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Kayadibi Y, Saracoglu MS, Kurt SA, Deger E, Boy FNS, Ucar N, Icten GE. Differentiation of Malignancy and Idiopathic Granulomatous Mastitis Presenting as Non-mass Lesions on MRI: Radiological, Clinical, Radiomics, and Clinical-Radiomics Models. Acad Radiol 2024:S1076-6332(24)00189-2. [PMID: 38641449 DOI: 10.1016/j.acra.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 04/21/2024]
Abstract
RATIONALE AND OBJECTIVES To investigate the effectiveness of machine learning-based clinical, radiomics, and combined models in differentiating idiopathic granulomatous mastitis (IGM) from malignancy, both presenting as non-mass enhancement (NME) lesions on magnetic resonance imaging (MRI), and to compare these models with radiological evaluation. MATERIAL AND METHODS A total of 178 patients (69 IGM and 109 breast cancer patients) with NME on breast MRI evaluated between March 2018 and April 2022, were included in this two-center study. Age, skin changes, presence of fistula, and abscess were recorded from hospital records. Two experienced radiologists evaluated MRI images according to the breast imaging reporting and data system 2013 lexicon. Lesions were segmented independently on T2-weighted, apparent diffusion coefficient, and post-contrast-T1-weighted sequences. Data were split into training and external testing sets. Machine learning models were built using Light GBM (light gradient-boosting machine). Radiological, clinical, radiomics, and clinical-radiomics models were created and compared. Decision curve analysis was performed. Quality of reporting and that of methodology were evaluated using CLEAR and METRICS tools. RESULTS IGM group was younger (p = 0.014). Abscesses (p < 0.001), fistulas (p < 0.001), and skin changes (p < 0.001) were significantly more common in the IGM group. No significant difference was detected in terms of lesion size (p = 0.213). In the evaluation of NME, the lowest performance belonged to the radiologists' evaluation (AUC for training, 0.740; for testing, 0.737), while the highest AUC was achieved by the model developed by combined clinical and radiomics features (AUC for training, 0.979; for testing, 0.942). CONCLUSION Our study has shown that the machine learning-based clinical-radiomics model might have the potential to accurately discriminate IGM and malignant lesions in evaluating NME areas.
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Affiliation(s)
- Yasemin Kayadibi
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Radiology, Kocamustafapasa, Istanbul, Türkiye.
| | - Mehmet Sakıpcan Saracoglu
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Radiology, Kocamustafapasa, Istanbul, Türkiye
| | - Seda Aladag Kurt
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Radiology, Kocamustafapasa, Istanbul, Türkiye
| | - Enes Deger
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Radiology, Kocamustafapasa, Istanbul, Türkiye
| | - Fatma Nur Soylu Boy
- Fatih Sultan Mehmet Education and Research Hospital, Department of Radiology, Atasehir, Istanbul, Türkiye
| | - Nese Ucar
- Gaziosmanspasa Education and Research Hospital, Department of Radiology, Gaziosmanpasa, Istanbul, Türkiye
| | - Gul Esen Icten
- Senology Research Institute, Acibadem Mehmet Ali Aydinlar University, Maslak, Istanbul, Türkiye
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Kawashima K, Yamamoto S, Narui K, Fujiwara Y, Adachi S, Sasamoto M, Oshi M, Yamada A, Kumagai E, Otani M, Endo I. Granulomatous mastitis in a male breast: A case report and review of literature. Clin Case Rep 2023; 11:e7048. [PMID: 36873068 PMCID: PMC9981576 DOI: 10.1002/ccr3.7048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/21/2023] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Granulomatous mastitis (GM) is a rare disease, particularly among men. Herein, we present a case of GM diagnosed in a 63-year-old male patient who showed reduction in the tumor size during 3 months of observation.
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Affiliation(s)
- Kei Kawashima
- Department of Breast and Thyroid Surgery Yokohama City University Medical Center Yokohama Japan
| | - Shinya Yamamoto
- Department of Breast and Thyroid Surgery Yokohama City University Medical Center Yokohama Japan
| | - Kazutaka Narui
- Department of Breast and Thyroid Surgery Yokohama City University Medical Center Yokohama Japan
| | - Yoshie Fujiwara
- Department of Breast and Thyroid Surgery Yokohama City University Medical Center Yokohama Japan
| | - Shoko Adachi
- Department of Breast and Thyroid Surgery Yokohama City University Medical Center Yokohama Japan
| | - Mahato Sasamoto
- Department of Gastroenterological Surgery Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Masanori Oshi
- Department of Gastroenterological Surgery Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Akimitsu Yamada
- Department of Gastroenterological Surgery Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Eita Kumagai
- Department of Pathology Yokohama City University Medical Center Yokohama Japan
| | - Masako Otani
- Department of Pathology Yokohama City University Medical Center Yokohama Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery Yokohama City University Graduate School of Medicine Yokohama Japan
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Muacevic A, Adler JR. A Case of a Female Patient Presenting With Idiopathic Granulomatous Mastitis With Superimposed Enterococcus Avium Infection. Cureus 2022; 14:e29997. [PMID: 36381742 PMCID: PMC9636988 DOI: 10.7759/cureus.29997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2022] [Indexed: 01/25/2023] Open
Abstract
Idiopathic granulomatous mastitis (IGM) is defined as an uncommon, benign, chronic inflammatory disease of unknown etiology that affects the breast and can mimic breast cancer. It usually manifests as a solid, ill-defined breast lump in postpartum women of reproductive age. Furthermore, because it lacks a particular radiographic finding, core biopsy and histology are the only ways to make a conclusive diagnosis. There is no agreement on the best way to treat IGM. Ideally, a multidisciplinary approach should be used to weigh the benefits and drawbacks of each treatment option, with options such as observation, antibiotics, surgery, and medication therapy being examined (steroids and immunosuppressants). In this report, we review a case of a patient who had IGM with superimposed Enterococcus avium infection. To our knowledge, such a report is considered unprecedented in the Middle East. A literature review on IGM will be presented, as well as the clinical presentation, association with bacterial infection, treatment, and pathological and radiographic findings.
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Tian C, Wang H, Liu Z, Han X, Ning P. Characteristics and Management of Granulomatous Lobular Mastitis Associated with Antipsychotics-Induced Hyperprolactinemia. Breastfeed Med 2022; 17:599-604. [PMID: 35447036 DOI: 10.1089/bfm.2021.0341] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: Granulomatous lobular mastitis (GM) is a rare inflammatory breast disease. Reports focusing on GM caused by antipsychotic-induced hyperprolactinemia (HPRL) are very rare. Aim: To report a study of GM associated with antipsychotic-induced HPRL and discuss the mechanism and management. Materials and Methods: A retrospective review of patients with GM and psychiatric disorders were carried out. The clinical characteristics, management and outcome were collected and analyzed. The relationship between antipsychotics and GM was evaluated using the Naranjo Adverse Drug Reaction Probability Scale (Naranjo scale). Results: Nineteen female GM patients with psychiatric diseases, aged 21-39 years, who had received antipsychotics for 0.5-10.2 years were included. Most patients took multiple antipsychotics, and 10 (52.6%) took risperidone-containing regimens. Increased prolactin (PRL) was detected in all patients (range 35.15-200 ng/mL). The scores of Naranjo scale were 7-8, indicated the antipsychotics probably induced GM. All patients received systemic therapy, and were prescribed bromocriptine. Seven patients (36.8%) decreased the dose of antipsychotics, six (31.6%) switched antipsychotics, three (15.8%) continued the primary antipsychotics, and three (15.8%) discontinued antipsychotics. In addition, 14 patients (73.7%) received corticosteroid, 4 (21.1%) received antimycobacterials. PRL decreased to normal in 1 month. Seven patients (36.8%) received excisional surgery. After 12 months' follow-up (range 9-56 months), only three patients (15.8%) had a recurrence. Conclusion: Long-term use of antipsychotics may increase PRL levels, and lead to GM. It is vital to assess PRL level and reduce PRL to normal in patients with GM.
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Affiliation(s)
- Chunxiang Tian
- Department of Breast Surgery and Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Han Wang
- Department of Pharmacy, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Zeyu Liu
- Department of Breast Surgery and Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaorong Han
- Department of Breast Surgery and Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Ping Ning
- Department of Breast Surgery and Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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5
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Magnetic resonance imaging findings associated with recurrence in idiopathic granulomatous mastitis. Clin Imaging 2022; 84:47-53. [DOI: 10.1016/j.clinimag.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/18/2021] [Accepted: 01/20/2022] [Indexed: 11/23/2022]
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Ramadan R, Koryem IM, Fayed H. Idiopathic granulomatous mastitis: Risk factors and management. Breast Dis 2022; 41:413-420. [PMID: 36530069 DOI: 10.3233/bd-220047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND IGM has a diagnostic and treatment dilemma. The etiology of IGM is unknown but some conditions have been discussed as predisposing factors including Oral Contraceptive Pills, pregnancy, breast feeding, reproductive age, hyperprolactinemia, infectious and autoimmune diseases. The current study aimed to determine possible risk factors for IGM and to evaluate our experience in its management. PATIENTS AND METHODS The study included forty patients with IGM and forty females with normal breasts as a control group. CST treatment was initiated for all patients; patients who responded completely were followed up without surgical intervention. Failure to respond to medical therapy or incidence of corticosteroid-related complications were considered indications for surgical treatment. All patients were followed up for 6 months to detect recurrence. RESULTS IGM had a significant higher incidence rate in young females within 5 years from the last lactation, smokers, those with hypperprolactinaemia, who had a history of breast feeding and those who received OCP (P = <0.001, <0.001, 0.006, 0.001, 0.023 and 0.027 respectively). The central part of the breast was more affected (9 cases (22.5%)). Multicenteric disease affected 8 cases (20%). Breast Mass was the most common presenting sign. After CST; the mass disappeared in 5 cases (12.5%), mass size reduced in 26 cases (65%) and mass size not affected in 9 cases (22.5%). Surgery was done in whom the mass size was reduced or not affected (35 cases (87.5%)). Disease recurrence was reported in 2 cases (5.7%). CONCLUSION IGM usually affects females in their childbearing period with multiple risk factors mainly parity, smoking, OCP and breast feeding with wide variation regarding the presenting manifestations. We should start with CST as there is always a chance to avoid unnecessary surgery and combination of both modalities can reduce the incidence of recurrence.
