Idiopathic Granulomatous Lobular Mastitis - Report of 43 Cases from Iran; Introducing a Preliminary Clinical Practice Guideline

Abstract

Background: We aimed to report a large series of idiopathic granulomatous lobular mastitis (IGLM) from Iran and sketch preliminary clinical practice guidelines (CPG) for approaching an inflammatory breast mass. Patients and Methods: In a retrospective records review, 43 consecutive IGLM cases were studied. Data on baseline, clinical, imaging, and pathologic characteristics were collected. Results: The mean age of the women was 33.5 years. All but 1 were married and had given birth. 16% had a cancer-like presentation. Inflammatory signs, architectural distortion, and a nodular pattern were the most common findings clinically, mammographically and ultrasonographically, respectively. 29.5% of the pathological reports indicated necrosis which was more common in younger subjects (p = 0.016); microabscesses were associated with a shorter lactation course (p = 0.006). Corticosteroids had been used as the initial treatment modality in 51%, immunosuppressive agents had not been administered, and a 16% relapse rate was recorded. We recognized the need for a multidisciplinary approach covering radiology, oncology, and surgery to best handle diagnostic and therapeutic issues and manage relevant infections as well as the major differential diagnosis, i.e. malignancy. Conclusion: We hypothesized that a shorter lactation period may cause more milk stasis and extravasation and be contributory to IGLM. CPGs are needed to incorporate the needed multidisciplinary approach and to standardize IGLM care. We present one such guideline.

Idiopathic granulomatous mastitis: A systematic review of 3060 patients

“…The characteristic of reviewed articles is summarized in Table (). The total number of articles was 70, 59 in group A and 11 in group B.…”

“…The characteristic of reviewed articles is summarized in Table 1( [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]…”

Scoring Idiopathic Granulomatous Mastitis: An Effective System for Predicting Recurrence?

“…The current approach to IGM treatment consists of short-term antibiotics, followed by histological confirmation with a core needle biopsy. Following pathological confirmation, the decision to proceed with steroid therapy and/or surgical excision is then left to the clinician (8). The decision criteria for steroid treatment, dose of steroid or the duration of steroid treatment are uncertain.…”

“…This correlation might be related to infectious agents, but Asoglu O et al (6) in a separate study, was not able to identify any microbiologic agents with sufficient evidence to be causal for IGM. In our study, patients received oral antibiotics in order to suppress possible infectious mastitis, which might complicate underlying IGM and to treat any possible infectious mastitis before the steroid treatment as is recommended in the study of Omranipour R et al (8).…”

Idiopathic Granulomatous Mastitis: Etiopathogenetic Considerations on a Rare Benign Inflammatory Breast Disease

“…The etiology of IGM remains controversial and several contributing factors, such as use of contraceptive pill, high level of prolactin [2], smoking and alpha-1 antitrypsin deficiency [3], have been emerged in the last decades. Overall, an autoimmune reaction related to presence of milk proteins in the interstitial breast tissues, as consequence of microtrauma secondary to infection, trauma or chemical irritation, seems to be the most accredited hypothesis for explaining the genesis of IGM [4]. This assumption is strongly supported not only by the clinical response to steroid treatment of women with IGM, but also by the immunohistochemical demonstration of T-lymphocyte dominance in biopsy specimens.…”