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Cui LY, Sun CP, Li YY, Liu S. Granulomatous mastitis in a 50-year-old male: A case report and review of literature. World J Clin Cases 2024; 12:451-459. [PMID: 38313639 PMCID: PMC10835698 DOI: 10.12998/wjcc.v12.i2.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/11/2023] [Accepted: 12/21/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Granulomatous mastitis (GM) an inflammatory disease of the breast that usually affects women of childbearing age, occurs very rarely in males. CASE SUMMARY We present a case study of a 50-year-old male patient with GM. The patient developed a breast lump following the cleaning of a previously embedded dirt-filled nipple. While an initial improvement was noted with antibiotic therapy, a recurrence occurred a year later, showing resistance to the previously effective antibiotics. Subsequently, the lesion was excised. The histopathological examination confirmed the diagnosis of GM. CONCLUSION GM should be considered a possible diagnosis of male breast masses.
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Affiliation(s)
- Le-Yin Cui
- Department of Breast Surgery, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Chen-Ping Sun
- Department of Breast Surgery, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Yun-Yuan Li
- Department of Pathology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Sheng Liu
- Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
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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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3
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Shin K, Ruiz-Flores L, Schopp J, Whitman GJ. Granulomatous Mastitis: What Radiologists Should Know With Imaging Examples of Biopsy Proven Cases. Ultrasound Q 2020; 37:34-42. [PMID: 32956245 DOI: 10.1097/ruq.0000000000000534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
ABSTRACT Granulomatous mastitis is a rare benign inflammatory disease of the breast, predominantly affecting women of childbearing age. Because of its low prevalence, the literature is limited, and its treatment algorithm is unclear. However, it is important to understand this disease for timely diagnosis and treatment. Our overview with imaging examples of biopsy-proven cases aims to improve our knowledge and to determine when it would be appropriate to include it in the differential diagnosis.
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Affiliation(s)
- Kyungmin Shin
- Division of Diagnostic Imaging, Department of Breast Imaging, The University of Texas MD Anderson Cancer, Houston
| | - Lorell Ruiz-Flores
- Division of Diagnostic Imaging, Department of Breast Imaging, The University of Texas MD Anderson Cancer, Houston
| | - Jennifer Schopp
- Department of Radiology, Division of Breast Imaging, The University of Texas Southwestern, Dallas, TX
| | - Gary J Whitman
- Division of Diagnostic Imaging, Department of Breast Imaging, The University of Texas MD Anderson Cancer, Houston
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4
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Matich A, Sud S, Buxi TBS, Dogra V. Idiopathic Granulomatous Mastitis and its Mimics on Magnetic Resonance Imaging: A Pictorial Review of Cases from India. J Clin Imaging Sci 2020; 10:53. [PMID: 33024608 PMCID: PMC7533078 DOI: 10.25259/jcis_112_2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 06/11/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: Idiopathic granulomatous mastitis (IGM) is a rare inflammatory disease of the breast, which is benign but potentially morbid. Mammographic and sonographic findings have been well characterized, but magnetic resonance imaging (MRI) findings have been less thoroughly documented. The objective of this study was to demonstrate characteristic findings for IGM and its mimics via a retrospective review. Material and Methods: Breast MRI examinations performed at Sir Ganga Ram Hospital in New Delhi, India between 2014 and 2019 were retrospectively reviewed to identify cases in which a pattern suggestive of granulomatous mastitis was seen. Cases of known malignancy were excluded. Any available breast pathology results were then obtained, and cases with presumptive or definitive diagnoses were compiled for analysis. Results: Overall, cases identified with characteristic imaging findings and confirmed diagnosis included seven cases of IGM, four cases of invasive ductal carcinoma, two cases of tuberculous mastitis, one case of non- tuberculous infectious mastitis, one case of foreign body mastitis, and one case of eosinophilc mastitis. One case of IGM with masses rather than of non-mass enhancement was also identified. Conclusion: In our review, cases with clustered ring enhancement were found to have inflammatory, idiopathic, infectious and malignant etiologies. While, these etiologies can only be reliably differentiated on pathology, familiarity with the pattern and an awareness of the differential may lead to decreased morbidity due to delays in diagnosis.
