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Chan A, Berman H, Zaid SK, Ghai S, Kulkarni S, Freitas V. Streamlining diagnosis of melanoma metastasis to the breast: A case report emphasizing distinctive MRI features as crucial diagnostic tool. Radiol Case Rep 2025; 20:3898-3902. [PMID: 40492160 PMCID: PMC12148502 DOI: 10.1016/j.radcr.2025.04.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2025] [Revised: 04/13/2025] [Accepted: 04/17/2025] [Indexed: 06/11/2025] Open
Abstract
This article describes the case of a 60-year-old woman with a remote history of uveal melanoma who presented with breast metastasis. The breast imaging findings are thoroughly discussed, covering conventional imaging, MRI, and PET-CT, with particular emphasis on the unique imaging characteristics of metastatic melanoma on MRI, which is notably different from other breast pathologies due to the paramagnetic properties of melanin. These properties contribute to a characteristic signal pattern that aids in distinguishing melanoma from other breast lesions, facilitating the diagnosis.
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Affiliation(s)
- Andrew Chan
- Joint Department of Medical Imaging, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada
| | - Hal Berman
- Department of Laboratory Medicine and Pathobiology, Laboratory Medicine Program, University of Toronto, University Health Network, 200 Elizabeth Street, 11-E444, Toronto, Ontario M5G 2C4, Canada
| | - Saeed Kamil Zaid
- Department of Laboratory Medicine and Pathobiology, Laboratory Medicine Program, University of Toronto, University Health Network, 200 Elizabeth Street, 11-E444, Toronto, Ontario M5G 2C4, Canada
| | - Sandeep Ghai
- Joint Department of Medical Imaging, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada
| | - Supriya Kulkarni
- Joint Department of Medical Imaging, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada
| | - Vivianne Freitas
- Joint Department of Medical Imaging, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada
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Rizzo L, Hovanessian-Larsen L, Yamashita M, Lei X, Cen S, Choi J, Lee T, Lee S. Idiopathic Granulomatous Mastitis: Imaging Findings and Outcomes with Nonsteroidal Treatment in a Predominantly Hispanic Population. JOURNAL OF BREAST IMAGING 2025; 7:63-74. [PMID: 39228113 DOI: 10.1093/jbi/wbae051] [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] [Received: 03/06/2024] [Indexed: 09/05/2024]
Abstract
OBJECTIVE We describe the demographics, clinical presentation, imaging findings, and treatment response among 235 cases of biopsy-proven idiopathic granulomatous mastitis (IGM) at a single institution. METHODS An institutional review board-approved retrospective search of the breast imaging database was performed to select patients with biopsy-proven IGM between 2017 and 2022. Retrospective review evaluated clinical presentation, imaging findings with US and mammography, and treatment recommendations (antibiotics, nonsteroidal anti-inflammatory drugs [NSAIDs], warm compresses, or observation only). Response to treatment was evaluated on follow-up US. A favorable treatment response was a decrease in size or resolution of disease on follow-up imaging. Statistical analysis using Poisson regression was performed to evaluate the clinical outcomes associated with each treatment. RESULTS A total of 235 patients met the selection criteria with a mean age of 38 years (18 to 68). The majority of patients were Hispanic (95%, 223/235). Of all patients, 75.3% (177/235) received treatment (consisting of 1 or any combination of antibiotics, NSAIDs, warm compresses), 24.7% (58/235) were treated with observation, 78.7% (185/235) returned for follow-up imaging, and 21.3% (50/235) were lost to follow-up. Of those with follow-up imaging, disease improvement was seen in 70.3% (102/145) of patients who received treatment compared with 72.5% (29/40) of patients treated by observation alone. Multivariate analysis further showed no difference in clinical outcomes among the treatment of unifocal, multifocal, or recurrent IGM. CONCLUSION Nonsteroidal treatment of IGM showed no significant improvement on follow-up imaging compared to treatment with observation alone in a predominantly Hispanic patient population.
