indexed: 08/17/2023] Open
Abstract
Idiopathic granulomatous mastitis (IGM) is a rare benign pathology of inflammation in the breast that commonly affects parous women of reproductive age and men although it is extremely rare. It has an unusual predilection for Hispanic women born outside of the United States, most notably in Mexico. Recently, this entity has been described more. However, the approach to management is still very controversial, and the approaches vary widely, although surgical approaches, including excision or mastectomy, have been less favored recently as a primary approach. Here, we present a case of a young female of reproductive age who presented initially with a suspicious breast lump diagnosed initially in the breast clinic as IGM and was referred to the rheumatology clinic for management with medical therapy.
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Affiliation(s)
- Saleh Alhalaseh
- Internal Medicine, St. Barnabas Hospital Health System, Bronx, USA
| | - Jordan Smith
- Internal Medicine, St. Barnabas Hospital Health System, Bronx, USA
| | - Nmair Alziadin
- Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, USA
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Aljawder AAA, Li JJX, Ng JKM, Chan RCK, Lui PCW, Poon IK, Tsang JYS, Tse GM. Idiopathic granulomatous mastitis and cystic neutrophilic granulomatous mastitis: two sides of the same coin or distinct entities? Pathology 2023; 55:335-341. [PMID: 36503636 DOI: 10.1016/j.pathol.2022.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/10/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022]
Abstract
Idiopathic granulomatous mastitis (IGM) is a benign mimic of breast carcinomas. It is defined histologically by the presence of granulomas and inflammation. The closely related cystic neutrophilic granulomatous mastitis (CNGM) shows lipogranulomas, with a reported association with corynebacteria. A large cohort of IGM was reviewed to compare clinical, microbiological and histological features between non-CNGM IGM and CNGM. Cases of IGM were reviewed for histological parameters including the presence of lipogranulomas and composition of inflammatory cells. Clinical data were obtained through hospital records. The cohort included 79 cases, including 51 non-CNGM IGM and 28 CNGM. Comparing non-CNGM IGM and CNGM, there were no differences in clinical or demographical data, other than a younger age of presentation (36.2 vs 41.5 years, p=0.012) for CNGM. Most IGM resolved within the follow-up period (n=57/64, 89.1%), with similar outcomes regardless of treatment (p>0.05). In CNGM, there were more infiltrates of neutrophils (p=0.001), histiocytes (p=0.047), and multinucleated giant cells (p=0.006), but less lymphocytes (p=0.008). Corynebacteria was cultured in two (25%) cases of CNGM, and one non-CNGM IGM (14.3%). Gram-positive bacilli were identified in two cases of CNGM. 'Early' lipogranulomas were observed closely associated to inflamed ducts in three cases of CNGM. Apart from age, there was no distinct clinical or microbiological feature for CNGM. These findings do not support CNGM as a distinct entity. Rather, CNGM-pattern may represent a continuum of IGM, possibly age-related and attributable to ductal inflammation and cystic changes in the breast parenchyma.
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Affiliation(s)
- Aysha A A Aljawder
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Joshua J X Li
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Joanna K M Ng
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Ronald C K Chan
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | | | - Ivan K Poon
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Julia Y S Tsang
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Gary M Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
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Autoimmune rheumatic diseases associated with granulomatous mastitis. Rheumatol Int 2023; 43:399-407. [PMID: 36418558 DOI: 10.1007/s00296-022-05251-9] [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: 09/13/2022] [Accepted: 11/14/2022] [Indexed: 11/25/2022]
Abstract
Granulomatous mastitis (GM) is a benign, inflammatory condition of the breast that mainly affects women of reproductive age. Although its pathogenesis remains unknown, previous studies revealed an association between autoimmune rheumatic diseases (ARDs) and GM in a subset of patients implicating immune-mediated mechanisms. The aim of this narrative review was to identify and describe the ARDs associated with GM to shed further light on disease pathogenesis. We conducted a comprehensive literature search of patients presenting with GM and coexisting ARDs using electronic databases. An association between GM and various ARDs has been reported, including sarcoidosis, systematic lupus erythematosus, granulomatosis with polyangiitis, psoriasis/psoriatic arthritis, familial Mediterranean fever, ankylosing spondylitis, Sjogren's syndrome, rheumatoid arthritis, and erythema nodosum, with the most common being granulomatous mastitis-erythema nodosum-arthritis syndrome (GMENA), granulomatosis with polyangiitis (Wegener's) and sarcoidosis. In addition, clinical characteristics, diagnostic and therapeutic approaches were recorded. Further research is warranted to better understand the association between GM and ARDs and raise awareness amongst rheumatologists.
