Medical and Surgical Treatment of Idiopathic Granulomatous Lobular Mastitis: A Benign Inflammatory Disease Mimicking Invasive Carcinoma

Abstract

PurposeIdiopathic granulomatous lobular mastitis (IGLM) is a rare chronic inflammatory disease of the breast with obscure etiology that mimics invasive carcinoma both clinically and radiologically. The treatment of IGLM remains controversial. The aim of proper management is to use a combination of medical and surgical treatment of this benign condition to achieve a good cosmetic result and low recurrence rate.MethodsA retrospective analysis of 19 patients with IGLM is performed based on the findings of clinical, radiological, and pathological examinations. The results of two treatments are presented: medical treatment with oral corticosteroids, and consecutive surgical excision after a follow-up period of 20 months (range, 6-75 months).ResultsThe majority of patients treated in this paper were young (mean, 34 years) parous women with a history of hormonal medication use. The main clinical finding is large, irregular, and painful mass. Hypoechoic lobulated, irregular tubular or oval shaped masses had been imaged by ultrasound. Mammographic findings were an ill-defined mass, enlarged axillary lymph nodes, asymmetric density, and architectural distortion. Diagnoses of IGLM had been established by cytological or histological examination. Symptoms subside and inflammatory changes regressed with medical treatment. The remaining lesions were excised by consecutive breast conserving surgery. The disease recurred in one patient during the follow-up period.ConclusionIGLM is an inflammatory breast disease found in young women who present with a large painful irregular mass, which mimics carcinoma, as a physical change. Breast imaging modalities are not helpful to differentiate IGLM from invasive cancer. The correct diagnosis is established by cytological or histological examination. Medical treatment with corticosteroids provides significant regression of the inflammatory disease, allowing more conservative surgery. Consecutive surgical excision of the remaining lesions with good cosmetic results provides definitive treatment and reduces the risk of recurrence.

Radiological and clinical features of adult non-puerperal mastitis

“…Lesions were mammographically undetectable in 6 of 25 females, possibly because of an overlying dense mammary gland pattern observed in most females. With mammography, two patients in our study showed nipple retraction, and one showed skin thickening in the mammary areola, which is more commonly observed in inflammatory breast carcinoma or invasive carcinoma [7][8][9]. The ultrasound manifestations of non-puerperal mastitis varied.…”

“…The majority of patients with non-puerperal mastitis usually exhibit one or several breast masses without any other signs of inflammation. Because it can be very difficult to distinguish these symptoms from breast carcinoma, these patients can easily be misdiagnosed as having an inflammatory breast carcinoma or an invasive carcinoma [7][8][9].…”

Idiopathic Granulomatous Mastitis- Challenges of Diagnosis and Treatment

“…Many causative agents have been reported to be linked with the condition like -local irritant, oral contraceptive pill, viruses, mycotic and parasitic infections, hyperprolactinemia, diabetes mellitus, smoking, alfa 1 antitrypsin deficiency, autoimmunity have been proposed to explain the etiology of IGM but never proven. [2][3][4][5][6][7] IGM presents most commonly with a unilateral painful, firm, tender, ill defined mass in the breast 7,8 . The lesions may be located in any quadrant of the breast 7 .…”

Bilateral Idiopathic Granulomatous Mastitis: A Case of Noncaseating Granulomas in a Patient With Latent Tuberculosis

“…Extensive scarring and fistula formation can occur, resulting in unsatisfactory cosmetic results [5]. Medical treatment with corticosteroids prior to surgery significantly decreases the inflammation, which allows for more conservative surgery and reduces the risk of recurrence [5,15].…”