The enigma of granulomatous mastitis: A series

Abstract

Granulomatous mastitis is a chronic inflammatory breast disease with an enigmatic clinical presentation that can delay diagnosis and perpetuate ineffective treatments. We report our experience with the diagnosis and management of eighteen cases of granulomatous mastitis in the setting of an urban public hospital. The patients were identified after a retrospective review of pathology and surgery databases. Demographic, clinical, radiographic, histopathological data and treatment responses were reviewed. Out of a total of 18 patients, 8 patients were noted to be from Mexico. The mean age at presentation was 35 years and 11 of the 18 patients reported a pregnancy in the last four years. Most cases were unsuccessfully managed as bacterial breast infections initially; definitive treatment involved surgical excision and steroids. A complete symptomatic and radiographic resolution was documented in 8 of the 18 patients. Despite posing a challenge for the unsuspecting physician, an early diagnosis of granulomatous mastitis improves patient outcomes.

Granulomatous lobular mastitis: Clinical update and case study

“…Idiopathic GM was first described in 1971, 1 and has since been described as an 'enigma'. 2 GM is rare, and incidence and prevalence have been difficult to estimate.…”

“…Patients with GM are typically women of childbearing age; a median age of approximately 35 years has been a relatively consistent finding. [2][3][4][5] Hormonal factors are hypothesised to contribute because of the association with parity, current pregnancy and the oral contraceptive pill. GM is rarely seen in nulliparous women, and the majority of patients are within five years of a pregnancy, supporting the theory of a hormonal aetiology.…”

“…In the USA, it is more common in Hispanic and African American women when compared with women of other ethnicities. 2,3 Personal or family history of breast cancer are not risk factors. GM has also been reported in males.…”

Granulomatous Mastitis: A Therapeutic and Diagnostic Challenge

“…The decision at what stage of the disease surgery is performed depends on the individual clinical appraisal of the patient as does the choice of surgical technique which varies from wide excision to mastectomy [17,18,31]. The decision whether surgery or medical treatment is preferred might as well depend on divergent regional resources, the patient's expectations, and surveillance opportunities.…”

“…GM is per definition a sterile inflammatory disease; therefore, antibiotic therapy usually fails [30,31] (table 1). …”