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Altıntaş T. The role of lower dose steroid therapy with vitamin D replacement in patients with idiopathic granulomatous mastitis. Turk J Surg 2022; 38:250-254. [PMID: 36846061 PMCID: PMC9948657 DOI: 10.47717/turkjsurg.2022.5576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 06/08/2022] [Indexed: 03/01/2023]
Abstract
Objectives Low-dose steroid therapy has been recommended in idiopathic granulomatous mastitis (IGM) in various studies in the literature, but the therapeutic minimum dose has not been determined yet. Furthermore, vitamin D deficiency, the effect of which is accepted in autoimmune diseases, has not been previously examined in IGM. The aim of our study was to evaluate the efficacy of lower dose steroid theraphy with adjustment of vitamin D replacement doses with measuring serum 25-hydroxyvitamin D levels in patients with idiopathic granulomatous mastitis (IGM). Material and Methods Vitamin D levels were evaluated in 30 IGM patients who applied to our clinic between 2017-2019. Vitamin D replacement was performed in patients with serum 25-hydroxyvitamin D level below 30 ng/mL and prednisolone was given to all patients at a dose of 0.05-0.1 mg/kg/ day. Clinical recovery times of the patients were compared with the literature. Results Vitamin D replacement was given to 22 (73.33%) patients. Recovery time was shorter in patients receiving vitamin D replacement (7.62 ± 2.38; 9.00 ± 3.38; p= 0.680). Average recovery time was 8.00 ± 2.68 weeks. Conclusion Treatment of IGM can be carried out with lower dose steroid therapy, leading to less complications and lower costs. Measuring serum 25-hydroxyvitamin D level and treating it with the appropriate dose may contribute to the healing process.
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Affiliation(s)
- Tansu Altıntaş
- Clinic of General Surgery, İstanbul Health Science University Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Türkiye
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Alper F, Karadeniz E, Güven F, Çankaya BY, Yalcin A, Özden K, Eşdur V, Kaşali K, Akçay MN. Comparison of the Efficacy of Systemic Versus Local Steroid Treatment in Idiopathic Granulomatous Mastitis: A Cohort Study. J Surg Res 2022; 278:86-92. [PMID: 35594619 DOI: 10.1016/j.jss.2022.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 03/01/2022] [Accepted: 04/06/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Steroid therapy is known to be effective against granulomatous mastitis. We aimed to compare the efficacy of local versus systemic steroid administration in patients with idiopathic granulomatous mastitis. MATERIALS AND METHODS This prospective cohort study included 58 patients who had either local (n = 42) or systemic (n = 16) treatment due to granulomatous mastitis between 2015 and 2019. Recurrence rates were determined as per ultrasound and magnetic resonance imaging examinations and the rate of side effects was evaluated as per patient complaints and physical examinations at the end of a 2-year follow-up period. RESULTS Median doses of 140 mg and 3810 mg were administered to the local and systemic group, respectively. Six (14.3%) patients in the local treatment group and 13 (81.3%) in the systemic treatment group had steroid-related side effects. The local treatment group had significantly fewer side effects than the systemic treatment group (P < 0.001). The recurrence rates were similar in both groups (P > 0.05). CONCLUSIONS Local steroid injection was as effective as systemic steroid therapy. Compared to systemic therapy, local steroid administration can be considered as a new therapeutic protocol with a lower dose and side effect rate.