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Affiliation(s)
- Rabie Ramadan
- Department of Surgery, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Islam M Koryem
- Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Haytham Fayed
- Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Radiologic Features of Idiopathic Granulomatous Mastitis and Emphasis on Analysis of Socioeconomic Status: Over 5 Years of Experience. Indian J Surg 2021. [DOI: 10.1007/s12262-021-03138-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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8
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Tissue Pathogens and Cancers: A Review of Commonly Seen Manifestations in Histo- and Cytopathology. Pathogens 2021; 10:pathogens10111410. [PMID: 34832566 PMCID: PMC8624235 DOI: 10.3390/pathogens10111410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 02/07/2023] Open
Abstract
Tissue pathogens are commonly encountered in histopathology and cytology practice, where they can present as either benign mimickers of malignancy or true malignancies. The aim of this review is to provide a timely synthesis of our understanding of these tissue pathogens, with an emphasis on pertinent diagnostic conundrums associated with the benign mimickers of malignancy that can be seen with viral infections and those which manifest as granulomas. The oncogenic pathogens, including viruses, bacteria, and parasites, are then discussed with relationship to their associated malignancies. Although not exhaustive, the epidemiology, clinical manifestations, pathogenesis, and histological findings are included, along with a short review of emerging therapies.
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Tariq H, Menon PD, Fan H, Vadlamudi KV, Pandeswara SL, Nazarullah AN, Mais DD. Detection of Corynebacterium kroppenstedtii in Granulomatous Lobular Mastitis Using Real-Time Polymerase Chain Reaction and Sanger Sequencing on Formalin-Fixed, Paraffin-Embedded Tissues. Arch Pathol Lab Med 2021; 146:749-754. [PMID: 34506619 DOI: 10.5858/arpa.2021-0061-oa] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Associations between granulomatous lobular mastitis (GLM) and Corynebacterium kroppenstedtii have been reported since 2002, but large scale studies to assess the actual prevalence of this bacterium in GLM have not been performed. OBJECTIVE.— To assess the prevalence of C kroppenstedtii in GLM using real-time polymerase chain reaction and Sanger sequencing. DESIGN.— We analyzed formalin-fixed, paraffin-embedded tissues from 67 cases of GLM by sequential DNA amplification and sequencing to assess the rate of C kroppenstedtii detection in GLM. A retrospective analysis including patient demographics, history of pregnancy and lactation, clinical signs and symptoms, radiographic findings, histologic pattern, Gram stain results, and microbial cultures was performed on 67 cases of GLM. In addition, 10 cases of nongranulomatous breast abscess were included as controls. RESULTS.— C kroppenstedtii 16S rRNA SYBR real-time polymerase chain reaction was positive on formalin-fixed, paraffin-embedded tissues from 46 of 67 (68.7%) GLM cases, while all control cases were negative. Among the positive cases, the majority showed features of cystic neutrophilic granulomatous mastitis. CONCLUSIONS.— C kroppenstedtii was highly prevalent in GLM cases and was not found to be associated with nongranulomatous breast abscess in our study (P < .001).
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Affiliation(s)
- Hamza Tariq
- Department of Pathology and Laboratory Medicine (Tariq, Menon, Fan, Nazarullah, Mais), University of Texas Health Science Center at San Antonio, San Antonio.,Tariq is currently in the Department of Pathology at Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Preethi D Menon
- Department of Pathology and Laboratory Medicine (Tariq, Menon, Fan, Nazarullah, Mais), University of Texas Health Science Center at San Antonio, San Antonio
| | - Hongxin Fan
- Department of Pathology and Laboratory Medicine (Tariq, Menon, Fan, Nazarullah, Mais), University of Texas Health Science Center at San Antonio, San Antonio
| | - Kumari V Vadlamudi
- Molecular Diagnostics Laboratory (Vadlamudi, Pandeswara), University of Texas Health Science Center at San Antonio, San Antonio
| | - Sri Lakshmi Pandeswara
- Molecular Diagnostics Laboratory (Vadlamudi, Pandeswara), University of Texas Health Science Center at San Antonio, San Antonio
| | - Alia N Nazarullah
- Department of Pathology and Laboratory Medicine (Tariq, Menon, Fan, Nazarullah, Mais), University of Texas Health Science Center at San Antonio, San Antonio
| | - Daniel D Mais
- Department of Pathology and Laboratory Medicine (Tariq, Menon, Fan, Nazarullah, Mais), University of Texas Health Science Center at San Antonio, San Antonio
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Basim P, Argun D, Argun F. Risk Factors for Idiopathic Granulomatous Mastitis Recurrence after Patient-Tailored Treatment: Do We Need an Escalating Treatment Algorithm? Breast Care (Basel) 2021; 17:172-179. [PMID: 35707181 PMCID: PMC9149487 DOI: 10.1159/000517399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/21/2021] [Indexed: 11/19/2022] Open
Abstract
<b><i>Objective:</i></b> Idiopathic granulomatous mastitis (IGM) is a rare, relapsing, benign inflammatory breast disease. Due to the conflicting etiology and differential diagnosis, the effect of varied treatment regimens on high recurrence is controversial. Therefore, we aimed to report our clinical experience in determining risk factors for recurrence after patient-tailored treatment. <b><i>Methods:</i></b> This study evaluated 122 patients diagnosed with IGM according to sociodemographic characteristics, reproductive history, clinical presentation, time of diagnosis and radiological examinations, treatment management, and outcomes. The patients were classified into three groups based on curative treatment settings: medical therapy alone, surgery alone, and combined therapy. <b><i>Results:</i></b> The rates of patients receiving medical therapy alone, surgical therapy alone, and combined therapy were 23, 15.6, and 62.4%, respectively. Low vitamin B<sub>12</sub> levels, accompanying rheumatological disease, complaints-fistulae, number of complaints ≥3, presence of erythema nodosum, multicentricity, and treatment modality had a significant effect on disease recurrence (<i>p</i> < 0.05). The effect on IGM recurrence was 2.8 times greater for the patients with lower vitamin B<sub>12</sub> levels, 4.5 times greater for those with rheumatological disease, 3.3 times greater for those with fistulae, 2.4 times greater for those presenting with ≥3 complaints, 2 times greater for the presence of multicentricity, 2.3 times greater for the presence of erythema nodosum, and 4.5 times greater for the patients receiving medical therapy alone. <b><i>Conclusion:</i></b> Describing a low-risk patient profile can be an alternative while choosing monotherapy methods. For IGM patients at high risk of recurrence, an escalating treatment system may be effective in preventing relapses.
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Affiliation(s)
- Pelin Basim
- Department of General Surgery, Medical Faculty, Istanbul Medipol University, Istanbul, Turkey
- *Pelin Basim,
| | - Derya Argun
- Department of Internal Medicine, Medical Faculty, Istanbul Aydin University, Istanbul, Turkey
| | - Ferit Argun
- Department of Internal Medicine, Medical Faculty, Istanbul Aydin University, Istanbul, Turkey
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11
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An Integrative Approach for Idiopathic Granulomatous Mastitis. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02170-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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12
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Papila Kundaktepe B, Velidedeoğlu M, Mete B. The effect of methotrexate monotherapy on treatment-resistant idiopathic granulomatous mastitis patients. Surgeon 2021; 20:e13-e19. [PMID: 33836950 DOI: 10.1016/j.surge.2021.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/16/2021] [Accepted: 03/09/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) is a disease of unknown etiology, involving a chronic inflammatory process, characterized by noncaseating granuloma formation. IGM can mimic a tumor clinically and radiologically. Since we are a tertiary referral center, most of our patients (n = 56, 87.5%) are secondary admissions who have previously had antibiotics and steroid treatments; therefore, we accept these patients as resistant cases. Here, we aim to present our single-center series of 64 patients with resistant IGM who underwent methotrexate monotherapy. To the best of our knowledge, our study includes the highest number of patients described in the literature with IGM who have undergone this treatment. METHODS This study included 64 patients, 56 of which were resistant cases, diagnosed with IGM between January 2013 and January 2020 at Istanbul University Cerrahpasa, Cerrahpasa Medical Faculty, General Surgery Breast Outpatient Clinic that were followed-up at least once. These patients were administered oral methotrexate monotherapy 15 mg/week for 24 weeks, and in relapsed cases, the treatment was up to 20 mg/week for 1 year. Folic acid 10 mg/week was given as a supplement to all patients. RESULTS Complete recovery was observed in 52 (81.25%) of the 64 patients. Follow-up was discontinued by 4 patients. The dose was increased and the duration of treatment was extended up to 1 year when relapse was observed in 8 patients and complete response was then obtained in these cases. Only 3 patients (4.69%) experienced side effects and were switched to subcutaneous treatment due to nausea. CONCLUSION Considering the high patient compliance, low recurrence, minimal side effects, and overall success of the treatment, we believe that methotrexate monotherapy may be used in treatment-resistant IGM patients and may also be the first choice for first-line treatment in the future.
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Affiliation(s)
- Berrin Papila Kundaktepe
- Istanbul University-Cerrahpasa, Cerrahpaşa Faculty of Medicine, Department of General Surgery, Turkey.
| | - Mehmet Velidedeoğlu
- Istanbul University-Cerrahpasa, Cerrahpaşa Faculty of Medicine, Department of General Surgery, Turkey.
| | - Bilgül Mete
- Istanbul University-Cerrahpasa, Cerrahpaşa Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Turkey.
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Şener Bahçe Z, Aktaş H. Patients with idiopathic granulomatous mastitis accompanied by erythema nodosum. Int J Clin Pract 2021; 75:e13928. [PMID: 33305438 DOI: 10.1111/ijcp.13928] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/08/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) is a rare, chronic inflammatory disease of the breast. The aetiology is unknown. Erythema nodosum (EN) is a rare skin disease associated with IGM. EN is a disease in which the aetiologic factors include infection, malignancy, autoimmune diseases, and pregnancy. OBJECTIVE The objective of this study was to evaluate the incidence and coexistence of EN with IGM and the approach to treatment. METHODS Patients who were admitted to the General Surgery and Dermatology Department of our hospital and diagnosed with EN and IGM were evaluated. Demographic data, symptoms, examination findings, number of birth, smoking, diagnosis and treatment methods, recurrence, and follow-up periods of the patients were evaluated. RESULTS EN was seen in six of the patients admitted to the clinic for IGM. Four patients with EN had pregnancy and all had arthritis. Two patients were not pregnant. Oral methylprednisolone treatment was started in patients whose IGM diagnosis was verified pathologically. CONCLUSION IGM may be associated with extramammary symptoms such as EN, arthralgia, and episcleritis. These extramammary findings suggest that IGM may be an autoimmune disease. For this reason, breast examination and history of IGM of the breast should be questioned in female patients admitted to different clinics with EN. This way, delays in the diagnosis and treatment of IGM can be prevented.
