Characteristics and Management of Granulomatous Lobular Mastitis Associated with Antipsychotics-Induced Hyperprolactinemia

Tian, Chunxiang; Han, Wei; Liu, Zeyu; Han, Xiao; Ning, Ping

doi:10.1089/bfm.2021.0341

Cited by 10 publications

(10 citation statements)

References 27 publications

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“…According to reports, HPRL has been proposed to play an important role in GM and is a suspected risk factor for recurrence [5, 14]. A few studies suggest that patients with HPRL may connect with higher GM recurrence rate [14].…”

Section: Discussionmentioning

confidence: 99%

“…Female patients with GM confirmed by pathological examination of core needle biopsy or postoperative specimens were included. The classic pathologic criteria are noncaseous granulomatous inflammatory reaction centered on the lobules, and lymphocytes, plasma cells, epithelioid histiocytes, multinucleated giant cells, and neutrophil infiltration with or without microabscess formation can be found in the granuloma [5]. Patients with periductal mastitis, Zuska's disease, tuberculosis and fungus infection were excluded.…”

Section: Methodsmentioning

confidence: 99%

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Management of Granulomatous Lobular Mastitis and Risk Factors Associated with Recurrence

et al. 2022

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Background Granulomatous lobular mastitis (GM), an inflammatory breast lesion with unknown etiology, is prone to recur. There is no global consensus on the optimal treatment at present. This study was conducted to show our stepby-step systemic procedure and discuss the recurrence risk factors of GM. Methods The medical record database was retrospectively searched for patients with GM treated in our hospital between January 2015 and September 2021. Patients were divided into non-recurrence group (group A) and recurrence group (group B). Demographic and clinical characteristics, treatment and follow-up were collected and analyzed. Results A total of 885 GM patients were included in our study, all of whom received step-by-step systemic management. The mean age was 33.2 ± 5.2 years. There were 760 (85.9%) patients in group A and 125 (14.1%) in group B. Univariate analysis showed that there was no statistically significant difference between the two groups in size of mass, pregnancy, hyperprolactinemia, bacterial cultures, erythema nodosum. Multivariate analysis showed that patients with purulent nipple discharge, skin lesion, bilateral disease and patients who need the combination of surgery and medication to achieve complete remission had higher risk of recurrence. Conclusions We built a step-by-step systemic procedure for GM, and the recurrence rate was 14.1%. Prolactin level and microbiological results are important for the management of GM. Purulent nipple discharge, skin lesion, bilateral disease and patients who need the combination of surgery and medication to achieve complete remission are associated with GM recurrence. Prolonged maintenance therapy may secure a better prognosis.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Management of Granulomatous Lobular Mastitis and Risk Factors Associated with Recurrence

et al. 2022

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“…Recent studies conducted over the last 10 years have emphasized that other factors such as genetic factors, smoking, and alpha-1 antitrypsin deficiency may have a role in the pathogenesis of the disease. It remains unclear whether GLM is caused by a single factor or a combination of factors (5,(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). Autoimmunity is considered the strongest theory in explaining the cause.…”

Section: Etiologymentioning

confidence: 99%

“…Neither report provided a clear explanation regarding a physiopathological mechanism that directly links prolactin levels with GLM. There have been some reports of patients developing GLM while on selective serotonin reuptake inhibitors (SSRIs), which are a known cause of hyperprolactinemia, but there is no clear evidence supporting SSRIs as a significant risk factor for GLM (20)(21)(22)(23).…”

Section: Hyperprolactinemiamentioning

confidence: 99%

An Update on Granulomatous Lobular Mastitis: It is Time to Tell the Untold

İrkörücü¹

2023

Erciyes Med J

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Objective: Granulomatous mastitis is an infrequent, benign, inflammatory disease of the breast that mostly affects young women of reproductive age. The main objective of this review was to clarify the latest terminology and to provide an update on the diagnosis and management. Materials and Methods:A total of 792 granulomatous mastitis-related articles published in the English literature from 1965 to 2022 were reviewed. Results:The management of this benign but daunting condition remains controversial, and there is no worldwide consensus regarding the best systematic treatment protocol. Good judgment is required to ensure optimal diagnosis and treatment. Conclusion:This narrative review deals with the latest developments in the diagnosis, etiopathogenesis, and modern treatment of the disease.

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“…The lymphocytes, plasma cells, epithelioid histiocytes, multinucleated giant cells, and neutrophil infiltration with or without microabscess formation can be found in the granuloma, as described in our previous study. 27 (2) Patients suffered corticosteroid resistance; it is defined as patients with no response in every 4 weeks' evaluation or worsening of disease during corticosteroid treatment or recurrence of disease after completion of corticosteroid treatment in 3 months.…”

Section: Study Design and Settingmentioning

confidence: 99%

Methotrexate and low‐dose corticosteroid: An effective alternate against corticosteroid‐resistant granulomatous lobular mastitis

Tian

Han

Liu

et al. 2022

J of Obstet and Gynaecol

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Aim: Granulomatous lobular mastitis (GM) is an inflammatory breast disease with unknown etiology. Studies showed that some patients could achieve complete remission with corticosteroids and excisional surgery. However, some patients would suffer from corticosteroid resistance. We aim to report our single-center experience with the highest number of corticosteroid-resistant GM patients treated by methotrexate and low-dose corticosteroid. Methods: The medical record database in our center was searched retrospectively for GM patients between January 2015 and January 2022. Patients suffered corticosteroid resistance and received methotrexatecontaining regimen were included in this study. The clinical characteristics, management and outcomes were collected and analyzed.Results: Eighty-one patients with the median follow-up of 18 months (range 5-61 months) were included. The median age was 30 years old (range 21-48 years). The common initial complaints were breast mass, pain, and erythema. The initial treatment of 80 (98.8%) patients was methylprednisolone. Patients were switched to methotrexate and low-dose corticosteroid due to corticosteroid resistance. Complete remission was achieved in 61 (75.3%) patients who received methotrexate and low-dose corticosteroid with or without segmental dissection. Nineteen methotrexate-resistant patients were referred for antimycobacterial treatment with the exception that one patient was lost during follow-up. Thirteen of them achieved complete remission, and the other five gained partial remission and received segmental dissection. None of these methotrexate-resistant patients recured. Conclusion: An approach with methotrexate and low-dose corticosteroid should be considered as an alternative method to corticosteroid-resistant GM patients.

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Characteristics and Management of Granulomatous Lobular Mastitis Associated with Antipsychotics-Induced Hyperprolactinemia

Cited by 10 publications

References 27 publications

Management of Granulomatous Lobular Mastitis and Risk Factors Associated with Recurrence

Management of Granulomatous Lobular Mastitis and Risk Factors Associated with Recurrence

An Update on Granulomatous Lobular Mastitis: It is Time to Tell the Untold

Methotrexate and low‐dose corticosteroid: An effective alternate against corticosteroid‐resistant granulomatous lobular mastitis

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