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Affiliation(s)
- Fatih Alper
- Department of Radiology, Ataturk University, Erzurum, Turkey; Clinical Research, Development and Design Application and Research Center, Erzurum, Turkey
| | - Erdem Karadeniz
- Department of General Surgery, Ataturk University, Erzurum, Turkey
| | - Fadime Güven
- Department of Radiology, Ataturk University, Erzurum, Turkey
| | | | - Ahmet Yalcin
- Department of Radiology, Ataturk University, Erzurum, Turkey.
| | - Kemalettin Özden
- Department of Infectious Diseases and Clinical Microbiology, Atatürk University, Erzurum, Turkey
| | - Veysel Eşdur
- Department of Radiology, Ataturk University, Erzurum, Turkey
| | - Kamber Kaşali
- Department of Biostatistics, Atatürk University, Erzurum, Turkey
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Breznik V, Marko PB. A Case of Overlapping Clinical Features of Idiopathic Granulomatous Mastitis, Hidradenitis Suppurativa, and Pyoderma Gangrenosum Successfully Treated with Adalimumab. Case Rep Dermatol 2022; 14:98-106. [PMID: 35702373 PMCID: PMC9149353 DOI: 10.1159/000523801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/12/2022] [Indexed: 11/23/2022] Open
Abstract
A 36-year-old woman with a 6-month history of painful unilateral mammary nodules and abscesses was initially treated by gynecologists under the diagnosis of idiopathic granulomatous mastitis (IGM). IGM is an entity that has not been described in classical dermatological textbooks and is considered a rare inflammatory breast disease assumingly associated with trauma, infection, or autoimmune system manifestations. In this patient, the lesions were refractory to conventional treatment of IGM comprising of surgical incisions, systemic antibiotics, dexamethasone, and methotrexate. At the initial visit to the dermatology department, a working diagnosis of localized hidradenitis suppurativa (HS) of breast was established, and treatment with systemic doxycycline was initiated. After the diagnostic incisional biopsy, the inflamed nodule deteriorated into a painful ulceration, implying a pathergy phenomenon. Histopathological features were consistent with the granulomatous type of pyoderma gangrenosum (PG). Treatment with systemic methylprednisolone and mycophenolate mofetil was unsuccessful. Subsequently, the patient developed nodules in the inguinal and axillary areas, typical for HS. Finally, adalimumab treatment resulted in the complete resolution of all lesions without relapse even after the biologic therapy was discontinued. Although in this case, IGM was not confirmed histopathologically, we noted several etiopathological and therapeutic similarities between IGM, PG, and HS and summarized them in a unique table. Further observations are needed to ascertain the potential associations among the three entities.
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Affiliation(s)
- Vesna Breznik
- Department of Dermatovenerology, University Medical Centre Maribor, Maribor, Slovenia
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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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Radiologic Features of Idiopathic Granulomatous Mastitis and Emphasis on Analysis of Socioeconomic Status: Over 5 Years of Experience. Indian J Surg 2021. [DOI: 10.1007/s12262-021-03138-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Imaging Features of Rare Breast Lesions in Young Women. CURRENT HEALTH SCIENCES JOURNAL 2021; 47:314-321. [PMID: 34765255 PMCID: PMC8551907 DOI: 10.12865/chsj.47.02.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 06/26/2021] [Indexed: 11/18/2022]
Abstract
Rare breast tumors, such as, pseudoangiomatous stromal hyperplasia, granulomatous mastitis, tubular adenoma, myofibroblastoma and xanthogranulomatous mastitis, sarcomas, neuroendocrine tumors can sometimes be misdiagnosed because of the similarities in their imagistic characteristics. The main objective of our report is to emphasize the importance of performing ultrasound-guided breast biopsies of suspect lesions in young patients. We performed an US-guided breast biopsy instead of an excisional biopsy because breast surgery has a huge psychological impact. We selected 3 atypical breast tumors in young women, with different clinical signs and symptoms, some of which similar to other breast lesions, but with rapid growth, which needed a different and multiple imaging approach.