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Affiliation(s)
- Zeynep Şener Bahçe
- Department of General Surgery, Private Memorial Hospital, Diyarbakir, Turkey
| | - Hamza Aktaş
- Department of Dermatology, Private Memorial Hospital, Diyarbakir, Turkey
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Agrawal S, Anthony ML, Paul P, Singh D, Mehan A, Singh A, Joshi PP, Kumar A, Syed A, Ravi B, Rao S, Chowdhury N. Prospective evaluation of accuracy of fine-needle aspiration biopsy for breast lesions using the International Academy of Cytology Yokohama System for reporting breast cytopathology. Diagn Cytopathol 2021; 49:805-810. [PMID: 33755356 DOI: 10.1002/dc.24743] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/12/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Classification of breast lesions into different cytological groups can accurately be done using the International Academy of Cytology (IAC) Yokohama System for reporting breast cytopathology. Fine needle aspiration biopsy (FNAB) of breast lesions has been considered to be the primary investigation in detecting breast cancers, especially in low-cost settings. The main objective of this study was to prospectively re-confirm the diagnostic accuracy of breast FNAB using the IAC Yokohama system. Additionally, separate secondary subgroup analysis was done to confirm the accuracy of breast FNAB excluding lymph-node positive and lymphadenopathy positive tumors. MATERIAL AND METHODS A prospective study was done on patients undergoing biopsy of breast lesions between September 01, 2019 and November 30, 2020 (519 biopsies on 487 unique patients). Of these 519 histopathology biopsies, 505 had corresponding FNAB report of the same site. The FNAB was reported using the IAC Yokohama system and the most suitable category was allotted in every case. The rates of malignancy for each category and the accuracy of breast FNAB in diagnosing malignancy were calculated. RESULTS Of the total 487 patients, 120 cases were benign on histology, while 367 were malignant. The rates of malignancy in benign, atypical, suspicious and malignant categories were 5%, 25%, 71%, and 99.7%, respectively. The diagnostic accuracy of atypical, suspicious and malignant categories was calculated as 90.1%, 95.2%, and 93.3%, respectively. CONCLUSION The high diagnostic accuracy for each BIRADS category suggest excellent accuracy for Breast FNAB using the IAC Yokohama system.
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Affiliation(s)
- Shruti Agrawal
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Science, Rishikesh, Uttarkhand, India
| | - Michael Leonard Anthony
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Science, Rishikesh, Uttarkhand, India
| | - Pranoy Paul
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Science, Rishikesh, Uttarkhand, India
| | - Divya Singh
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Science, Rishikesh, Uttarkhand, India
| | - Anoushika Mehan
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Science, Rishikesh, Uttarkhand, India
| | - Ashok Singh
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Science, Rishikesh, Uttarkhand, India
| | - Prashant Pranesh Joshi
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Science, Rishikesh, Uttarkhand, India
| | - Arvind Kumar
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Science, Rishikesh, Uttarkhand, India
| | - Anjum Syed
- Integrated Breast Care Centre, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Bina Ravi
- Integrated Breast Care Centre, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Shalinee Rao
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Science, Rishikesh, Uttarkhand, India
| | - Nilotpal Chowdhury
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Science, Rishikesh, Uttarkhand, India
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Yin Y, Liu X, Meng Q, Han X, Zhang H, Lv Y. Idiopathic Granulomatous Mastitis: Etiology, Clinical Manifestation, Diagnosis and Treatment. J INVEST SURG 2021; 35:709-720. [PMID: 33691563 DOI: 10.1080/08941939.2021.1894516] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Idiopathic granulomatous mastitis (IGM) is a rare form of chronic inflammatory breast disease. Although it is a benign breast lesion, it may be sometimes difficult to distinguish from breast cancer. The cause of IGM is unknown, but may be associated with autoimmunity, abnormal hormone levels and infection. While the clinical manifestations of IGM involve various manifestations of inflammation, the diagnosis is principally established by histopathology, characterized by non-caseating granulomas and microabscess formation centered on the breast lobules. Therapeutic options for IGM range from observation to various medical treatments, such as steroids, immunosuppressants, and antibiotics, to surgical intervention, particularly if secondarily infected. Given that the controversy on etiology and treatment choices, we accomplished the present review through reviewing IGM-related literature published in 'Pubmed' and 'Web of science' databases during 1997 to 2020, aiming to provide the basis for rational clinical diagnosis and treatment.
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Affiliation(s)
- Yulong Yin
- Department of Thyroid Breast Surgery, The Affiliated Hospital of Northwest University, Xi'an, Shaanxi Province, China
| | - Xianghua Liu
- Department of Thyroid Breast Surgery, The Affiliated Hospital of Northwest University, Xi'an, Shaanxi Province, China
| | - Qingjie Meng
- Department of Thyroid Breast Surgery, The Affiliated Hospital of Northwest University, Xi'an, Shaanxi Province, China
| | - Xiaogang Han
- Department of Thyroid Breast Surgery, The Affiliated Hospital of Northwest University, Xi'an, Shaanxi Province, China
| | - Haomeng Zhang
- Department of Thyroid Breast Surgery, The Affiliated Hospital of Northwest University, Xi'an, Shaanxi Province, China
| | - Yonggang Lv
- Department of Thyroid Breast Surgery, The Affiliated Hospital of Northwest University, Xi'an, Shaanxi Province, China
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Yu TF, He W, Gan CG, Zhao MC, Zhu Q, Zhang W, Wang H, Luo YK, Nie F, Yuan LJ, Wang Y, Guo YL, Yuan JJ, Ruan LT, Wang YC, Zhang RF, Zhang HX, Ning B, Song HM, Zheng S, Li Y, Guang Y. Deep learning applied to two-dimensional color Doppler flow imaging ultrasound images significantly improves diagnostic performance in the classification of breast masses: a multicenter study. Chin Med J (Engl) 2021; 134:415-424. [PMID: 33617184 PMCID: PMC7909320 DOI: 10.1097/cm9.0000000000001329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The current deep learning diagnosis of breast masses is mainly reflected by the diagnosis of benign and malignant lesions. In China, breast masses are divided into four categories according to the treatment method: inflammatory masses, adenosis, benign tumors, and malignant tumors. These categorizations are important for guiding clinical treatment. In this study, we aimed to develop a convolutional neural network (CNN) for classification of these four breast mass types using ultrasound (US) images. METHODS Taking breast biopsy or pathological examinations as the reference standard, CNNs were used to establish models for the four-way classification of 3623 breast cancer patients from 13 centers. The patients were randomly divided into training and test groups (n = 1810 vs. n = 1813). Separate models were created for two-dimensional (2D) images only, 2D and color Doppler flow imaging (2D-CDFI), and 2D-CDFI and pulsed wave Doppler (2D-CDFI-PW) images. The performance of these three models was compared using sensitivity, specificity, area under receiver operating characteristic curve (AUC), positive (PPV) and negative predictive values (NPV), positive (LR+) and negative likelihood ratios (LR-), and the performance of the 2D model was further compared between masses of different sizes with above statistical indicators, between images from different hospitals with AUC, and with the performance of 37 radiologists. RESULTS The accuracies of the 2D, 2D-CDFI, and 2D-CDFI-PW models on the test set were 87.9%, 89.2%, and 88.7%, respectively. The AUCs for classification of benign tumors, malignant tumors, inflammatory masses, and adenosis were 0.90, 0.91, 0.90, and 0.89, respectively (95% confidence intervals [CIs], 0.87-0.91, 0.89-0.92, 0.87-0.91, and 0.86-0.90). The 2D-CDFI model showed better accuracy (89.2%) on the test set than the 2D (87.9%) and 2D-CDFI-PW (88.7%) models. The 2D model showed accuracy of 81.7% on breast masses ≤1 cm and 82.3% on breast masses >1 cm; there was a significant difference between the two groups (P < 0.001). The accuracy of the CNN classifications for the test set (89.2%) was significantly higher than that of all the radiologists (30%). CONCLUSIONS The CNN may have high accuracy for classification of US images of breast masses and perform significantly better than human radiologists. TRIAL REGISTRATION Chictr.org, ChiCTR1900021375; http://www.chictr.org.cn/showproj.aspx?proj=33139.
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Affiliation(s)
- Teng-Fei Yu
- Department of Ultrasound, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100070, China
| | - Wen He
- Department of Ultrasound, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100070, China
| | - Cong-Gui Gan
- Department of R&D, CHISON Medical Technologies Co., Ltd, Wuxi, Jiangsu 214028, China
| | - Ming-Chang Zhao
- Department of R&D, CHISON Medical Technologies Co., Ltd, Wuxi, Jiangsu 214028, China
| | - Qiang Zhu
- Department of Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Wei Zhang
- Department of Ultrasound, The Third Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 9530031, China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, China
| | - Yu-Kun Luo
- Department of Ultrasound, Chinese PLA General Hospital, Beijing 100850, China
| | - Fang Nie
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, Gansu 730030, China
| | - Li-Jun Yuan
- Department of Ultrasound, Xi’an Tangdu Hospital of No. 4 Military Medical University, Xi’an, Shaanxi 710038, China
| | - Yong Wang
- Department of Ultrasound, Chinese Academy of Medical Sciences Cancer Institute and Hospital, Beijing 100021, China
| | - Yan-Li Guo
- Department of Ultrasound, The Third Military Medical University Southwest Hospital, Chongqing 400038, China
| | - Jian-Jun Yuan
- Department of Ultrasound, Henan Provincial People's Hospital, Zhengzhou city, Henan 450003, China
| | - Li-Tao Ruan
- Department of Ultrasound, Xi’an Jiaotong University Medical College First Affiliated Hospital, Xi’an, Shaanxi 710061, China
| | - Yi-Cheng Wang
- Department of Ultrasound, Hebei Medical University First Affiliated Hospital, Zhangjiakou, Hebei 075061, China
| | - Rui-Fang Zhang
- Department of Ultrasound, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan 450052, China
| | - Hong-Xia Zhang
- Department of Ultrasound, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100070, China
| | - Bin Ning
- Department of Ultrasound, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100070, China
| | - Hai-Man Song
- Department of Ultrasound, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100070, China
| | - Shuai Zheng
- Department of Ultrasound, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100070, China
| | - Yi Li
- Department of Ultrasound, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100070, China
| | - Yang Guang
- Department of Ultrasound, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100070, China
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Kurt F. Vacuum-assisted closure for wound healing in idiopathic granulomatous mastitis: our clinical experience. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.19.05025-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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18
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Azizi A, Prasath V, Canner J, Gharib M, Sadat Fattahi A, Naser Forghani M, Sajjadi S, Farhadi E, Vasigh M, Kaviani A, Omranipour R, Habibi M. Idiopathic granulomatous mastitis: Management and predictors of recurrence in 474 patients. Breast J 2020; 26:1358-1362. [PMID: 32249491 DOI: 10.1111/tbj.13822] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/03/2020] [Accepted: 03/10/2020] [Indexed: 01/23/2023]
Abstract
Idiopathic Granulomatous Mastitis (IGM) is an uncommon inflammatory disease of the breast, with similar presentations as breast cancer and a relatively high recurrence rate. We reviewed the demographics, clinical presentations, and treatment modalities of a large cohort of patients in Iran. Most of the patients had history of pregnancy and breastfeeding. The most common clinical finding was pain and a palpable mass, respectively. Most of the patients received medical treatment, and about half of the patients had surgery. The recurrence rate was 24.8%, and breast skin lesions were associated with a significantly higher odds of recurrence.