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Affiliation(s)
- Alison Matich
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, United States
| | - Seema Sud
- Departments of Magnetic Resonance Imaging and Computed Tomography, Sir Ganga Ram Hospital, New Delhi, Delhi, India
| | - T B S Buxi
- Departments of Magnetic Resonance Imaging and Computed Tomography, Sir Ganga Ram Hospital, New Delhi, Delhi, India
| | - Vikram Dogra
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, United States
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Sahin C, Agridag Ucpinar B. Idiopathic granulomatous mastitis in a male breast following intravesical Bacille Calmette–Guerin treatment. J Infect Public Health 2020; 13:830-832. [DOI: 10.1016/j.jiph.2019.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 04/29/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022] Open
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6
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[Idiopathic granulomatous mastitis associated with erythema nodosum]. Ann Dermatol Venereol 2020; 146:571-576. [PMID: 31151772 DOI: 10.1016/j.annder.2019.04.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 12/24/2018] [Accepted: 04/08/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) is a rare, chronic, granulomatous, inflammatory disorder with potentially misleading clinical and radiological features. IGM is diagnosed after exclusion of infectious or tumoral diseases. Herein we report a case of erythema nodosum associated with IGM, which serves as a reminder that erythema nodosum may constitute an extra-mammary sign of IGM. PATIENTS AND METHODS A 36-year-old nulliparous woman presented with fever and skin rash at our dermatology clinic at the North Franche-Comté hospital in July 2017. Symptoms had occurred 2 days previously. The patient had a fever of 38.8°C and typical erythema nodosum on the limbs. Physical examination showed an irregular, inflammatory, abscessed mass measuring 20cm with multiple shrinkage zones that had been developing for 4 weeks and for which breast examinations were being performed. Laboratory tests showed an inflammatory state (CRP 155mg/mL, WBC 14.6×109/L), other tests (serum electrolytes and calcium, hepatic and renal tests, Streptotest, T-spot, HIV, HBV, HCV serology, anti-streptolysin, anti-streptodornase, local microbiology samples, antinuclear antibodies, soluble antigens antibodies, hemocultures, angiotensin-converting-enzyme and chest x-rays) were normal. Microbiology investigations were negative. Mammography revealed invasive mastitis. Breast sample biopsies showed giant cell granulomas without caseous necrosis or tumor cells, and histochemical staining (PAS, Ziehl, Grocott, Gram) was negative. The final diagnosis was of IGM associated with erythema nodosum. Symptoms rapidly improved with oral steroids. DISCUSSION As reported herein, erythema nodosum may be associated with IGM and support the diagnosis thereof. This association is rare, with fewer than 30 case reports described in the literature. IGM is an uncommon benign disorder of the breast that can mimic two frequent breast disorders: breast carcinoma and breast abscess. It usually occurs in young sexually active women. It appears as a tumor with an inflammatory solid painful mass, with nipple and skin retraction, occasionally with abscesses and accompanied by homolateral axillary lymphadenopathies. Radiologic findings are usually not specific for or suggestive of cancer. The histopathological picture of IGM is characterized by the presence of multinucleated giant cells and epithelioid histiocytes forming non-caseating granulomas around lobules. Minor ductal and periductal inflammation is usually present. IGM is rarely associated with autoimmune system manifestations, especially erythema nodosum, arthritis, episcleritis or hidradenitis suppurativa. Although the physiopathology of IGM remains unclear, this case serves as additional evidence that the etiology of IGM is of autoimmune origin. While there is no recommendation for the treatment of IGM, oral steroids remain the cornerstone of therapy. CONCLUSION We report a case of IGM associated with erythema nodosum. Dermatologists must be aware of this association.