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Alsaleh N. Assertive clinical practice in managing patients with idiopathic granulomatous mastitis: Review of literature. Ann Med Surg (Lond) 2021; 70:102792. [PMID: 34691410 PMCID: PMC8519765 DOI: 10.1016/j.amsu.2021.102792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/24/2021] [Accepted: 09/02/2021] [Indexed: 12/19/2022] Open
Abstract
Idiopathic granulomatous mastitis (IGM) is a benign persistent inflammatory breast entity characterized histologically by lobulo centric granulomas. Diagnosis may be difficult and involves a strong index of suspicion. There are plentiful studies are published which render the disease more frequently than expected. The strategy for imaging IGM depends on patient age, clinical manifestations, and risk factors. Patients have an excellent prognosis when they are appropriately treated. The management remains contentious, good judgment is required to ensure optimum treatment form and timing.
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Affiliation(s)
- Nuha Alsaleh
- Division of General Surgery, Department of Surgery, College of Medicine and King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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16
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Oncoplastic breast surgery to treat recurrent granulomatous abscess: A new approach. Int J Surg Case Rep 2021; 87:106440. [PMID: 34571347 PMCID: PMC8479639 DOI: 10.1016/j.ijscr.2021.106440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 11/29/2022] Open
Abstract
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. Granulomatous mastitis is a rare challenging condition. Up to now, there isn’t a commonly recommended therapeutic strategy. Relapse rate is high with an unsatisfactory cosmetic outcome. Oncoplastic surgery may provide cosmetic result with low relapse rate.
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Invited Discussion on: Management of Granulomatous Mastitis Following Aesthetic Breast Surgery. Aesthetic Plast Surg 2021; 45:882-883. [PMID: 33051720 DOI: 10.1007/s00266-020-01996-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 09/26/2020] [Indexed: 10/23/2022]
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Zhang X, Li J, Hu XJ. Postoperative Yanghe decoction regimen improves outcomes for idiopathic granulomatous mastitis: A retrospective cohort study. Medicine (Baltimore) 2020; 99:e23136. [PMID: 33157994 PMCID: PMC7647528 DOI: 10.1097/md.0000000000023136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The etiology of idiopathic granulomatous mastitis (IGM), a rare inflammatory breast disease, is not understood. There is no consensus regarding the treatment of IGM. The purpose of this study was to determine the efficacy of surgery combined with traditional Chinese medicine for the treatment of IGM.We retrospectively analyzed 53 patients of IGM who were treated with surgical excision at our hospital. Group A (n = 25) included patients treated with only surgery, and Group B included patients treated with surgery combined with postoperative Yanghe decoction. The clinical data were compared between the 2 groups, including demographics, clinical characteristics, and outcomes.All patients were female with a mean age of 34.6 ± 5.9 years. There were no significant differences between the groups regarding preoperative demographics or clinical characteristics. The follow-up time was comparable between the groups (13.2 ± 10.0 vs 12.0 ± 10.2 months). Patients in Group B had shorter complete remission (CR) times than patients in Group A (76.1 ± 15.2 vs 84.0 ± 12.2 days; P < .05). The CR rate was higher in Group B than in Group A (96.4% vs 76.0%; P < .05), and the recurrence rate was lower in Group B than in Group A (0% vs 16.0%; P < .05).The postoperative Yanghe decoction regimen was associated with more rapid recovery after IGM surgery. Surgical management combined with postoperative oral Yanghe decoction treatment yielded a higher CR rate and lower recurrence rate than surgery alone. The effect of traditional Chinese medicine in IGM treatment requires further study.
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Affiliation(s)
- Xing Zhang
- Department of Thyroid and Breast Surgery
| | - Jing Li
- Department of Traditional Chinese Medicine, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China
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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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20
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Current Recommendations for Breast Imaging of the Pregnant and Lactating Patient. AJR Am J Roentgenol 2020; 216:1462-1475. [PMID: 32755376 DOI: 10.2214/ajr.20.23905] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
During pregnancy and lactation, the breast undergoes unique changes that manifest as varied clinical and imaging findings. Understanding the expected physiologic changes of the breast as well as recognizing the best imaging modalities for a given clinical scenario can help the radiologist identify the abnormalities arising during this time. Discussion with the patient about the safety of breast imaging can reassure patients and improve management. This article reviews the physiologic changes of the breast during pregnancy and lactation; the safety and utility of various imaging modalities; upto-date consensus on screening guidelines; recommendations for diagnostic evaluation of breast pain, palpable abnormalities, and nipple discharge; and recommendations regarding advanced modalities such as breast MRI. In addition, the commonly encountered benign and malignant entities affecting these patients are discussed.