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Affiliation(s)
- Armina Azizi
- Department of General Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Vishnu Prasath
- Department of General Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Joseph Canner
- Department of General Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | | | | | | | - Effat Farhadi
- Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahtab Vasigh
- Breast Disease Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Ahmad Kaviani
- Breast Disease Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Ramesh Omranipour
- Breast Disease Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Mehran Habibi
- Department of General Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
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19
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Oddó D, Domínguez F, Gómez N, Méndez GP, Navarro ME. Granulomatous lobular mastitis associated with ductal carcinoma in situ of the breast. SAGE Open Med Case Rep 2019; 7:2050313X19836583. [PMID: 30899513 PMCID: PMC6419248 DOI: 10.1177/2050313x19836583] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 02/15/2019] [Indexed: 11/16/2022] Open
Abstract
The association of granulomatous lobular mastitis and carcinoma of the breast is very infrequent. We present the case of a 44-year-old woman with concurrent granulomatous lobular mastitis with coryneform bacteria and ductal carcinoma in situ in the same breast.
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Affiliation(s)
- David Oddó
- Department of Anatomic Pathology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Domínguez
- Department of Surgical Oncology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Natalia Gómez
- Department of Anatomic Pathology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gonzalo P Méndez
- Department of Anatomic Pathology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - María Elena Navarro
- Department of Radiology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Etiología de la mastitis crónica: propuesta de secuencia diagnóstica. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2018. [DOI: 10.1016/j.gine.2016.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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21
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Zhang L, Hu J, Guys N, Meng J, Chu J, Zhang W, Liu A, Wang S, Song Q. Diffusion-weighted imaging in relation to morphology on dynamic contrast enhancement MRI: the diagnostic value of characterizing non-puerperal mastitis. Eur Radiol 2017; 28:992-999. [PMID: 28956122 PMCID: PMC5811586 DOI: 10.1007/s00330-017-5051-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 08/10/2017] [Accepted: 08/22/2017] [Indexed: 02/05/2023]
Abstract
Objectives To demonstrate the value of diffusion-weighted imaging (DWI) in the characterisation of mastitis lesions. Methods Sixty-one non-puerperal patients with pathologically confirmed single benign mastitis lesions underwent preoperative examinations with conventional MRI and axial DWI. Patients were categorised into three groups: (1) periductal mastitis (PDM), (2) granulomatous lobular mastitis (GLM), and (3) infectious abscess (IAB). Apparent diffusion coefficient (ADC) values of each lesion were recorded. A one-way ANOVA with logistic analysis was performed to compare ADC values and other parameters. Discriminative abilities of DWI modalities were compared using the area under the receiver operating characteristic curve (AUC). P < 0.05 was considered statistically significant. Results ADC values differed significantly among the three groups (P = 0.003) as well as between PDM and IAB and between PDM and GLM. The distribution of non-mass enhancement on dynamic contrast-enhanced (DCE) MRI differed significantly among the three groups (P = 0.03) but not between any two groups specifically. There were no differences in lesion location, patient age, T2WI or DWI signal intensity, enhancement type, non-mass internal enhancement, or mass enhancement characteristics among the three groups. Conclusions ADC values and the distribution of non-mass enhancement are valuable in classifying mastitis subtypes. Key points • Mastitis subtypes exhibit different characteristics on DWI and DCE MRI. • ADC values are helpful in isolating PDM from other mastitis lesions. • Distribution of non-mass enhancement also has value in comparing mastitis subtypes.
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Affiliation(s)
- Lina Zhang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang, Dalian, Liaoning, 116011, China
| | - Jiani Hu
- Department of Radiology, Wayne State University, 540 East Canfield Street, Detroit, MI, 48201, USA
| | - Nicholas Guys
- Department of Radiology, Wayne State University, 540 East Canfield Street, Detroit, MI, 48201, USA
| | - Jinli Meng
- Department of Radiology, Chengban Branch of West China Hospital, 37 Guoxue Alley, Wuhou, Chengdu, Sichuan, 610041, China
| | - Jianguo Chu
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang, Dalian, Liaoning, 116011, China
| | - Weisheng Zhang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang, Dalian, Liaoning, 116011, China
| | - Ailian Liu
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang, Dalian, Liaoning, 116011, China.
| | - Shaowu Wang
- Department of Radiology, Second Affiliated Hospital of Dalian Medical University, 467 Zhongshan Road, Shahekou, Dalian, Liaoning, 116023, China.
| | - Qingwei Song
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang, Dalian, Liaoning, 116011, China
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Freeman CM, Xia BT, Wilson GC, Lewis JD, Khan S, Lee SJ, Lower EE, Edwards MJ, Shaughnessy EA. Idiopathic granulomatous mastitis: A diagnostic and therapeutic challenge. Am J Surg 2017; 214:701-706. [PMID: 28739122 DOI: 10.1016/j.amjsurg.2017.07.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 06/12/2017] [Accepted: 07/03/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Idiopathic granulomatous mastitis is a rare benign breast disease of women of reproductive age. It usually presents as a painful mass. Since the etiology is unclear, directed diagnosis and management is lacking. METHODS This is a retrospective chart review of 14 patients, over twelve years (2004-2016), identified through query of pathology findings. RESULTS Two asymptomatic patients were diagnosed after oncologic breast resection following neoadjuvant chemotherapy. The remaining twelve patients were young (31.7 years, range 23-43 years), predominantly non-white (50% African/African-American, 36% Hispanic, 7% Asian), pregnant within the last five years (86%), with no prior granulomatous disease. Evaluation included breast imaging, microbial cultures and staining, and biopsy. Treatment included antibiotics (57%), corticosteroids (21%), methotrexate (7%), and/or surgery (71%). Imaging suggests segmental masses, possibly abscess. CONCLUSION Granulomatous mastitis is uncommon, and difficult to diagnose and manage. We review our experience, the literature, and propose an algorithm for diagnosis and management.
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Affiliation(s)
- C M Freeman
- Department of Surgery, Division of Surgical Oncology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - B T Xia
- Department of Surgery, Division of Surgical Oncology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - G C Wilson
- Department of Surgery, Division of Surgical Oncology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - J D Lewis
- Department of Surgery, Division of Surgical Oncology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - S Khan
- Department of Pathology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - S J Lee
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - E E Lower
- Department of Medicine, Division of Hematology and Medical Oncology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - M J Edwards
- Department of Surgery, Division of Surgical Oncology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - E A Shaughnessy
- Department of Surgery, Division of Surgical Oncology, University of Cincinnati Medical Center, Cincinnati, OH, USA.
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Abstract
The aim of this study was to determine possible risk factors for recurrence development in patients with idiopathic granulomatous mastitis (IGM). Demographic, clinical, radiologic, and histopathologic characteristics of 34 consecutive patients with IGM were retrospectively reviewed. Also, 32 patients who were informed about recurrence status were divided into non-recurrent (n = 27) and recurrent (n = 5) groups. Both groups were compared for demographic and clinical parameters. This study included 34 female patients with IGM aged between 26 and 70 years (median: 38 years). During the follow-up period, no recurrence occurred in 27 patients whereas recurrence developed in 5 patients. No significant difference was found between the groups with respect to age, lesion size, breast-feeding, number of child, marital status, use of oral contraceptive, familial or personal tuberculosis history, PPD test, smoking, lesion side, lesion location on the breast, and treatment choice. The diagnostic tools of the IGM as follows: tru-cut (n = 18); incisional (n = 6); tru-cut + incisional (n = 5); tru-cut + excisional (n = 2); tru-cut + FNAB (n = 1); FNAB + excisional (n = 1) and FNAB (n = 1). Treatment options were as follow: antibiotics + drainage (n = 10); antibiotics + drainage + corticosteroid (n = 9); wait and watch (n = 6); corticosteroid (n = 3); antibiotics + antituberculous (n = 1); antituberculous (n = 1); antibiotics + breast conserving surgery + chemotherapy (n = 1); modified radical mastectomy + chemotherapy + radiotherapy (n = 1); and no available (n = 2). This study shows that no demographic and clinical data contributes to the development of recurrence disease. To give a strong message, this study should be supported by other high volume and prospective studies.
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Abstract
A 33-year-old mother of 2 healthy children presented with bilateral recurrent breast infections despite successful treatment of each episode of an infection. With a negative rheumatologic medical history as well as a negative review of systems, she continued to have these infections frequently. Hence, a breast biopsy was performed after the treatment with a course of antimicrobials, which revealed changes suggestive of granulomatous mastitis. She was started on methotrexate (MTX) with a good response. But, due to persistent nodularity, corticosteroids were added to the regimen with MTX dose escalation. Patient remained disease free thereafter without any adverse effects.
