Granulomatous lobular mastitis: Clinical update and case study

Brennan, Meagan; Morgan, Melissa; Heilat, Ghaith; Kanesalingam, Kavitha

doi:10.31128/ajgp-08-19-5042

Cited by 15 publications

(20 citation statements)

References 10 publications

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“…None of the patients after medical and surgical treatment had recurrence with a median follow-up period of 8–9 months. A total success rate of 76.5% had been achieved in accordance with the literature on MTX [7, 25, 30-33]. Joseph et al [25] reported side effects, such as hair loss and elevated liver function tests, due to MTX administration in 2 patients out of 7.…”

Section: Discussionsupporting

confidence: 76%

Low-Dose Methotrexate Use in Idiopathic Granulomatous Mastitis: An Alternative Treatment Method

Kafadar

Bahadır

Gırgın³

2021

Breast Care

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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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Section: Discussionsupporting

confidence: 76%

Low-Dose Methotrexate Use in Idiopathic Granulomatous Mastitis: An Alternative Treatment Method

Kafadar

Bahadır

Gırgın³

2021

Breast Care

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“…Both surgical and nonsurgical (antibiotic therapy, oral steroids, observation) treatments have been advocated as the first-line treatments of GM [3][4][5][6][7][8]. Because the clinical and imaging features of GM are very similar to those of breast carcinoma, tissue biopsy remains the gold standard to confirm the diagnosis [9].…”

Section: Discussionmentioning

confidence: 99%

“…Many authors suggested that possible etiology of GM include breast infection with microbes, autoimmune disorders and hypeprolactinemia [2]. Uncertain etiology leads to nonoptimal treatment for GM and included watch and wait strategy, antibiotics, steroids and surgery as earliest and most widely used therapy [3][4][5][6][7][8]. In cases when GM is localized in only one part of the breast, local excision is used and radical treatment is recommended only for the most extensive forms, when all breast tissue is involved [2,3,5].…”

Section: Introductionmentioning

confidence: 99%

Idiopathic granulomatous mastitis - new approach in operative treatment

2022

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Introduction. Idiopathic granulomatous mastitis (GM) is described as a very rare, non-lactating, chronic mastitis that occurs primarily in women of childbearing age. Significant clinical problem related to GM is the diagnostic differentiation from breast cancer. Less advanced forms of GM can be successfully treated with limited surgical excisions and radical treatment is recommended only for the most extensive forms. Case report. First examination of the patient, by the surgeon at Oncology Institute of Vojvodina was in December 2018., when initial suspicion of breast cancer was set up. Core needle biopsy was performed and after histopathological (HP) analysis, confirmation of GM was obtained. The patient was initially offered Prednisone and Methotrexate therapy, which she refused and accepted only surgical treatment. Surgical treatment was performed few weeks after needle biopsy and consisted of performing a nipple spearing mastectomy with excision of the orifices of all fistulous ducts and their primary sutures. The HP findings of the operative specimen confirmed the diagnosis of GM. While there were no signs of dieses relapse, patient was suggested secondary reconstruction of the left breast. Twelve months after the primary operation, secondary breast reconstruction was performed with the interposition of a contoured silicone implant into a muscle pocket in a standard manner. Conclusion. Nipple spearing mastectomy with secondary breast reconstruction is aesthetically satisfactory treatment for patients with locally advanced GM.

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“…Since the clinical manifestations and auxiliary examinations of GLM are non-specific, the initial clinician is prone to misdiagnose GLM as other diseases. GLM should be differentiated from other easily misdiagnosed diseases at first, and the most important thing is to differentiate it from inflammatory breast cancer (22). GLM can only be confirmed by histopathology, and core needle aspiration biopsy is the gold standard with a sensitivity of 96% (11).…”

Section: Discussionmentioning

confidence: 99%

A clinical observation of stage I implant breast reconstruction for mass-like granulomatous lobular mastitis

Zhang¹,

Wu²,

Wang³

et al. 2021

Gland Surg

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Background: Granulomatous lobular mastitis (GLM) is a chronic benign inflammatory breast disease, and mainly mass-like granulomatous lobular mastitis (MGLM) clinically. There are few reports on applications of stage I implant breast reconstruction in GLM. This observational study was conducted to evaluate the safety and efficacy of stage I implant breast reconstruction in the treatment of MGLM. Methods: Patients suffering from MGLM who visited at hospital from April 2019 to June 2020 were selected and graded according to the magnetic resonance imaging (MRI) examination. Patients with MGLM were grouped into the prosthesis implantation group and the traditional treatment group according to their preferences. Clinical parameters of the two groups were analyzed before and after surgery, such as postoperative infection, recurrence, and satisfaction with appearance and aesthetics were observed. To evaluate the safety and efficacy of the implant breast reconstruction in MGLM.Results: There were 59 cases of MGLM, 31 cases of grade 3-4 GLM, 11 cases of bilateral metachronous GLM. There were 18 patients in the prosthesis implantation group, including 9 patients with bilateral metachronous GLM, 2 patients with synchronous GLM, and 41 patients in the traditional treatment group. All the patients were followed up with a median of 17.5 months. One patient in the observation group had an infection on the reconstructed side 3 weeks after surgery, and the implant was retained after 2 weeks of conservative treatment such as antibiotics. Two patients in the prosthesis implantation group were not satisfied with size of the reconstructed breast was smaller than the opposite side. In the traditional treatment group, there were 3 cases of postoperative infection or delayed wound healing, and 26 cases of postoperative breast asymmetry.Conclusions: For patients with MGLM, it is safe to select stage I prosthesis implantation after conservative treatment, with exact effect and high patient satisfaction.

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Granulomatous lobular mastitis: Clinical update and case study

Cited by 15 publications

References 10 publications

Low-Dose Methotrexate Use in Idiopathic Granulomatous Mastitis: An Alternative Treatment Method

Low-Dose Methotrexate Use in Idiopathic Granulomatous Mastitis: An Alternative Treatment Method

Idiopathic granulomatous mastitis - new approach in operative treatment

A clinical observation of stage I implant breast reconstruction for mass-like granulomatous lobular mastitis

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