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Montazer M, Dadashzadeh M, Moosavi Toomatari SE. Comparison of the Outcome of Low Dose and High-Dose Corticosteroid in the Treatment of Idiopathic Granulomatous Mastitis. Asian Pac J Cancer Prev 2020; 21:993-996. [PMID: 32334460 PMCID: PMC7445984 DOI: 10.31557/apjcp.2020.21.4.993] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory breast condition with unknown etiology. Different treatments including corticosteroids have been recommended with no universal consensus. In this study we evaluated the efficacy of low dose vs. high dose prednisolone in treatment of IGM. METHODS In this randomized clinical trial, 30 female patients with IGM were randomly allocated to receive low dose or high dose prednisolone. First group received 5 mg daily prednisolone, while the second group received 50 mg for three days, 25 mg for the next three days and then 12.5 mg for further three days and 5 mg daily afterwards, both for two months. Patients were evaluated 2, 3, 6 and 12 months after treatment. The success and recurrence rate was compared between groups. RESULTS High dose group had significantly higher rate of remission compared to low dose group (93.3% vs. 53.3%, p=0.03). One patient in high dose group and 5 patients in low dose group underwent lumpectomy due to persistent symptoms. Two other patients in low dose group received high dose treatment after three months due to no change in symptoms. Among patients with remission, recurrence was also significantly lower in high dose compared to low dose prednisolone (0% vs. 37.5%, p=0.04). CONCLUSION High dose prednisolone has high success rate with lower recurrence in the treatment of IGM and could reduce the need for surgery. However, further studies are necessary to confirm these findings.
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Affiliation(s)
- Majid Montazer
- Department of General Surgery, Imam Reza Hospital, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Dadashzadeh
- Department of General Surgery, Imam Reza Hospital, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Ehsan Moosavi Toomatari
- Department of General Surgery, Imam Reza Hospital, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Maione C, Palumbo VD, Maffongelli A, Damiano G, Buscemi S, Spinelli G, Fazzotta S, Gulotta E, Buscemi G, Lo Monte AI. Diagnostic techniques and multidisciplinary approach in idiopathic granulomatous mastitis: a revision of the literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:11-15. [PMID: 30889150 PMCID: PMC6502167 DOI: 10.23750/abm.v90i1.6607] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 04/10/2018] [Indexed: 12/23/2022]
Abstract
Idiopathic granulomatous mastitis (IGM) is a chronic benign inflammatory disease of the breast that may mimic breast cancer. It is most common in parous young fertile women, although it can occur in nulliparous women and in men. IGM is an idiopathic disease due to the influence of some environmental factors in genetically predisposed subjects. Several pathogenic hypothesis have been proposed in the last years (autoimmune, hormonal, infective genesis). IGM presents as a painful palpable mass located in one of the two udders. The skin is usually normal but could present signs of inflammation with or without lymph nodes involvement. Ultrasonography, mammography, magnetic resonance can be diagnosed an IGM, but pathognomonic radiological signs has not yet reported in literature. Biopsy findings show granulomatous lesion centered on the breast lobule, as in granulomatous mastitis induced by tuberculosis or sarcoidosis. The aim of this review of literature is to verify the development of new advanced diagnostic techniques and multidisciplinary approach for this condition. In the last years innovative approaches have modified IGM diagnosis and therapy, avoiding surgery in most of cases, introducing a more conservative medical approach based on recent etiopathological hypothesis. (www.actabiomedica.it)
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Chirappapha P, Thaweepworadej P, Supsamutchai C, Biadul N, Lertsithichai P. Idiopathic granulomatous mastitis: A retrospective cohort study between 44 patients with different treatment modalities. Ann Med Surg (Lond) 2018; 36:162-167. [PMID: 30479764 PMCID: PMC6240599 DOI: 10.1016/j.amsu.2018.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/29/2018] [Accepted: 11/01/2018] [Indexed: 12/29/2022] Open
Abstract
Background Idiopathic granulomatous mastitis (IGM) is an uncommon benign chronic inflammatory disease which can clinically and radiographically mimic abscess or breast cancer. Definitive diagnosis was made by histopathology and exclusion of an identifying etiology. Optimal treatment has not been yet established. The aim of this study was to report and describe the clinical signs, radiological findings, managements, clinical course, and clinical outcomes after treatment of IGM. Method We retrospectively studied IGM medical records of 44 patients in our institute collected from March 1990 to October 2016. The patient characteristics, clinical presentations, radiological findings, microbiological workups, tissue pathology, treatment modalities, outcomes, and follow-up data were reviewed and analyzed. The success rate, recurrence rate and time-to-healing were compared focusing on the treatment modalities to find the proper treatments for IGM patient. Results Forty-four patients were diagnosed as IGM. The median follow-up time was 20.73 months ranging