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Management of granulomatous mastitis: a series of 13 patients who were evaluated for treatment without corticosteroids. Int Surg 2016; 100:774-82. [PMID: 26011195 PMCID: PMC4452962 DOI: 10.9738/intsurg-d-14-00231.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Granulomatous mastitis (GM) is a rare chronic inflammatory breast condition with unknown etiology. There is still no generally accepted optimal treatment for GM. Corticosteroid treatment and/or wide excision is most commonly reported in the literature. Incision and drainage or limited excision alone has little benefit because of a strong tendency of recurrence. Corticosteroids also have a high failure rate and possible side effects. In the current series, we treated GM patients without corticosteroids, except for one patient. We also devised multidirectional deep drainage for advanced and complicated abscesses, which are characteristic of GM. This retrospective study included 13 women who met the required histologic criteria of GM. The mean age of the patients was 41 years. All of the patients were premenopausal. Six patients had breast-fed in the last 5 years. Five patients were under medication with antidepressants. A total of 11 patients developed abscesses during the clinical course, and the abscesses penetrated the retromammary space in 4 patients. We treated 2 of these 4 patients with multidirectional deep drainage and obtained complete remission in 5 and 6.5 months, respectively. These times were much shorter than those in the other 2 patients. The time to resolution in 11 patients was 4 to 28 months. This overall outcome was comparable with that of corticosteroid treatment reported in the literature. Because the natural history of GM is thought to be self-limiting, close observation and minimally required drainage of abscesses without corticosteroid administration remain the treatment modality of choice.
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Magnetic resonance imaging features of idiopathic granulomatous mastitis: is there any contribution of diffusion-weighted imaging in the differential diagnosis? Radiol Med 2016; 121:857-866. [DOI: 10.1007/s11547-016-0666-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 06/22/2016] [Indexed: 10/21/2022]
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Aslan H, Pourbagher A, Colakoglu T. Idiopathic granulomatous mastitis: magnetic resonance imaging findings with diffusion MRI. Acta Radiol 2016; 57:796-801. [PMID: 26508792 DOI: 10.1177/0284185115609804] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 09/01/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) is a rare benign breast disease with unknown etiology which can mimic breast carcinoma, both clinically and radiologically. Magnetic resonance imaging (MRI) findings of IGM have been previously described; however there is no study evaluating diffusion-weighted MRI findings of IGM. PURPOSE To analyze conventional, dynamic contrast-enhanced, and diffusion-weighted MRI signal characteristics of IGM by comparing it with the contralateral normal breast parenchyma. MATERIAL AND METHODS A total of 39 patients were included in the study. On dynamic contrast-enhanced MRI, the distribution and enhancement patterns of the lesions were evaluated. We also detected the frequencies of involving quadrants, retroareolar involvement, accompanying abscess, and skin edema. T2-weighted (T2W) and STIR signal intensities and both mean and minimum apparent diffusion coefficient (ADC) values were compared with the contralateral normal parenchyma. RESULTS IGM showed significantly lower mean and minimum ADC values when compared with the normal parenchyma. Signal intensities on T2W and STIR sequences of the lesion were significantly higher than the normal parenchyma. On dynamic contrast-enhanced MRI, 7.7% of the patients had mass-like contrast enhancement, 92.3% of the patients had non-mass-like contrast enhancement. Abscess was positive in 33.3% of the patients. CONCLUSION As a result, IGM showed commonly non-mass-like lesions with restricted diffusion. Although it is a benign pathology, it may show clustered ring-like enhancement like malignant lesions.
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Affiliation(s)
- Hulya Aslan
- Department of Radiology, Baskent University Faculty of Medicine, Adana Teaching and Medical Research Center, Adana, Turkey
| | - Aysin Pourbagher
- Department of Radiology, Baskent University Faculty of Medicine, Adana Teaching and Medical Research Center, Adana, Turkey
| | - Tamer Colakoglu
- Department of General Surgery, Baskent University Faculty of Medicine, Adana Teaching and Medical Research Center, Adana, Turkey
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Oztekin PS, Durhan G, Nercis Kosar P, Erel S, Hucumenoglu S. Imaging Findings in Patients with Granulomatous Mastitis. IRANIAN JOURNAL OF RADIOLOGY 2016; 13:e33900. [PMID: 27853497 PMCID: PMC5107257 DOI: 10.5812/iranjradiol.33900] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 02/11/2016] [Accepted: 03/02/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Granulomatous mastitis (GM) is a rare inflammatory breast disease that may mimic the clinical characteristics and radiologic imaging findings of breast carcinoma. Considering the importance of making a correct diagnosis, careful radiologic evaluations and recognition of imaging features are necessary. OBJECTIVES The aim of this study was to review the radiological findings and diagnostic value of the imaging in GM. PATIENTS AND METHODS This retrospective study involved a total of 29 patients who were diagnosed with GM between 2009 and 2013 and who underwent mammography (MG) and/or ultrasound (US) examination in addition to magnetic resonance imaging (MRI) before diagnosis. RESULTS Among 14 patients over 35 years of age who underwent MG imaging, focal asymmetric, ill-defined nodular, or diffusely increased densities were detected in nine (64.3%), two (14.3%), and one (7.1%) subjects, respectively, while there were no pathological findings in two (14.3%) patients. In the overall group of 29 patients, US showed heterogeneous hypoechoic lesions with tubular extensions in 16 (55.2%), well-demarcated heterogeneous hypoechoic lesions in eight (27.6%), parenchymal heterogeneous appearance in three (10.3%), and a heterogeneous hypoechoic lesion with irregular margins in one (3.4%), with another (3.4%) patient having normal US findings. MRI findings included lesions consistent with solitary or multiple separate or confluent abscesses with marked peripheral ring enhancement in 25 (86.2%) patients, accompanied by intensity changes suggesting edematous inflammation in the peripheral parenchyma, as well as non-mass-like heterogeneous segmental and regional contrast enhancement. Four (13.8%) patients had non-mass-like segmental and regional contrast enhancement only. A histopathological diagnosis of GM was established in all patients with biopsy. CONCLUSION GM presents with a wide range of conventional radiological findings, hampering the diagnosis. In patients with inconclusive conventional findings, MRI may assist in the differential diagnosis and assessment of the extent of disease. However, a definitive diagnosis and relevant treatment require histopathological confirmation.
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Affiliation(s)
- Pelin Seher Oztekin
- Radiology Department, Ankara Training and Research Hospital, Ankara, Turkey
- Corresponding author: Pelin Seher Oztekin, Radiology Department, Ankara Training and Research Hospital, Ankara, Turkey, E-mail:
| | - Gamze Durhan
- Radiology Department, Ankara Training and Research Hospital, Ankara, Turkey
| | - Pinar Nercis Kosar
- Radiology Department, Ankara Training and Research Hospital, Ankara, Turkey
| | - Serap Erel
- 4th Surgery Department, Ankara Training and Research Hospital, Ankara, Turkey
| | - Sema Hucumenoglu
- Pathology Department, Ankara Training and Research Hospital, Ankara, Turkey
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Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) is a rare, benign, and chronic disease of the breast. Despite the various treatment approaches described for this disease, a gold standard treatment modality has not yet been defined. In this study, the effect of topical steroids was reviewed and assessed in patients with IGM. METHODS The records of patients with IGM who were treated only with topical steroids were retrospectively reviewed. Patients were grouped as "completely healed," "inadequately healed," "stable," "worsened," or "recurred" if they had once healed but their symptoms returned. Patients whose skin changes were completely ameliorated were considered "completely healed." RESULTS All of the patients were women, and the average patient age was 35.7 years (range 24-48 years). During the average follow-up of 37.2 months (range 12-72 months) in patients who received only topical steroid treatment, recurrence was observed in three patients (3/28, 10.7 %), and no side effects or steroid-related complications occurred. CONCLUSIONS Topical steroids seem to be effective in the treatment of IGM characterized by skin changes. Prospective clinical studies would be useful in determining the clinical efficacy of topical steroids in the treatment of IGM.
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Benson JR, Dumitru D. Idiopathic granulomatous mastitis: presentation, investigation and management. Future Oncol 2016; 12:1381-94. [PMID: 27067146 DOI: 10.2217/fon-2015-0038] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory condition of the breast which although benign can mimic carcinoma. Establishing a diagnosis can be challenging and requires a high index of suspicion with exclusion of infective and autoimmune breast diseases. IGM is characterized histologically by noncaseating granulomas which are of a lobulo-centric pattern and often associated with microabscess formation. Management of confirmed cases remains controversial with proponents of initial surgical or medical therapies - each has its associated problems which can be worse than the original symptoms of IGM. However, many patients require more than one modality of treatment to completely resolve IGM lesions and careful judgment is necessary to ensure optimal type and sequencing of treatments.
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Affiliation(s)
- John R Benson
- Cambridge Breast Unit, Addenbrooke's Hospital & University of Cambridge, Cambridge, CB2 0QQ, UK.,University of Cambridge, Cambridge, UK
| | - Dorin Dumitru
- Cambridge Breast Unit, Addenbrooke's Hospital & University of Cambridge, Cambridge, CB2 0QQ, UK
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Ahmed YS, Abd El Maksoud W. Evaluation of therapeutic mammoplasty techniques in the surgical management of female patients with idiopathic granulomatous mastitis with mild to moderate inflammatory symptoms in terms of recurrence and patients' satisfaction. Breast Dis 2016; 36:37-45. [PMID: 27177342 DOI: 10.3233/bd-150198] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Although idiopathic granulomatous mastitis (IGM) affects young females, its surgical management usually leads to disfigurement of the breasts. OBJECTIVES To assess the use of therapeutic mammoplasty techniques for management of IGM in terms of recurrence and postoperative patients' satisfaction. METHODS This prospective clinical study included thirteen patients who were diagnosed histologically as IGM. Patients with moderate to large breasts, who had a breast mass between 20-50% of the breast size with failed medical treatment or intolerability to steroids were subjected to therapeutic mammoplasty techniques. Only patients with large breasts were offered contra-lateral reduction mammoplasty to resume symmetry and achieve better aesthetic results. RESULTS Early postoperative bleeding that was encountered in one patient (7.7%) was the only serious postoperative complication. Patient was re-operated and the bleeder was secured. Recurrence occurred in 2 patients (15.4%) at 16 and 24 months after the operation. Kyungpook National University Hospital (KNUH) breast reconstruction satisfaction questionnaire used to assess patients' satisfaction 6 months after the operation and revealed that 10 patients (76.9%) were satisfied after the operation. CONCLUSION Using therapeutic mammoplasty techniques in surgical management of IGM in moderate to large breasts seems justifiable with good results regarding recurrence and postoperative patients' satisfaction.