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Affiliation(s)
- Lucien Rizzo
- Department of Radiology, Keck School of Medicine, University of California, Los Angeles, CA,USA
| | | | - Mary Yamashita
- Department of Radiology, Keck School of Medicine, University of California, Los Angeles, CA,USA
| | - Xiaomeng Lei
- Department of Radiology, Keck School of Medicine, University of California, Los Angeles, CA,USA
| | - Steven Cen
- Department of Radiology, Keck School of Medicine, University of California, Los Angeles, CA,USA
| | - Jennifer Choi
- Department of Radiology, Keck School of Medicine, University of California, Los Angeles, CA,USA
| | - Tiffany Lee
- Department of Pathology, Keck School of Medicine, University of California, Los Angeles, CA,USA
| | - Sandy Lee
- Department of Radiology, Keck School of Medicine, University of California, Los Angeles, CA,USA
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Alper F, Abbasguliyev H, Yalcin A, Cankaya BY, Ozmen S, Akçay MN, Aydin F, Yeşilyurt M. Ultrasonography-based staging of inflammatory granulomatous mastitis and estimation of steroid response. Br J Radiol 2024; 97:1538-1544. [PMID: 38538829 PMCID: PMC11332675 DOI: 10.1093/bjr/tqae069] [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] [Received: 11/12/2023] [Revised: 02/16/2024] [Accepted: 03/20/2024] [Indexed: 08/21/2024] Open
Abstract
OBJECTIVES The aim of this study is to present novel diagnostic ultrasonography (USG)-based classification of inflammatory granulomatous mastitis (IGM) and to assess and compare dosage responses of locoregional steroid therapy. METHODS From January 2017 through March 2023, total of 230 biopsy-proven IGM patients were reclassified (grades I, II, and III) according to USG-based morphological features. The injection applications were grouped in Group1 (40 mg/mL between years 2017 and 2019) versus Group2 (80 mg/mL between years 2019 and 2023), and effectiveness was analysed for each grade in between groups. RESULTS The mean age was 31 years old (range: 19-60) with median follow-up period of 7 months. The most common clinical presentation was breast mass accompanying draining skin sinuses of the affected skin and hypoechogenic mass with tubular extensions was the most prevalent feature on USG examination. As per USG-based features, 79 (34.3%) patients were redefined as grade I, 64 (27.8%) as grade II, and 87 (37.8%) as grade III. All patients underwent locoregional steroid injection only. The average number of treatments in the first group was 6 (±3 SD) with an effective dose of 40 mg/mL in the first group, and 4 (±2 SD) with an effective dose of 80 mg/mL in the second group. The generalized linear mixed model was used to investigate effects between groups (P < .05). CONCLUSIONS High-dose steroid treatment was effective in burnout lesions (grades II and III), and it was found to be statistically significant in lowering number of treatments irrespective of grade. ADVANCES IN KNOWLEDGE This novel classification could be a convenient tool in terms of common language between radiologists and clinicians. In addition, our study is a pioneer in comparing steroid dosage with no relapse in IGM patients.
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Affiliation(s)
- Fatih Alper
- Department of Diagnostic and Interventional Radiology, Ataturk University Research Hospital, Erzurum 25700, Turkey
| | - Hasan Abbasguliyev
- Department of Diagnostic and Interventional Radiology, Ataturk University Research Hospital, Erzurum 25700, Turkey
| | - Ahmet Yalcin
- Department of Diagnostic and Interventional Radiology, Ataturk University Research Hospital, Erzurum 25700, Turkey
| | - Bahar Yilmaz Cankaya
- Department of Diagnostic and Interventional Radiology, Ataturk University Research Hospital, Erzurum 25700, Turkey
| | - Sevilay Ozmen
- Department of Pathology, Ataturk University Research Hospital, Erzurum 25700, Turkey
| | - Müfide Nuran Akçay
- Department of General Surgery, Ataturk University Research Hospital, Erzurum 25700, Turkey
| | - Fahri Aydin
- Department of Diagnostic and Interventional Radiology, Ataturk University Research Hospital, Erzurum 25700, Turkey
| | - Mustafa Yeşilyurt
- Department of Diagnostic and Interventional Radiology, Ataturk University Research Hospital, Erzurum 25700, Turkey
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Moldoveanu D, Lee C, Hesley G. Framework and guide for intralesional steroid injections in idiopathic granulomatous mastitis. Eur J Radiol 2023; 168:111118. [PMID: 37804652 DOI: 10.1016/j.ejrad.2023.111118] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/06/2023] [Accepted: 09/26/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE Literature on how to perform intralesional steroid injections, a valuable therapy for idiopathic granulomatous mastitis (IGM), is limited. This technical note offers a detailed technical guide on intralesional steroid injections for IGM and provides a framework for long-term follow-up. METHODS Ultrasound characterization of IGM severity considering breadth, depth, and ancillary findings was used to guide steroid dosing and injection frequency. Clinical and sonographic breast diagrams were designed for accurate longitudinal tracking of IGM. A step-by-step guide for ultrasound-guided IGM aspirations and intralesional steroid injections was developed. RESULTS A detailed approach for ultrasound-guided IGM interventions with clinical and sonographic breast diagrams for longitudinal follow-up is now in practice. CONCLUSIONS The treatment approach described provides a framework for multidisciplinary treatment of IGM and offers insights that may contribute to the ongoing development and improvement of management strategies for this challenging disease.