from 1.26 to 118.8 months while the median time of the diagnosis was 21 days ranging from 2 to 246 days. Due to the follow-up period, only thirty-nine patient data were used for the analysis. In the first setting, 30 patients were treated by surgery, 6 patients were treated by using steroid while other 3 patients were treated by other different treatments. Only 25 from 39 patients (64.10%) were cured by the first modality. The overall median time-to-healing was 84 days while the medians of time-to-healing treated by surgery, steroid and the rest were 75, 114.5, and 238 days respectively. The surgical treatment had the shortest time-to-healing but not statistically significant (p = 0.23). Thirteen patients out of twenty-five (52%) had wound complications after performing an excision. Lastly, five patients out of thirty-nine (12.82%) had recurrence. Conclusion IGM is an uncommon benign disease which is hardly distinguished from malignancy. There is not a significant difference among treatment modalities in term of time-to-healing and recurrence of disease. The result shows that surgery is outperformed by the shortest healing time. However, the surgical treatment must be chosen with careful due to high rate of wound complications. Multimodality treatment is recommended as the proper treatments for IGM patient. No difference between each treatment modalities for IGM in term of time-to-healing and recurrence of disease. The success rate by wide local excision alone was 65.22% and had the shortest healing time. But wound complication rate from surgery was quite high (52%) even in the case performing mastectomy. Multimodality treatment is required in one-third of the patients.
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Affiliation(s)
- Prakasit Chirappapha
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Panya Thaweepworadej
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Department of Surgery, Bangkok Metropolitan Administration General Hospital, Bangkok, Thailand
| | - Chairat Supsamutchai
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Namsiri Biadul
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Panuwat Lertsithichai
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Russu MC, Nastasia Ş, Degeratu D, Stănculescu RV. Breast and Cervix Uteri: Rare Locations for Mycobacterium Tuberculosis Infections and Complications-Cases Report and Literature Review. Tuberculosis (Edinb) 2018. [DOI: 10.5772/intechopen.75044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Pluguez-Turull CW, Nanyes JE, Quintero CJ, Alizai H, Mais DD, Kist KA, Dornbluth NC. Idiopathic Granulomatous Mastitis: Manifestations at Multimodality Imaging and Pitfalls. Radiographics 2018. [DOI: 10.1148/rg.2018170095] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Cedric W. Pluguez-Turull
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Jennifer E. Nanyes
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Cristina J. Quintero
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Hamza Alizai
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Daniel D. Mais
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Kenneth A. Kist
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Nella C. Dornbluth
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
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Shin YD, Park SS, Song YJ, Son SM, Choi YJ. Is surgical excision necessary for the treatment of Granulomatous lobular mastitis? BMC WOMENS HEALTH 2017; 17:49. [PMID: 28738795 PMCID: PMC5525244 DOI: 10.1186/s12905-017-0412-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 07/19/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND We aimed to investigate the role of surgical excision in treating granulomatous lobular mastitis. METHODS We performed a retrospective chart review of patients with granulomatous lobular mastitis treated from March 2008 to March 2014. We analyzed clinical features and therapeutic modalities and compared the patient outcomes based on treatment. RESULTS During the study period, a total of 34 patients were diagnosed with granulomatous lobular mastitis and treated. Initial treatments included wide excision (18), oral steroids after incision and drainage (14), and antibiotic therapy (2). The patients receiving only antibiotic therapy showed no improvement after 1 month and wide excision was then performed. Wide excision resulted in nine case of delayed wound healing with fistula. These patients were treated with oral steroids for 1.5-5 months, with subsequent improvement. Overall, 11 out of 20 patients who had underwent wide excision showed improvement without additional treatment. Fourteen patients who had initially received oral steroids for 1 to 6 months (average, 2.8 months) after incision and drainage showed complete remission. During the median follow-up period with 45.5 months (range, 22-98 months), six patients (17.6%) experienced recurrence. Wide excision group experienced recurrence in five (25%) and steroid and drainage group experienced recurrence in one (7.1%). All six recurrences responded to additional steroid therapy for average 3.5 months. Most wide excision group left extensive breast scarring with deformation that was not in steroid and drainage group. CONCLUSIONS Wide excision resulted high recurrence than steroid and drainage group and left extensive scarring. Steroid therapy with or without abscess drainage may be the first choice of treatment for majority cases with granulomatous lobular mastitis.