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Affiliation(s)
- Yasser S Ahmed
- Medical Research Institute, University of Alexandria, Egypt
| | - Walid Abd El Maksoud
- Department of General Surgery, Faculty of Medicine, University of Alexandria, Egypt
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Korkut E, Akcay MN, Karadeniz E, Subasi ID, Gursan N. Granulomatous Mastitis: A Ten-Year Experience at a University Hospital. Eurasian J Med 2015; 47:165-73. [PMID: 26644764 DOI: 10.5152/eurasianjmed.2015.118] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE In this study we aimed to define clinical, radiologic and pathological specialties of patients who applied to General Surgery Department of Atatürk University Medical Faculty with granulomatous mastitis and show medical and surgical treatment results. With the help of this study we will be able to make our own clinical algorithm for diagnosis and treatment. MATERIALS AND METHODS We searched retrospectively addresses, phone numbers and clinical files of 93 patients whom diagnosed granulomatous mastitis between a decade of January 2001 - December 2010. We noted demographic specialties, ages, gender, medical family history, main complaints, physical findings, radiological and laboratory findings, medical treatments, postoperative complications and surgical procedures if they were operated; morbidity, recurrence and success ratios, complications after treatment for patients discussed above. RESULTS In this study we evaluated 93 patients, 91 females and 2 males, with granulomatous mastitis retrospectively who applied to General Surgery Department of Atatürk University Medical Faculty between January 2001 and December 2010. Mean age was 34.4 years. The diagnosis was confirmed by histopathologic examination of the lesions. Seventy three patients had idiopathic granulomatous lobular mastitis and 20 patients had specific granulomatous mastitis IGM (18 tuberculosis mastitis, 1 alveolar echinococcosis and 1 silk reaction). All the patients had surgical debridement or antibiotic, and anti-inflammatory treatment with results bad clinical response before applied our clinic. CONCLUSION Empiric antibiotic therapy and drainage of the breast lesions are not enough for complete remission of idiopathic granulomatous mastitis. The lesion must be excised completely. In selected patients, corticosteroid therapy can be useful. In the patients with tuberculous mastitis, abscess drainage and antituberculous therapy can be useful, but wide excision must be chosen for the patients with recurrent disease.
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Affiliation(s)
- Ercan Korkut
- Department of General Surgery, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Mufide Nuran Akcay
- Department of General Surgery, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Erdem Karadeniz
- Department of General Surgery, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Irmak Durur Subasi
- Department of Radiology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Nesrin Gursan
- Department of Pathology, Atatürk University Faculty of Medicine, Erzurum, Turkey
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Velidedeoglu M, Kilic F, Mete B, Yemisen M, Celik V, Gazioglu E, Ferahman M, Ozaras R, Yilmaz MH, Aydogan F. Bilateral idiopathic granulomatous mastitis. Asian J Surg 2015; 39:12-20. [PMID: 25944108 DOI: 10.1016/j.asjsur.2015.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 02/24/2015] [Accepted: 02/25/2015] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Idiopathic granulomatous mastitis (IGM) is a benign rare inflammatory pseudotumor. Bilateral involvement of IGM has been reported in a few cases. To our knowledge, this study is the largest series of bilateral cases to date. The goals of this study were to present clinical features of bilateral IGM and to evaluate the results of treatments. MATERIALS AND METHODS We performed a retrospective review of the idiopathic granulomatous mastitis database from 2010 to 2013. Ten female patients who met required histologic and clinical criteria of IGM in both breasts were included in study. Demographic data, clinical findings, medication history, and radiologic findings are presented. RESULTS The mean age at onset of the disease was 38.4 ± 8.3 years (range: 29-52 years). Nine patients had no recurrence during a mean follow-up period of 21 months (range: 11-26 months). Additionally, the median time to second breast involvement was 15.6 months. CONCLUSION Bilateral IGMs have a higher rate of more relapse and greater resistance to medical therapies than do unilateral IGMs. Surgical management should be avoided unless all medical treatment options have been exhausted. Nevertheless, expectant management seems a rational option for the treatment of bilateral IGM.
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Affiliation(s)
- Mehmet Velidedeoglu
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Fahrettin Kilic
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Birgul Mete
- Department of Infectious Diseases, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Mucahit Yemisen
- Department of Infectious Diseases, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Varol Celik
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ertugrul Gazioglu
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Mehmet Ferahman
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Resat Ozaras
- Department of Infectious Diseases, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Mehmet Halit Yilmaz
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Fatih Aydogan
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
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Yabanoğlu H, Çolakoğlu T, Belli S, Aytac HO, Bolat FA, Pourbagher A, Tezcaner T, Yildirim S, Haberal M. A Comparative Study of Conservative versus Surgical Treatment Protocols for 77 Patients with Idiopathic Granulomatous Mastitis. Breast J 2015; 21:363-9. [PMID: 25858348 DOI: 10.1111/tbj.12415] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The purpose of this study was to analyze the clinical features and demographic data of patients with idiopathic granulomatous mastitis (IGM) and to compare the results of conservative versus surgical treatment protocols. The demographic data, clinical findings, microbiological and pathologic features, scanning and treatment methods, recurrence, and recovery rates of 77 patients were analyzed retrospectively. The patients were divided into two groups based on the type of treatment received. Core biopsies were used to diagnose 37 patients: 26 using incisional biopsies and 14 using excisional biopsies. Of the patient population with IGM, 31 were treated with surgical excision, one with a simple mastectomy, and one with a subcutaneous mastectomy combined with a breast implant, whereas 44 were treated with steroids. The recovery rates of the 44 patients who were treated conservatively were 6 (1-15) months while for the 33 patients who were treated surgically, it was 1 (1-5) month (p = 0.001). Nine patients from the conservative treatment group experienced a recurrence while there were no recurrences in the surgically treated group (p = 0.009). Among all patients, the recurrence rate was 11.7% (9/77) while the average follow-up period was 16.57 ± 18.57 months. As a comparative study between conservative treatment protocols and surgical ones for patients with idiopathic granulomatous mastitis (IGM), this study is the largest to date. A wide surgical excision is the preferred approach for treating patients with IGM because of the low recurrence rate.
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Affiliation(s)
- Hakan Yabanoğlu
- Department of General Surgery, Baskent University Faculty of Medicine, Adana, Turkey
| | - Tamer Çolakoğlu
- Department of General Surgery, Baskent University Faculty of Medicine, Adana, Turkey
| | - Sedat Belli
- Department of General Surgery, Baskent University Faculty of Medicine, Adana, Turkey
| | - Huseyin Ozgur Aytac
- Department of General Surgery, Baskent University Faculty of Medicine, Adana, Turkey
| | - Filiz Aka Bolat
- Department of Pathology, Baskent University Faculty of Medicine, Adana, Turkey
| | - Ayşin Pourbagher
- Department of Radiology, Baskent University Faculty of Medicine, Adana, Turkey
| | - Tugan Tezcaner
- Department of General Surgery, Baskent University Faculty of Medicine, Adana, Turkey
| | - Sedat Yildirim
- Department of General Surgery, Baskent University Faculty of Medicine, Adana, Turkey
| | - Mehmet Haberal
- Department of General Surgery, Baskent University Faculty of Medicine, Adana, Turkey
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Skandarajah A, Marley L. Idiopathic granulomatous mastitis: a medical or surgical disease of the breast? ANZ J Surg 2014; 85:979-82. [PMID: 25424519 DOI: 10.1111/ans.12929] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2014] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Idiopathic granulomatous mastitis (IGM) is a rare benign breast disease, which can be protracted, disfiguring and may be linked to an underlying autoimmune disorder. The clinical presentation may mimic bacterial mastitis or carcinoma. AIMS To review the mode of presentation, diagnosis, management, resolution and incidence of IGM in three tertiary breast centres and propose guidelines for management. METHODS The breast and anatomical databases of three centres were reviewed from January 2000 to December 2013 to identify patients with histological diagnosis of IGM. Clinical and demographic characteristics were retrieved and treatment modalities and time to resolution were recorded. RESULTS Seventeen patients were identified with a median age of 40. The majority of patients were premenopausal, multiparous and presented with a mass. All patients had initial treatment as infectious mastitis. The diagnosis was made by core biopsy in 71%. Eleven patients required immunosuppressive treatment with steroids and four of these patients required a steroid-sparing agent because of steroidal side effects, recurrence or persistence of symptoms. The median time to resolution was 3 months (0-24 months). One patient had subsequent systemic Wegener's granulomatosis diagnosed. CONCLUSIONS Idiopathic granulomatosis mastitis requires histological confirmation, close monitoring, exclusion of underlying systemic autoimmune conditions and judicious use of steroids and steroid-sparing agents such as methotrexate. It has a protracted course with some patients relapsing quickly upon cessation of steroids.
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Affiliation(s)
- Anita Skandarajah
- Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Combined Breast Service, The Royal Melbourne and Women's Hospitals, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Leah Marley
- Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
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Karanlik H, Ozgur I, Simsek S, Fathalizadeh A, Tukenmez M, Sahin D, Dursun M, Kurul S. Can Steroids plus Surgery Become a First-Line Treatment of Idiopathic Granulomatous Mastitis? Breast Care (Basel) 2014; 9:338-42. [PMID: 25759614 PMCID: PMC4322692 DOI: 10.1159/000366437] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The aim of this study is to compare the clinical course of idiopathic granulomatous mastitis (IGM) treated with low-dose oral corticosteroid therapy alone as opposed to treatment with low-dose corticosteroid therapy followed by surgery. PATIENTS AND METHODS 37 patients were treated with an approach that consisted of methylprednisolone at a dose of 0.5 mg/kg/day followed by wide excision, and 23 patients were treated with an approach that consisted only of methylprednisolone. The treatment efficacy was compared between the two groups. RESULTS Clinical and radiological regression was reported in all patients with steroid therapy, and the regression rate had a median of 75% (25-100%). No recurrence was observed in patients who were treated with wide surgical excision after steroid therapy during the median follow-up period of 38 (22-78) months. The control group of 23 patients was treated only with steroid therapy, and 7 (30%) of these patients experienced recurrence in the follow-up period (p < 0.001). CONCLUSIONS Steroid therapy was effective in the treatment of IGM by reducing the lesion size and extent. With regard to the current treatment options available for IGM, surgical excision after steroid therapy seems the better treatment option compared to steroid therapy without surgical excision. This treatment sequence reduces the rate of recurrence.
