Differential Diagnosis in Idiopathic Granulomatous Mastitis and Tuberculous Mastitis

Abstract

PurposeIdiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory disease of unknown etiology. The diagnosis of IGM requires that other granulomatous lesions in the breast be excluded. Tuberculous mastitis (TM) is also an uncommon disease that is often difficult to differentiate from IGM. The purpose of this study is to develop a new algorithm for the differential diagnosis and treatment of IGM and TM.MethodsMedical records of 68 patients (58 with IGM and 10 with TM) between July 1999 and February 2009 were retrospectively reviewed.ResultsThe mean age of the patients was 33.5 (IGM) and 40 (TM) years (p=0.018). The median follow-up was 84 months. Of the total 10 patients with TM, 5 patients had a history of pulmonary tuberculosis. The most common symptoms of the diseases were breast lump and pain. However, axillary lymphadenopathy was more seen in TM (50%) compared to IGM (20.6%) (p=0.048). TM showed more cancer-mimicking findings on radiologic study (p=0.028). In IGM, 48 patients (82.7%) underwent surgical wide excision and 21 patients (36.2%) were managed with corticosteroid therapy and antibiotics. All of the TM patients received anti-tuberculosis medications and 9 patients (90%) underwent wide excision. The mean treatment duration was 2.8 months in IGM and 8.4 months in TM. Recurrence developed in 5 patients (8.6%) in IGM and 1 patient (10%) in TM.ConclusionThis study shows different characteristics between IGM and TM. The IGM patients were younger and had more mastalgia symptoms than the TM patients. Axillary lymphadenopathy was seen more often in TM patients. Half of the TM patients had pulmonary tuberculosis or tuberculosis lymphadenitis. Surgical wide excision might be both therapeutic and useful for providing an exact diagnosis.

Radiological and clinical features of adult non-puerperal mastitis

“…Nonpuerperal mastitis is not a single specific histopathological entity but includes a wide spectrum of different disorders [2][3][4][5][6]. The most frequently used classification subtypes are subareolar abscess of the breast, mastitis complicating fibrocystic disease, inflammation of a cyst and plasma cell mastitis [10,20].…”

“…The aetiology of this disease is still unknown, but it may or may not be accompanied by infection [1,2]. Non-puerperal mastitis includes a wide spectrum of different disorders, such as newborn mastitis, thelitis in young females, bacterial infections, non-bacterial infections that generally originate from deeper milk ducts (such as plasma cell mastitis and granulomatous mastitis), as well as inflammatory disorders of the breast skin [2][3][4][5][6]. The majority of patients with non-puerperal mastitis usually exhibit one or several breast masses without any other signs of inflammation.…”

Breast Tuberculosis

“…Nucleic acid amplification tests (NAAT) such as polymerase chain reaction (PCR) are rapid and specific but suffer from low sensitivity especially in AFB smear-negative cases. Sensitivity as low as 50 % have been reported in some series [46]. This low sensitivity is due to the presence of polymerase enzyme inhibitors in approximately 20 % of extrapulmonary specimens.…”

“…A predominantly neutrophilic background and the absence of necrosis favor a diagnosis of IGM. It should be considered when high numbers of epithelioid histiocytes are seen [46].…”

Scope of Breast Imaging in Developing Countries

“…Interestingly, both of these conditions are more common in developing countries than in the western world. 15 Idiopathic granulomatous mastitis is generally seen in young women in their reproductive age who present with firm breast lump, often with inflammation of overlying skin. Sinus formation, invasion of chest wall and axillary lymphadenopathy may also be seen.…”