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Affiliation(s)
- Dan Moldoveanu
- Department of Surgery, Breast and Melanoma Surgical Oncology, Mayo Clinic, 200 First St SW, Rochester MN, 55905, United States.
| | - Christine Lee
- Department of Radiology, Breast Imaging and Intervention, Mayo Clinic, 200 First St SW, Rochester MN, 55905, United States. https://twitter.com/MayoRadiology
| | - Gina Hesley
- Department of Radiology, Breast Imaging and Intervention, Mayo Clinic, 200 First St SW, Rochester MN, 55905, United States.
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Chen X, Shao S, Wu X, Feng J, Qu W, Gao Q, Sun J, Wan H. LC/MS-based untargeted lipidomics reveals lipid signatures of nonpuerperal mastitis. Lipids Health Dis 2023; 22:122. [PMID: 37553678 PMCID: PMC10408177 DOI: 10.1186/s12944-023-01887-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/28/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Nonpuerperal mastitis (NPM) is a disease that presents with redness, swelling, heat, and pain during nonlactation and can often be confused with breast cancer. The etiology of NPM remains elusive; however, emerging clinical evidence suggests a potential involvement of lipid metabolism. METHOD Liquid chromatography‒mass spectrometry (LC/MS)-based untargeted lipidomics analysis combined with multivariate statistics was performed to investigate the NPM lipid change in breast tissue. Twenty patients with NPM and 10 controls were enrolled in this study. RESULTS The results revealed significant differences in lipidomics profiles, and a total of 16 subclasses with 14,012 different lipids were identified in positive and negative ion modes. Among these lipids, triglycerides (TGs), phosphatidylethanolamines (PEs) and cardiolipins (CLs) were the top three lipid components between the NPM and control groups. Subsequently, a total of 35 lipids were subjected to screening as potential biomarkers, and the chosen lipid biomarkers exhibited enhanced discriminatory capability between the two groups. Furthermore, pathway analysis elucidated that the aforementioned alterations in lipids were primarily associated with the arachidonic acid metabolic pathway. The correlation between distinct lipid populations and clinical phenotypes was assessed through weighted gene coexpression network analysis (WGCNA). CONCLUSIONS This study demonstrates that untargeted lipidomics assays conducted on breast tissue samples from patients with NPM exhibit noteworthy alterations in lipidomes. The findings of this study highlight the substantial involvement of arachidonic acid metabolism in lipid metabolism within the context of NPM. Consequently, this study offers valuable insights that can contribute to a more comprehensive comprehension of NPM in subsequent investigations. TRIAL REGISTRATION Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine (Number: 2019-702-57; Date: July 2019).
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Affiliation(s)
- Xiaoxiao Chen
- Department of Breast, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200001, China
- Shanghai University of Traditional Chinese Medicine, Shanghai, 200000, China
| | - Shijun Shao
- Department of Breast, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200001, China
| | - Xueqing Wu
- Department of Breast, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200001, China
| | - Jiamei Feng
- Department of Breast, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200001, China
| | - Wenchao Qu
- Department of Breast, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200001, China
| | - Qingqian Gao
- Department of Breast, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200001, China
| | - Jiaye Sun
- Department of Breast, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200001, China
| | - Hua Wan
- Department of Breast, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200001, China.
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Soylu Boy FN, Esen Icten G, Kayadibi Y, Tasdelen I, Alver D. Idiopathic Granulomatous Mastitis or Breast Cancer? A Comparative MRI Study in Patients Presenting with Non-Mass Enhancement. Diagnostics (Basel) 2023; 13:diagnostics13081475. [PMID: 37189576 DOI: 10.3390/diagnostics13081475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/20/2023] [Accepted: 03/16/2023] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE To compare and determine discriminative magnetic resonance imaging (MRI) findings of idiopathic granulomatous mastitis (IGM) and breast cancer (BC) that present as non-mass enhancement. MATERIALS AND METHODS This retrospective study includes 68 IGM and 75 BC cases that presented with non-mass enhancement on breast MRI. All patients with a previous history of breast surgery, radiotherapy, or chemotherapy due to BC or a previous history of mastitis were excluded. On MRI images, presence of architectural distortion skin thickening, edema, hyperintense ducts containing protein, dilated fat-containing ducts and axillary adenopathies were noted. Cysts with enhancing walls, lesion size, lesion location, fistulas, distribution, internal enhancement pattern and kinetic features of non-mass enhancement were recorded. Apparent diffusion coefficient (ADC) values were calculated. Pearson chi-square test, Fisher's exact test, independent t test and Mann-Whitney U test were used as needed for statistical analysis and comparison. Multivariate logistic regression model was used to determine the independent predictors. RESULTS IGM patients were significantly younger than BC patients (p < 0.001). Cysts with thin (p < 0.05) or thick walls (p = 0.001), multiple cystic lesions, (p < 0.001), cystic lesions draining to the skin (p < 0.001), and skin fistulas (p < 0.05) were detected more often in IGM. Central (p < 0.05) and periareolar (p < 0.001) location and focal skin thickening (p < 0.05) were significantly more common in IGM. Architectural distortion (p = 0.001) and diffuse skin thickening (p < 0.05) were associated with BC. Multiple regional distribution was more common in IGM, whereas diffuse distribution and clumped enhancement were more common in BC (p < 0.05). In kinetic analysis, persistent enhancement was more common in IGM, whereas plateau and wash-out types were more common in BC (p < 0.001). Independent predictors for BC were age, diffuse skin thickening and kinetic curve types. There was no significant difference in the diffusion characteristics. Based on these findings, MRI had a sensitivity, specificity and accuracy of 88%, 67.65%, and 78.32%, respectively, in differentiating IGM from BC. CONCLUSIONS In conclusion, for non-mass enhancement, MRI can rule out malignancy with a considerably high sensitivity; however, specificity is still low, as many IGM patients have overlapping findings. Final diagnosis should be complemented with histopathology whenever necessary.