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Affiliation(s)
- Hasan Karanlik
- Surgical Oncology Unit, Institute of Oncology, Istanbul University, Turkey
| | | | - Serife Simsek
- Surgical Oncology Unit, Institute of Oncology, Istanbul University, Turkey
| | | | - Mustafa Tukenmez
- Department of General Surgery, Istanbul Medical Faculty, Istanbul University, Turkey
| | - Dilek Sahin
- Department of Radiology, Institute of Oncology, Istanbul University, Turkey
| | - Memduh Dursun
- Department of Radiology, Istanbul Medical Faculty, Istanbul University, Turkey
| | - Sidika Kurul
- Surgical Oncology Unit, Institute of Oncology, Istanbul University, Turkey
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Corticosteroid treatment in the management of idiopathic granulomatous mastitis to avoid unnecessary surgery. Surg Today 2014; 45:457-65. [PMID: 24993812 DOI: 10.1007/s00595-014-0966-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 04/01/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory disease of the breast. It can mimic breast carcinoma clinically and radiologically, and usually affects females of childbearing age. There is no commonly accepted optimal treatment for IGM. In this study, we present the clinical and histopathological features and outcomes of the therapeutic management of IGM, as well as the clinical course of the disease when patients were treated with oral corticosteroids. METHODS This retrospective study included 49 of 87 patients who met the required histological criteria for IGM who were followed up between January 2009 and December 2011. All patients had a disease-free follow-up period of at least 6 months. The data regarding the clinical features at presentation, laboratory values and the treatment modalities were obtained from the medical records of the patients. RESULTS The mean age of the patients was 34.3 ± 4.37 years. Forty patients were treated with prednisolone, five were started on antituberculosis treatment, two received non-steroidal anti-inflammatory drugs, one received antibiotics and one underwent wide excision. All patients who received steroids responded well to the therapy. CONCLUSION Systemic therapy with corticosteroids is an effective and appropriate treatment option for IGM. It can provide complete disease resolution and prevent recurrence in the long term. A multidisciplinary approach including specialists in the fields of both general surgery and infectious diseases is essential for the diagnosis, treatment and follow-up of IGM.
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Akcan A, Oz AB, Dogan S, Akgün H, Akyüz M, Ok E, Gök M, Talih T. Idiopathic Granulomatous Mastitis: Comparison of Wide Local Excision with or without Corticosteroid Therapy. ACTA ACUST UNITED AC 2014; 9:111-5. [PMID: 24944554 DOI: 10.1159/000360926] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) is an uncommon chronic inflammatory disease of the breast with uncertain optimal treatment regimen. In this study, our purpose was to report our clinical experience with 74 IGM patients who were treated wide local excision with or without steroid therapy. PATIENTS AND METHOD 74 cases diagnosed histologically as IGM were identified from surgical and pathological records between January 1995 and January 2012. Group 1 (surgery-only group) comprised 53 patients, and the 21 patients in group 2 were treated with corticosteroids prior to surgical treatment (steroid-and-surgery group). RESULTS Follow-up data were complete for 67 (91.7%) of the 73 patients. Recurrence developed in 4 (7.5%) patients in the surgery-only group, while there was no recurrence in the steroid-and-surgery group; the difference was not statistically significant (p = 0.19). CONCLUSION Systemic steroid therapy with surgical resection is the recommended first-line treatment strategy for IGM.
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Affiliation(s)
- Alper Akcan
- Department of General Surgery, Erciyes University School of Medicine, Kayseri, Turkey
| | - A Bahadir Oz
- Department of General Surgery, Erciyes University School of Medicine, Kayseri, Turkey
| | - Serap Dogan
- Department of General Surgery, Erciyes University School of Medicine, Kayseri, Turkey
| | - Hülya Akgün
- Department of General Surgery, Erciyes University School of Medicine, Kayseri, Turkey
| | - Muhammet Akyüz
- Department of General Surgery, Erciyes University School of Medicine, Kayseri, Turkey
| | - Engin Ok
- Department of General Surgery, Erciyes University School of Medicine, Kayseri, Turkey
| | - Mustafa Gök
- Department of General Surgery, Erciyes University School of Medicine, Kayseri, Turkey
| | - Tutkun Talih
- Department of General Surgery, Erciyes University School of Medicine, Kayseri, Turkey
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Omranipour R, Mohammadi SF, Samimi P. Idiopathic granulomatous lobular mastitis - report of 43 cases from iran; introducing a preliminary clinical practice guideline. Breast Care (Basel) 2014; 8:439-43. [PMID: 24550752 DOI: 10.1159/000357320] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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.
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Affiliation(s)
- Ramesh Omranipour
- Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Parisa Samimi
- Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
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Konan A, Kalyoncu U, Dogan I, Kiliç YA, Karakoç D, Akdogan A, Kiraz S, Kaynaro Lu V, Onat D. Combined long-term steroid and immunosuppressive treatment regimen in granulomatous mastitis. ACTA ACUST UNITED AC 2013; 7:297-301. [PMID: 23904832 DOI: 10.1159/000341388] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory disease of the breast. It is related to various etiological factors. The treatment of IGM is challenging as there is a lack of consensus in the literature and treatment options vary widely. Conservative treatment with antibiotics, glucocorticoids and immunosuppressive drugs, and surgery are used in the management of the disease. In this article we report our experience with IGM patients receiving immunosuppressive treatment. PATIENTS AND METHODS The medical records of patients with IGM receiving systemic therapy at the Hacettepe University Hospital between October 2007 and May 2010 were reviewed. 15 cases of histopathologically proven IGM were identified. The data was examined for risk factors and success of treatment. RESULTS 14 patients were given prednisolone together with azathioprine, and 1 patient who was pregnant at the time of diagnosis received only prednisolone (30 mg/day). 11 (73%) patients had a complete response to systemic therapy. 2 patients had a relapse, of whom 1 required surgical drainage and 1 was treated with a higher dose of glucocorticoids. CONCLUSION Systemic therapy is a safe and effective treatment for IGM. The addition of azathioprine to glucocorticoid therapy permits quick tapering of the steroid doses and increases the treatment success.
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Affiliation(s)
- Ali Konan
- Department of General Surgery, Division of Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Hur SM, Cho DH, Lee SK, Choi MY, Bae SY, Koo MY, Kim S, Choe JH, Kim JH, Kim JS, Nam SJ, Yang JH, Lee JE. Experience of treatment of patients with granulomatous lobular mastitis. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2013; 85:1-6. [PMID: 23833753 PMCID: PMC3699681 DOI: 10.4174/jkss.2013.85.1.1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 03/15/2013] [Accepted: 03/18/2013] [Indexed: 12/11/2022]
Abstract
Purpose To present the author's experience with various treatment methods of granulomatous lobular mastitis (GLM) and to determine effective treatment methods of GLM. Methods Fifty patients who were diagnosed with GLM were classified into five groups based on the initial treatment methods they underwent, which included observation (n = 8), antibiotics (n = 3), steroid (n = 13), drainage (n = 14), and surgical excision (n = 12). The treatment processes in each group were examined and their clinical characteristics, treatment processes, and results were analyzed respectively. Results Success rates with each initial treatment were observation, 87.5%; antibiotics, 33.3%; steroids, 30.8%; drainage, 28.6%; and surgical excision, 91.7%. In most cases of observation, the lesions were small and the symptoms were mild. A total of 23 patients underwent surgical excision during treatment. Surgical excision showed particularly fast recovery, high success rate (90.3%) and low recurrence rate (8.7%). Conclusion The clinical course of GLM is complex and the outcome of each treatment type are variable. Surgery may play an important role when a lesion is determined to be mass-forming or appears localized as an abscess pocket during breast examination or imaging study.
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Affiliation(s)
- Sung Mo Hur
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
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An unusual case of bilateral granulomatous mastitis. Case Rep Radiol 2013; 2013:694697. [PMID: 23781373 PMCID: PMC3677014 DOI: 10.1155/2013/694697] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 05/09/2013] [Indexed: 12/13/2022] Open
Abstract
Idiopathic granulomatous mastitis (IGM) is an uncommon benign disorder of the breast. At clinical examination, IGM is characterized by an inflammatory process of the breast, usually unilateral. Possible clinical findings are palpable mass with erythematous skin, pain, sterile abscesses, fistula and nipple retraction. Mammography and ultrasound findings are not specific for IGM. Magnetic resonance imaging (MRI) is a useful tool for the differential diagnosis; it is also necessary to delineate the exact extension of the disease and to plan the correct treatment. Final diagnosis is histological. We described an unusual case of IGM with bilateral involvement in a patient with history of pacemaker implantation and IGM typical clinical symptoms. Mammography, ultrasound, and MRI examinations were performed to identify the inflammatory disorder and to plan the correct therapy. Imaging features were correlated with final histological diagnosis of IGM.
