Idiopathic Granulomatous Mastitis: Time to Avoid Unnecessary Mastectomies

Abstract

Idiopathic granulomatous mastitis is a rare disease of the breast. Clinically and radiologically it may mimic breast carcinoma. Awareness of surgeons, pathologists, and radiologists is essential to avoid unnecessary mastectomies. Data regarding 24 patients with histologically confirmed idiopathic granulomatous mastitis treated at our center over 8 years were analyzed. The mean age of patients was 34.3 years. Breast lump was the most common presentation. The right breast was affected in 16 cases. Four patients were pregnant at the time of presentation. Lactation within 6 months of presentation was documented in four patients. Two patients used contraceptives pills. A clinical suspicion of malignancy was present in 17 cases. Mammography was performed in 16 patients and showed focal asymmetrical dense lesions in 9, well-circumscribed opacity in 4, spiculated lesion in 1, and was normal in 2. Fine-needle aspiration was performed in 17 patients, of which 2 were reported as malignant. Wide local excision was the mainstay of treatment. One patient underwent mastectomy upon clinical, mammographic, and repeated cytologic findings consistent with malignancy, and the final histology confirmed idiopathic granulomatous mastitis with no evidence of malignancy. Four patients developed recurrence after a mean follow-up of 31.2 months. A greater awareness of the rare entity of idiopathic granulomatous mastitis is mandatory to avoid unnecessary mastectomies. Clinical, radiologic, and even cytologic findings are sometimes confused with malignancy. To the best of our knowledge, our patient who developed the disease at the age of 11 years is the youngest reported case.

Idiopathic granulomatous mastitis: diagnosis and follow-up with magnetic resonance imaging

“…In some cases, breast abscess, fibroses and fat necrosis can occur. Reactive axillary lymphadenopathy may also be presented, as in our case report 1,5,8,10,11 . Histology is characterized by a non-caseating granulomatous inflammatory response of the breast lobules in the absence of specific underlying causes.…”

“…The MRI can include a parenchymal asymmetry or distortion with different contrast enhancement patterns (diffuse, heterogeneous and ring-shaped enhancement). In our case, the MRI showed a regional enhancement, and because there were other signs in the skin and lymph nodes, an inflammatory process was suggested 1,4,10 . Although radiology findings have a limited value, our report showed that they can be used to monitor the clinical response in a conservative treatment 13 .…”

Idiopathic Granulomatous Mastitis : Diagnostic Strategy and Therapeutic Implications in Omani Patients = إلتهاب الثدي الحبيبي : خطط التشخيص و التطبيقات العلاجية للمرضى العمانيين

“…Mammographic features of IGM are essentially nonspecific, with focal asymmetric density being the most common feature. [7][8][9][10][11] Our study showed that the most common radiological findings observed were dilated ducts with inflammatory changes, with some patients (15%) showing cystic lesions with thick debris. Using mammography, 20% of our patients displayed asymmetric diffuse density of fibroglandular tissue and with ultrasound, 20% of the patients showed hypoechoic ill-defined lesions.…”

Granulomatous Mastitis Concurrence with Breast Cancer

“…Clinically and radiologically, it mimics carcinoma of the breast. The most common complaints of patients are unilaterally emerging breast pain or painless masses (2,3). This case highlights the possibility that the concurrence of chronic granulomatous mastitis with breast cancer may be explained just as an adjunct situation or a coincidence and may be the difficulty in distinguishing one from the other.…”