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Önder Ö, Azizova A, Durhan G, Elibol FD, Akpınar MG, Demirkazık F. Imaging findings and classification of the common and uncommon male breast diseases. Insights Imaging 2020; 11:27. [PMID: 32072386 PMCID: PMC7028902 DOI: 10.1186/s13244-019-0834-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/18/2019] [Indexed: 02/06/2023] Open
Abstract
Male breast hosts various pathological conditions just like "female breast." However, histo-anatomical diversities with female breast lead to many differences regarding the frequency and presentation of diseases, the radiologic appearance of lesions, the diagnostic algorithm, and malignity features.Radiological modalities may play an important role in evaluating male breast lesions. Although some imaging findings are non-specific, having knowledge of certain imaging characteristics and radiologic patterns is the key to reduce the number of differential diagnoses or to reach an accurate diagnosis.Male breast imaging is mostly based on physical examination and is required for the complaints of palpable mass, breast enlargement, tenderness, nipple discharge, and nipple-skin changes. The majority of the male breast lumps are benign and the most common reason is gynecomastia. Although it is difficult to exclude malignancy in some cases, gynecomastia often has distinguishable imaging features. Pseudogynecomastia is another differential diagnosis that may be confused with gynecomastia. The distinction is important for the treatment plan.Apart from gynecomastia, other male breast lesions form a highly heterogeneous group and can be classified based on "Tissue origin," "Histopathological type and behavior," and "Radiologic features" for both simplification and comprehensive understanding.This article mainly focuses on emphasizing the results of basic histo-anatomical differences of male and female breasts, classifying male breast lesions, covering the spectrum of male breast diseases, and assisting radiologists in recognizing the imaging findings, in interpreting them through a holistic approach, in making a differential diagnosis, and in being a part of proper patient management.
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Affiliation(s)
- Ömer Önder
- Department of Radiology, School of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Aynur Azizova
- Department of Radiology, School of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Gamze Durhan
- Department of Radiology, School of Medicine, Hacettepe University, 06100, Ankara, Turkey.
| | - Funda Dinç Elibol
- Department of Radiology, School of Medicine, Muğla Sıtkı Koçman University, 48000, Muğla, Turkey
| | - Meltem Gülsün Akpınar
- Department of Radiology, School of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Figen Demirkazık
- Department of Radiology, School of Medicine, Hacettepe University, 06100, Ankara, Turkey
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Granulomatous Mastitis and Factors Associated with Recurrence: An 11-Year Single-Centre Study of 113 Patients in Singapore. World J Surg 2019; 43:1737-1745. [PMID: 31049604 DOI: 10.1007/s00268-019-05014-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Granulomatous mastitis (GM) is an inflammatory breast disease of unknown aetiology. It poses diagnostic and therapeutic challenges with myriad forms of clinical presentation, varying results to treatments and propensity to recur. This study aims to look at clinical and treatment factors that predispose to recurrence of GM. METHODS We performed a retrospective review of 113 patients in our unit with histologically proven GM from 2006 to 2016. Demographic, clinical, treatment and outcomes data were collected and analysed. RESULTS Eighty-nine patients were treated with antibiotics (78.8%), 79 (69.9%) with steroids and 23 (20.4%) patients underwent surgery. Twenty (17.7%) patients had recurrence. Patients who presented with inflammatory signs and symptoms had increased odds of having subsequent recurrence: skin changes (1.50), pain (2.00), fistula (4.39) and antibiotic treatment (6.65). Four patients (20%) with recurrence had positive bacterial cultures. All 4 grew Corynebacterium. Patients with Corynebacterium infection had a 2.64 times higher risk of recurrence. Surgery did not preclude recurrence. There was a 70% (7/10) penicillin resistance rate in our patients with positive cultures for Corynebacterium. CONCLUSION Initial presentation with inflammatory signs and symptoms may confer increased risk of recurrence, warranting closer monitoring. Corynebacterium infection may play a part as a causative factor and risk factor for recurrence. Non-penicillin antibiotics should be considered as first-line antibiotics for patients presenting with inflammatory changes. Further prospective studies with larger patient populations might reveal information on the aetiology of GM and result in the development of a more standardized and effective treatment regimen.
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9
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Pluguez-Turull CW, Nanyes JE, Quintero CJ, Alizai H, Mais DD, Kist KA, Dornbluth NC. Idiopathic Granulomatous Mastitis: Manifestations at Multimodality Imaging and Pitfalls. Radiographics 2018. [DOI: 10.1148/rg.2018170095] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Cedric W. Pluguez-Turull
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Jennifer E. Nanyes
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Cristina J. Quintero
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Hamza Alizai
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Daniel D. Mais
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Kenneth A. Kist
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
| | - Nella C. Dornbluth
- From the Departments of Radiology (C.W.P.T., J.E.N., H.A., K.A.K., N.C.D.) and Pathology (D.D.M.), University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; and Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, Pa (C.J.Q.)