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Jayia P, Oberg E, Tuffaha H, Leff DR, Al-Mufti R, Hadjiminas D. Should We Manage All Cases of Granulomatous Mastitis Conservatively? A 14 year Experience. Breast J 2013; 19:215-6. [DOI: 10.1111/tbj.12087] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Parveen Jayia
- General Surgery Unit; Imperial College Healthcare NHS Trust; St Mary's Hospital; London; England
| | - Emma Oberg
- General Surgery Unit; Imperial College Healthcare NHS Trust; St Mary's Hospital; London; England
| | - Hussain Tuffaha
- General Surgery Unit; Imperial College Healthcare NHS Trust; St Mary's Hospital; London; England
| | - Daniel R. Leff
- General Surgery Unit; Imperial College Healthcare NHS Trust; St Mary's Hospital; London; England
| | - Ragheed Al-Mufti
- General Surgery Unit; Imperial College Healthcare NHS Trust; St Mary's Hospital; London; England
| | - Dimitri Hadjiminas
- General Surgery Unit; Imperial College Healthcare NHS Trust; St Mary's Hospital; London; England
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Abstract
Background Plasma cell mastitis is distinct from the common form of mastitis and clinically resembles breast carcinoma. The lesion occurs in non-lactating young women, and the incidence rate is rising. Surgical resection is the main treatment, but cannot prevent recurrence of the disease. Disfigurement or removal of breast after the operations can cause marked physical and psychological distress. The etiology of plasma cell mastitis is unclear up till now. It is therefore necessary to investigate further the underlying immunological changes of the disease. Methods The lesions of plasma cell mastitis removed from patients through aseptic operation were mixed with normal saline into homogenate tube machine (homogenate tubes were disinfected and sterilized prior to treatment). The mixture was homogenized at medium speed and grinded in ultrasonic cell disruptor. The homogenate obtained was made into oil emulsion with Freund's adjuvant. Thirty female BALB/c mice (6 weeks after sexual maturity) were divided into five groups A-E: group A was blank control; group B was normal saline control; group C was inoculated with 0.02 ml water-in-oil emulsion; group D was inoculated with 0.04 ml water-in-oil emulsion; group E was complete Freund's adjuvant control. Results Pathology results showed that mouse mammary gland acinar cells remained integral without any abnormal changes observed in control groups A and B. Experimental groups C and D showed dilation of mouse mammary ductal tissue with a large number of epithelial cells and debris in the lumen, and fibrosis around ducts accompanied by large duct cells, neutrophils, lymphocytes, and especially plasma cell infiltration. Pathological changes were observed in 3 (50%) mice and 5 (83.3%) mice in group C and D respectively. In group E, neutrophil infiltration in mammary gland was observed in 5 mice, but neither infiltration of plasma cells nor other abnormal pathological changes were observed. Conclusions The lesions of patient with plasma cell mastitis could make the female BALB/c mice experience the similar clinical and pathological manifestation. High-dose group can successfully establish a mouse model of plasma cell mastitis.
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Kayahan M, Kadioglu H, Muslumanoglu M. Management of Patients with Granulomatous Mastitis: Analysis of 31 Cases. ACTA ACUST UNITED AC 2012; 7:226-230. [PMID: 22872797 DOI: 10.1159/000337758] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND: Granulomatous mastitis is a benign recurrent disease. Accurate diagnosis is only by histopathology. PATIENTS AND METHODS: 31 cases with histological diagnosis were retrospectively analyzed. RESULTS: Mean follow-up was 42.4 months for recurrent and 27.8 months for non-recurrent cases. Etiology was tuberculosis in 1 case. 5 cases (16%) relapsed. 6 patients (19.3%) treated with abscess drainage healed completely, but 50% relapsed. Relapses were treated with excision or steroids. Steroid therapy was the initial treatment in 12 cases (38.7%), with 1 relapse (8.3%) which was treated in the same manner. 2 patients had incomplete response necessitating excision, and another 2 developed abscesses which were treated with steroids or excision after drainage. Surgical excision was preferred in 12 cases (38.7%) due to suspicion for carcinoma in 8 patients (25.8%) and/or low probability of poor cosmetic outcome. All healed without complication, and recurrence was observed in 1 case (8.3%) which was treated with re-excision. CONCLUSION: Both excision and steroid therapy had low and similar relapse rates, but excision was superior to steroid therapy in providing strict diagnosis with much faster healing and fewer complications. In refractory cases, and when deformity is inevitable, steroid therapy should be preferred.
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Affiliation(s)
- Munire Kayahan
- Dept. of General Surgery, Bezmialem Vakif University, Istanbul, Turkey
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Boufettal H, Essodegui F, Noun M, Hermas S, Samouh N. Idiopathic granulomatous mastitis: a report of twenty cases. Diagn Interv Imaging 2012; 93:586-96. [PMID: 22677299 DOI: 10.1016/j.diii.2012.04.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Idiopathic granulomatous mastitis is a benign lesion of the mammary gland characterised by the presence of non-infectious inflammatory breast lesions limited to the lobules. OBJECTIVE We report twenty cases of idiopathic granulomatous mastitis (IGM) with a discussion of epidemiology, clinical and diagnostic features, treatment and progress of this pathological entity. MATERIALS AND METHODS A retrospective study of twenty cases compiled from a ten-year period, from 952 pathological anatomy examinations carried out to investigate various breast pathologies. RESULTS The patients had a mean age of 45.5 years. Clinical examinations revealed a tumefaction measuring between 2.5 and 18 cm in diameter. The mean size was 5.5 cm. Mammography showed nodular lesions and sonography demonstrated hypoechoic nodules. On histological examination there was a granulomatous inflammatory infiltrate of epithelioid and giant cells, without caseation necrosis, made up of lymphocytes, plasma cells and neutrophils. Microbiology investigations were negative. Lesion involvement was principally lobulocentric. Surgical excision of the lesions was combined with corticosteroid therapy in twelve cases, with non-steroidal anti-inflammatory drugs in another four and with antibiotic therapy in four cases. The patients made good progress in the short-term. DISCUSSION AND CONCLUSION IGM is a rare entity. It poses a problem of differential diagnosis because it clinically resembles other forms of mastitis. The diagnosis can be made with certainty on histological studies. The treatment is medical alongside surgical excision. The prognosis of this disease remains favourable.
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Affiliation(s)
- Houssine Boufettal
- Department of Obstetrics and Gynaecology C, Ibn Rochd University Hospital, School of Medicine and Pharmacy, Aïn Chok University, Casablanca, Morocco.
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Seo HRN, Na KY, Yim HE, Kim TH, Kang DK, Oh KK, Kang SY, An YS, Chun M, Kim W, Park RW, Jung YS, Kim KS. Differential diagnosis in idiopathic granulomatous mastitis and tuberculous mastitis. J Breast Cancer 2012; 15:111-8. [PMID: 22493637 PMCID: PMC3318162 DOI: 10.4048/jbc.2012.15.1.111] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 02/17/2012] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory disease of unknown etiology. The diagnosis of IGM requires that other granulomatous lesions in the breast be excluded. Tuberculous mastitis (TM) is also an uncommon disease that is often difficult to differentiate from IGM. The purpose of this study is to develop a new algorithm for the differential diagnosis and treatment of IGM and TM. METHODS Medical records of 68 patients (58 with IGM and 10 with TM) between July 1999 and February 2009 were retrospectively reviewed. RESULTS The mean age of the patients was 33.5 (IGM) and 40 (TM) years (p=0.018). The median follow-up was 84 months. Of the total 10 patients with TM, 5 patients had a history of pulmonary tuberculosis. The most common symptoms of the diseases were breast lump and pain. However, axillary lymphadenopathy was more seen in TM (50%) compared to IGM (20.6%) (p=0.048). TM showed more cancer-mimicking findings on radiologic study (p=0.028). In IGM, 48 patients (82.7%) underwent surgical wide excision and 21 patients (36.2%) were managed with corticosteroid therapy and antibiotics. All of the TM patients received anti-tuberculosis medications and 9 patients (90%) underwent wide excision. The mean treatment duration was 2.8 months in IGM and 8.4 months in TM. Recurrence developed in 5 patients (8.6%) in IGM and 1 patient (10%) in TM. CONCLUSION This study shows different characteristics between IGM and TM. The IGM patients were younger and had more mastalgia symptoms than the TM patients. Axillary lymphadenopathy was seen more often in TM patients. Half of the TM patients had pulmonary tuberculosis or tuberculosis lymphadenitis. Surgical wide excision might be both therapeutic and useful for providing an exact diagnosis.
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Affiliation(s)
- Hee Ri Na Seo
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
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Hali F, Khadir K, Idhammou W, Bensardi FZ, Lefriyekh MR, Benider A, Zamiati S, Benchikhi H. Manifestations cutanées du cancer du sein chez l’homme. Presse Med 2011; 40:e483-8. [DOI: 10.1016/j.lpm.2011.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 03/11/2011] [Accepted: 04/04/2011] [Indexed: 10/18/2022] Open
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Sakurai K, Fujisaki S, Enomoto K, Amano S, Sugitani M. Evaluation of follow-up strategies for corticosteroid therapy of idiopathic granulomatous mastitis. Surg Today 2011; 41:333-7. [PMID: 21365412 DOI: 10.1007/s00595-009-4292-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Accepted: 11/16/2009] [Indexed: 02/06/2023]
Abstract
PURPOSE Idiopathic granulomatous mastitis (IGM) is a rare inflammatory pseudotumor. No therapeutic modality has been established because of the rareness of this disease. The aim of this study was to investigate the clinical course of IGM treated with corticosteroid, and to evaluate the optimal methods of observation during corticosteroid therapy of IGM. METHODS The retrospective study included eight women who met the required histological criteria of IGM. The clinical data of the presentation, histopathology, and management were analyzed by reviewing the medical records. RESULTS The mean age of the patients was 44.8 years (range, 28-75 years) and all patients complained of a breast mass. Seven of them had pain. All of them underwent a core needle biopsy and were diagnosed as having IGM. Five took prednisolone orally and three received prednisolone plus antibiotics; one patient of the latter group underwent a resection due to severe pain. Seven patients healed without surgery and it took from 4 to 10 months to achieve a cure. The period until confirmation of the disappearance of a mass was the shortest by palpation, followed by contrast magnetic resonance imaging and ultrasonography in that order. CONCLUSION Steroid therapy was effective for the treatment of IGM, which was cured without surgery in seven of eight cases. Ultrasonography was considered an excellent method for evaluating the treatment outcomes.
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Affiliation(s)
- Kenichi Sakurai
- Division of Breast and Endocrine Surgery, Department of Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
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Ergin AB, Cristofanilli M, Daw H, Tahan G, Gong Y. Recurrent granulomatous mastitis mimicking inflammatory breast cancer. BMJ Case Rep 2011; 2011:2011/jan20_1/bcr0720103156. [PMID: 22715267 DOI: 10.1136/bcr.07.2010.3156] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Granulomatous mastitis (GM) is an uncommon benign breast lesion. Diagnosis is a matter of exclusion from other inflammatory, infectious and granulomatous aetiologies. Here, we presented an atypical GM case, which had clinical and radiologic features overlapping with inflammatory breast cancer (IBC). The disease had multiple recurrences. The patient is a 40-year-old Caucasian woman with a sudden onset of left breast swelling accompanied by diffuse skin redness, especially of the subareolar region and malodorous yellow nipple discharge from the left nipple. The disease progressed on antibiotic treatment and recurred after local resection. A similar lesion developed even after bilateral mastectomy. GM may show clinical/radiologic features suggestive of IBC. Multiple recurrences can be occasionally encountered. GM after recurrence could be much more alarming clinically. Pathology confirmation is the key for accurate diagnosis and a multidisciplinary approach is important to rule out IBC.
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