Idiopathic granulomatous mastitis: case series and clinical review

Idiopathic granulomatous mastitis: a 5-year retrospective review of cases in a tertiary centre in Dublin, Ireland

AIMS

Idiopathic granulomatous mastitis (IGM) is a rare, benign, inflammatory breast disorder of unknown aetiology usually affecting women of reproductive age. It classically presents as a unilateral painful breast mass. It is frequently mistaken for carcinoma or other inflammatory breast diseases. Diagnostic investigations include clinical examination, appropriate imaging and tissue sampling. A link between IGM and infection with the Corynebacterium species in particular Corynebacterium kroppenstedtii has been described.

METHODS

A retrospective single-centre cohort study was conducted over a 5-year period (2017-2022); all cases of IGM were identified.

RESULTS

Forty-one patients were diagnosed with IGM. Breast lump was the most common presenting complaint (n=29). The average age was 45 years. Eighteen patients had samples sent for culture and sensitivity, 11 of which had positive microbiology results indicative of Corynebacterium spp infection.An 82% resolution rate (27 of 33) was recorded in those who received either a short-antibiotic course or none at all. Eight patients reported persistent disease at 3 months, five of which had evidence of Corynebacterium spp.

DISCUSSION

This 5-year review highlights the impact of IGM in a tertiary centre in Dublin, Ireland. Although no treatment guidelines exist, options include antibiotics, immunomodulators and surgery. Due to risk of fistulae and unfavourable cosmetic outcomes, surgery should be reserved for refractory IGM. We suspect that there may be a subset of patients where prolonged antibiotic therapy should be considered. Defining this subgroup requires further study, but likely includes those with cystic neutrophilic granulomatous mastitis, relapsing disease and in whom Corynebacterium spp is recovered.

Cystic neutrophilic granulomatous mastitis: A case report and review of the literature

The present study describes a case of cystic neutrophilic granulomatous mastitis. The clinical and radiological findings of the patient were consistent with idiopathic granulomatous mastitis. Cystic neutrophilic granulomatous mastitis is a rare subtype of mastitis with a distinct histological pattern that is associated with the Corynebacterium species. The diagnosis and treatment of cystic neutrophilic granulomatous mastitis remains a significant challenge due to the scarcity of available data. The present study describes a classic case of cystic neutrophilic granulomatous mastitis that includes clinical, radiological and histopathological findings. To the best of our knowledge, this is the first case documenting radiological findings before and after treatment. This report encourages the consideration of this entity in the differential diagnoses of mastitis.

Idiopathic granulomatous mastitis: A case report and literature review

Key Clinical Message

Idiopathic granulomatous mastitis (IGM) is a challenging chronic inflammatory disease in diagnosis with unknown etiology. Although the most appropriate treatment protocol has not yet been identified, prednisolone was used in our patient as an effective and practical choice in the treatment of IGM.

Abstract

Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory disease of the breast and mimics disorders such as breast cancer and breast abscess. Due to the uncommon of this disease, there is no definitive etiology, or treatment. A 38-year-old woman presented with a 3-week history of painful right retro-areolar mass. She had no history of breast trauma and a family history of breast cancer. She had a history of breastfeeding her second child for 12 months in the past year. Diagnostic tests and investigations led to the IGM diagnosis. Therefore, the patient was successfully treated with a course of corticosteroids, but after 2 months, during treatment, she developed Brucellosis. Despite the patient's Brucella infection and treatment with anti-Brucella drugs, prednisolone as an anti-inflammatory corticosteroid therapy was influential in the treatment of IGM.

What predicts the recurrence in ıdiopathic granulomatous mastitis?

INTRODUCTION

Idiopathic granulomatous mastitis (IGM) is a rarely seen chronic and benign disease of the breast. IGM usually emerges in women between 30 and 45 years of age and within the first 5 years after lactation. There is no consensus on the treatment of the disease. Steroids, immunosuppressive agents such as methotrexate and azathioprine, antibiotics, and surgical and conservative treatments can be preferred. In the present study, it was aimed to demonstrate the treatment options and follow-up data of the patients with IGM and to investigate the effective factors on recurrence if developed in the follow-up period.

MATERIALS AND METHOD

The data of 120 patients diagnosed with idiopathic granulomatous mastitis were evaluated for this cross-sectional retrospective study. The demographic, clinical, treatment, and follow-up features of the patients were obtained from the file records.

RESULTS

The median age value of the 120 female patients included in the study was 35 (24-67) years. Of the patients, 45%, 79.2%, 49.2%, and 15% had a past history of surgical intervention, steroid use, methotrexate use, and azathioprine use, respectively. Recurrent lesion developed after the treatment in 57 (47.5%) patients. The recurrence rate was 66.1% in the patients who underwent surgical intervention in the initial treatment. There was a statistically significant difference between the patients with and without recurrence regarding the presence of abscess, the presence of recurrent abscess, and having surgical intervention as the initial treatment in the past history. The rate of having surgery was statistically significantly higher compared with the administration of steroid therapy alone and the combination of steroid and immunosuppressive therapy in the initial treatment of the patients who developed recurrence. The rate of having surgery together with the administration of steroid and immunosuppressive therapy was statistically significantly higher than the administration of steroid and immunosuppressive therapies.

DISCUSSION

Our study showed that surgical intervention and the presence of abscess increased recurrence in the treatment of IGM. Key Points • This study has shown that surgical intervention and the presence of abscess increase recurrence. • A multidisciplinary approach to the treatment of IGM and management of the disease by the rheumatologists may be critical.

Steroid refractory granulomatous mastitis treated by top surgery: A case report

RATIONALE

Granulomatous mastitis (GM) is a rare inflammatory disease and the presentation mimics infectious mastitis or breast cancer. The disease usually develops at the unilateral breast in women with breast-feeding history at their child-bearing age. Systemic steroids had been proposed as the first-line treatment, the combination of surgery was also recommended for complicated disease. However, recurrence might still happen in some rare cases. Few studies have addressed the management of such difficult situations.

PATIENT CONCERNS

We report the case of a 33-year-old androgynous and nulliparous woman who initially presented left breast erythematous swelling and was treated as infectious mastitis with debridement and antibiotics.

DIAGNOSIS

After wider excision for pathology, the diagnosis of GM was confirmed.

INTERVENTIONS

Steroids combined with methotrexate were prescribed. However, the symptoms only subsided temporarily and progressed to the contralateral side within 3 months. She finally underwent double-incision mastectomy and free nipple grafting.

OUTCOMES

The surgery was completed uneventfully, and she had a satisfactory result with no more recurrence at the 6-month follow-up.

LESSON

This GM case with the refractory treatment courses brought out the importance of surgical resection and was the first case report of treating GM with top surgery in the literature. Total mastectomy facilitated a highest complete remission rate of GM and may be advantageous for selected patients, especially in cases where steroids are intolerable.

Common Complications of Breastfeeding and Lactation: An Overview for Clinicians

Lactation and breastfeeding are core components of reproductive health care and obstetrical providers should be familiar with common complications that may arise in lactating individuals. While many breastfeeding challenges are best addressed by a lactation consultant, there are conditions that fall out of their scope and require care from a clinician. The objective of this chapter is to review common complications of breastfeeding and lactation including inflammatory conditions, disorders of lactogenesis, dermatologic conditions, and persistent pain with lactation.