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Moris D, Damaskos C, Davakis S, Vailas M, Garmpis N, Spartalis E, Kontos M, Kontzoglou K. Is idiopathic granulomatous mastitis a surgical disease? The jury is still out. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:309. [PMID: 28856149 DOI: 10.21037/atm.2017.05.24] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Idiopathic granulomatous mastitis (IGM), is a rare entity of chronic inflammatory disorder of the breast of unknown etiology. Very few cases have been described so far, almost exclusively in women. Here we describe a case of IGM in a 53-year-old man presented with a right breast mass, progressively enlarging during the last 6 months. Due to the findings of clinical examination and CT-scan, the suspicion for a potentially malignant lesion was given and the decision for surgical resection was made. Microscopic analysis of the specimen showed non-caseating granulomas around mammary lobules, findings compatible with IGM. The patient is recurrence-free at 18-month follow-up. IGM is a rare benign inflammatory breast disease, usually seen in females of reproductive age. Establishing a diagnosis can be challenging for a surgeon and requires a high index of suspicion as most patients are initially misdiagnosed by their primary care physicians. Steroids and immunosuppressive drugs are considered as fundamental treatment modalities but they are correlated with increased rates of disease response and recurrence. On the contrary, surgical resection demonstrated significantly superior results compared to steroid-alone treatment in terms of recurrence and post-treatment recovery.
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Affiliation(s)
- Demetrios Moris
- Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Damaskos
- Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Davakis
- Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Michail Vailas
- Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Garmpis
- Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftherios Spartalis
- Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Kontos
- Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Kontzoglou
- Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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11
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Prasad S, Jaiprakash P, Dave A, Pai D. Idiopathic granulomatous mastitis: an institutional experience. Turk J Surg 2017; 33:100-103. [PMID: 28740959 DOI: 10.5152/turkjsurg.2017.3439] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 03/24/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To study idiopathic granulomatous mastitis with respect to its various clinical features, etiologic factors, treatment modalities and complications. MATERIAL AND METHODS Retrospective study of all patients who were diagnosed with idiopathic granulomatous mastitis from 1st January 2006 to 31st December 2014 at Kasturba Hospital, Manipal, India (a tertiary care referral centre). The research was performed according to the World Medical Association Declaration of Helsinki. Informed consent was taken from the patient before invasive procedures including surgery. Data was analysed using the Statistical Package for Social Sciences version 16.0 wherever appropriate. RESULTS 73 patients diagnosed with idiopathic granulomatous mastitis during the time period were included. One patient was a male (1.37%), rest were all females (98.63%). The mean age of presentation was 32.67 years (range 23 to 66 years). 70 patients (95.89%) were parous females. Average duration since last childbirth was 4.6 years (range: 3 months to 33 years). 8 patients (10.95%) were lactating. History of oral contraceptive pill use was present in 40 patients (54.79%). The right breast was affected in 44 patients (60.27%), and the left breast in 29 patients (39.73%). None of the patients had bilateral disease. The most common symptom was a painless lump (61.64%). Rest of the patients (38.36%) presented with features of a breast abscess. 19 out of 39 FNACs done (48.72%) were positive for granulomatous mastitis. 59 were primarily managed surgically (lumpectomy/wide excision-33, incision & drainage-26). One patient was treated primarily with prednisolone. 13 patients did not receive specific treatment, and were only kept on regular follow-up. Patients managed with lumpectomy/wide excision had the least rate of complications & recurrence (18.18%). CONCLUSION Patients with idiopathic granulomatous mastitis can present with a wide variety of symptoms which mimic other more common conditions. Surgical management in the form of wide excision appears to provide the best long term outcome in patients with idiopathic granulomatous mastitis.
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Affiliation(s)
- Seetharam Prasad
- Department of General Surgery, Kasturba Medical College, Manipal, India
| | | | - Aniket Dave
- Department of General Surgery, Kasturba Medical College, Manipal, India
| | - Deepti Pai
- Department of General Surgery, Kasturba Medical College, Manipal, India
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Al Manasra ARA, Al-Hurani MF. Granulomatous Mastitis: A Rare Cause of Male Breast Lump. Case Rep Oncol 2016; 9:516-519. [PMID: 27721777 PMCID: PMC5043282 DOI: 10.1159/000448990] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 08/09/2016] [Indexed: 11/21/2022] Open
Abstract
Background Mastitis is a common benign disorder of the female breast. It is frequently associated with tenderness, swelling and nipple discharge. We are describing an extremely rare case of an idiopathic granulomatous mastitis in the male breast. Only 1 previous case was reported. Case Report A 29-year-old male patient presented with a hard, painless lump in the right breast of 2 weeks duration. The patient underwent surgical excision with margin. The histopathologic findings were consistent with granulomatous mastitis. The case was reported as idiopathic granulomatous mastitis after exclusion of all known causes of the disease. Conclusion Granulomatous mastitis is rare in females and extremely rare in male breast tissue. Since this disease mimics breast cancer in its clinical picture and radiologic findings are usually not conclusive, surgical excision is recommended in all cases.