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Affiliation(s)
- Young Duck Shin
- Department of Anesthesiology, Chungbuk National University Hospital, Chungbuk National University School of Medicine, 410 Sungbong-ro, Heungdeok-gu, Cheongju, 28644, Chungcheongbuk-do, South Korea
| | - Sung Su Park
- Department of Surgery, Chungbuk National University Hospital, Chungbuk National University School of Medicine, 410 Sungbong-ro, Heungdeok-gu, Cheongju, 28644, Chungcheongbuk-do, South Korea
| | - Young Jin Song
- Department of Surgery, Chungbuk National University Hospital, Chungbuk National University School of Medicine, 410 Sungbong-ro, Heungdeok-gu, Cheongju, 28644, Chungcheongbuk-do, South Korea
| | - Seung-Myoung Son
- Department of Pathology, Chungbuk National University Hospital, Chungbuk National University School of Medicine, 410 Sungbong-ro, Heungdeok-gu, Cheongju, Chungcheongbuk-do, 28644, South Korea
| | - Young Jin Choi
- Department of Surgery, Chungbuk National University Hospital, Chungbuk National University School of Medicine, 410 Sungbong-ro, Heungdeok-gu, Cheongju, 28644, Chungcheongbuk-do, South Korea.
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Abstract
The aim of this study was to determine possible risk factors for recurrence development in patients with idiopathic granulomatous mastitis (IGM). Demographic, clinical, radiologic, and histopathologic characteristics of 34 consecutive patients with IGM were retrospectively reviewed. Also, 32 patients who were informed about recurrence status were divided into non-recurrent (n = 27) and recurrent (n = 5) groups. Both groups were compared for demographic and clinical parameters. This study included 34 female patients with IGM aged between 26 and 70 years (median: 38 years). During the follow-up period, no recurrence occurred in 27 patients whereas recurrence developed in 5 patients. No significant difference was found between the groups with respect to age, lesion size, breast-feeding, number of child, marital status, use of oral contraceptive, familial or personal tuberculosis history, PPD test, smoking, lesion side, lesion location on the breast, and treatment choice. The diagnostic tools of the IGM as follows: tru-cut (n = 18); incisional (n = 6); tru-cut + incisional (n = 5); tru-cut + excisional (n = 2); tru-cut + FNAB (n = 1); FNAB + excisional (n = 1) and FNAB (n = 1). Treatment options were as follow: antibiotics + drainage (n = 10); antibiotics + drainage + corticosteroid (n = 9); wait and watch (n = 6); corticosteroid (n = 3); antibiotics + antituberculous (n = 1); antituberculous (n = 1); antibiotics + breast conserving surgery + chemotherapy (n = 1); modified radical mastectomy + chemotherapy + radiotherapy (n = 1); and no available (n = 2). This study shows that no demographic and clinical data contributes to the development of recurrence disease. To give a strong message, this study should be supported by other high volume and prospective studies.
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Idiopathic Granulomatous Mastitis: Do We Really Regard it as a Surgical Disease Anymore? World J Surg 2015; 39:2724-5. [DOI: 10.1007/s00268-015-3185-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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