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Affiliation(s)
- Abdel Rahman A Al Manasra
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad F Al-Hurani
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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13
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Fazzio RT, Shah SS, Sandhu NP, Glazebrook KN. Idiopathic granulomatous mastitis: imaging update and review. Insights Imaging 2016; 7:531-9. [PMID: 27221974 PMCID: PMC4956627 DOI: 10.1007/s13244-016-0499-0] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 04/02/2016] [Accepted: 05/03/2016] [Indexed: 12/15/2022] Open
Abstract
Objectives The purpose of this study was to review the imaging features of idiopathic granulomatous mastitis (IGM) with clinical and pathology correlation. Methods With institutional review board (IRB) approval, a retrospective search of the surgical pathology database from January 2000 to July 2015 was performed. Clinical, imaging and histology findings were reviewed. Cases of granulomatous mastitis without a known source, diagnosed with percutaneous or surgical biopsy, were included in our analysis. Results Seventeen cases of IGM were identified with imaging available for review. The majority of patients presented with a palpable abnormality, whereas a minority were asymptomatic with an abnormal screening mammogram. At imaging, IGM most often demonstrated a focal asymmetry at mammography, a hypoechoic mass with irregular or angular margins at ultrasound, and robust enhancement with mixed progressive and plateau kinetics at magnetic resonance imaging (MRI). Axillary lymph nodes were reactive in appearance at ultrasound. Molecular breast imaging performed in one case showed mild focal asymmetric radiotracer uptake. Conclusion IGM is a rapidly progressive rare inflammatory condition of the breast resulting in non-necrotizing granuloma formation. Imaging features mimic breast carcinoma and diagnosis can be difficult. Radiologists’ awareness of this condition is essential to prevent delayed or unnecessary treatment. Teaching points • Idiopathic granulomatous mastitis is rapidly progressive inflammatory condition. • Imaging features may mimic breast carcinoma or infection. • Ultrasound shows irregular hypoechoic masses with increased vascularity and sinus tracts. • MRI shows irregular, enhancing masses or non-mass enhancement with microabscesses. • MRI is useful for assessment of breast involvement and response to treatment.
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Affiliation(s)
- Robert T Fazzio
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
| | - Sejal S Shah
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Nicole P Sandhu
- Department of Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Katrina N Glazebrook
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
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Raman R T, Manimaran D. Idiopath=ic Granulomatous Lobular Mastitis Masquerading as a Breast Tumor: A Case Report. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e33982. [PMID: 27437133 PMCID: PMC4939413 DOI: 10.5812/ircmj.33982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 11/28/2015] [Accepted: 03/05/2016] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Idiopathic granulomatous lobular mastitis (IGLM) is an inflammatory disease of the breast with an obscure etiology. It occurs mainly in women of reproductive age, and the lesion mimics carcinoma of the breast both clinically and radiologically. CASE PRESENTATION We present the case of a 29-year-old female who visited our hospital in Kancheepuram, Tamil Nadu, with a 4 × 3 cm lump in the upper outer quadrant of her left breast. The clinical and radiological findings were indicative of a malignant lesion; however, fine-needle aspiration cytology (FNAC) revealed features of granulomatous mastitis, and the subsequent histology of the excised lump confirmed the diagnosis of IGLM. CONCLUSIONS IGLM should be considered as one of the differential diagnoses when granulomas are encountered in breast FNAC and biopsy. A definitive diagnosis of IGLM can be made by identifying its characteristic histomorphology and ruling out other causes for granulomatous inflammation. An exact diagnosis is essential since the treatment for different granulomatous conditions of the breast varies.
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Affiliation(s)
- Thulasi Raman R
- Department of Pathology, Shri Sathya Sai Medical College and Research Institute, Tamil Nadu, India
- Corresponding Author: Thulasi Raman R, Department of Pathology, Shri Sathya Sai Medical College and Research Institute, Tamil Nadu, India. Tel: +91-8939452506, E-mail:
| | - D Manimaran
- Department of Pathology, Shri Sathya Sai Medical College and Research Institute, Tamil Nadu, India
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Laas E, Touboul C, Kerdraon O, Catteau-Jonard S. Mastites inflammatoires et infectieuses du sein en dehors de la grossesse et de la période d’allaitement : recommandations. ACTA ACUST UNITED AC 2015; 44:996-1016. [DOI: 10.1016/j.jgyn.2015.09.055] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 09/25/2015] [Accepted: 09/25/2015] [Indexed: 10/22/2022]
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La mastite granulomateuse idiopathique. Rev Med Interne 2013; 34:358-62. [DOI: 10.1016/j.revmed.2012.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 07/31/2012] [Indexed: 01/14/2023]
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Abstract
Idiopathic granulomatous lobular mastitis (IGLM) is a rare breast condition with prominent skin findings. It is typically seen in young parous women. Painful breast masses, draining sinuses, scarring, and breast atrophy are the main clinical manifestations. IGLM can resemble a variety of other inflammatory and neoplastic processes of the breast. It is thought to result from obstruction and rupture of breast lobules. Extravasated breast secretions then induce an inflammatory reaction. Corynebacteria have also been implicated in the pathogenesis. Treatment is surgical, but systemic corticosteroids, methotrexate, and antibiotics also play a role.
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Akbulut S, Yilmaz D, Bakir S. Methotrexate in the management of idiopathic granulomatous mastitis: review of 108 published cases and report of four cases. Breast J 2011; 17:661-8. [PMID: 21951547 DOI: 10.1111/j.1524-4741.2011.01162.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This study aimed to discuss the role of agents, such as steroids and methotrexate (MTX), in the treatment of patients with idiopathic granulomatous mastitis (IGM). Using Pubmed and Google Scholar data bases, a retrospective study was carried out on IGM cases treated with steroids and/or MTX between 1972 and 2010. Four IGM cases treated with MTX at our clinic were also summarized in this study. A total of 541 IGM cases since 1972, including ours, were retrospectively analyzed. Steroid treatment 5-85 mg was administered over 5 days-22 months to 112 patients aged 21-48 years. Recurrence occurred in 22 patients, steroid-induced diabetes mellitus in 5 patients, no response to treatment was observed in 4 patients, in 2 patients, the mass decreased in size, and static disease was observed in one. The steroid treatment was changed to MTX treatment in 4 patients who had recurrence, 5 with steroid-induced DM and in 4 who were nonrespondents. Three patients were started on steroid together with MTX as a primary treatment. Of the patients treated with MTX, a satisfactory result was obtained in 14 cases and in 2, mastectomy was performed because of recurrence despite the treatment with MTX. IGM is a troublesome condition that presents management problems due to the side effects of steroids. Our study demonstrates that the use of MTX in IGM cases has been effective in preventing complications, in resolving the inflammatory process, and in limiting side effects of corticosteroids.
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Affiliation(s)
- Sami Akbulut
- Department of Surgery Department of Pathology, Diyarbakir Education and Research Hospital, Dagkapi, Diyarbakir, Turkey.
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Hwang MJ, Rogers A, Vidya R. Idiopathic granulomatous mastitis: rare but important. BMJ Case Rep 2010; 2010:2010/sep10_1/bcr1020092334. [PMID: 22778243 DOI: 10.1136/bcr.10.2009.2334] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 61-year-old woman attended the breast clinic with unresolving mastitis and an associated mass, following failed treatment with antibiotics. Triple assessment confirmed idiopathic granulomatous mastitis. Unresponsive to further conservative management and steroid therapy, she underwent surgical excision and made uneventful recovery. No evidence of recurrence was detected at 18 months follow-up.
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Affiliation(s)
- M J Hwang
- Department of General Surgery, Stafford Hospital, Kings Norton, Birmingham, UK.
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Martella S, Matthes AGZ, Bassi F, Fasani R, De Lorenzi F, Gatti G, Luini A. Lupus mastitis in male mimicking a breast lump. Int J Surg 2008; 6:e67-9. [PMID: 17462967 DOI: 10.1016/j.ijsu.2007.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2007] [Accepted: 02/27/2007] [Indexed: 11/27/2022]
Affiliation(s)
- Stefano Martella
- European Institute of Oncology, Division of Plastic and Reconstructive Surgery, Via Ripamonti 435, 20141 Milan, Italy
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