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Affiliation(s)
- Fatma Nur Soylu Boy
- Department of Radiology, Fatih Sultan Mehmet Training and Research Hospital, 34758 Istanbul, Turkey
| | - Gul Esen Icten
- Senology Research Institute, Acibadem Mehmet Ali Aydınlar University, 34457 Istanbul, Turkey
- Department of Radiology, School of Medicine, Acibadem Mehmet Ali Aydınlar University, 34457 Istanbul, Turkey
| | - Yasemin Kayadibi
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, 34320 Istanbul, Turkey
| | - Iksan Tasdelen
- Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, 34758 Istanbul, Turkey
| | - Dolunay Alver
- Department of Radiology, Fatih Sultan Mehmet Training and Research Hospital, 34758 Istanbul, Turkey
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Mohindra N, Jain N, Sabaretnam M, Agrawal V, Mishra P, Chaturvedi P, Mishra A, Agarwal G. Mammography and Digital Breast Tomosynthesis in Granulomatous and Nongranulomatous Mastitis. J Surg Res 2023; 281:13-21. [PMID: 36108534 DOI: 10.1016/j.jss.2022.08.009] [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: 04/05/2022] [Revised: 07/13/2022] [Accepted: 08/17/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Digital Mammography (DM) is extensively used for breast imaging however, lesion visibility is often limited by overlapping tissues, which affects lesion characterization. Digital breast tomosynthesis (DBT) reduces the effect of overlapping tissues and helps in revealing obscured findings. We aimed to describe the mammographic findings in granulomatous and non-granulomatous mastitis and assess the utility of adjunctive DBT in lesion characterization. MATERIALS AND METHODS DM and DBT images of histo-pathologically diagnosed cases of granulomatous (GM) and non-granulomatous mastitis (NGM) were reviewed according to the BI-RADS lexicon. Presence of contiguous/ interconnected lesions, tubular densities, interspersed hypodensities/fat densities within the involved areas were also assessed. The perceived utility of adjunct DBT was scored from 0-2. RESULTS Of 33 reviewed patients (24 GM, 9 NGM; median age 39 years, range 24-78); 13/33 (39.4%) were under 35 years of age. DBT detected masses in 24/33 (72.7%), whereas only 15/33 (45.4%) were visible on DM alone. Contiguous or inter-connected lesions were found in 10/33 (30.3%) cases. Tubular extensions were seen in 14 cases and interspersed hypodensities in 15. None of the enlarged lymph nodes had irregular shape or indistinct margins or loss of fatty hilum. DBT was able to categorize more lesions as BIRADS 4a or below, as compared to DM alone. CONCLUSIONS Mammographic presence of multiple contiguous iso-dense masses, reniform contour of axillary lymph nodes with preserved fatty hilum despite a large area of breast involvement favour a benign etiology; especially if DBT reveals tubular extensions or lesions with inhomogenous low density areas within.
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Affiliation(s)
- Namita Mohindra
- Department of Radio-Diagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India.
| | - Neeraj Jain
- Department of Radio-Diagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Mayilvaganan Sabaretnam
- Department of Endocrine & Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Vinita Agrawal
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Prabhakar Mishra
- Department of Biostatistics, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Pragya Chaturvedi
- Department of Radio-Diagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Anjali Mishra
- Department of Endocrine & Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Gaurav Agarwal
- Department of Endocrine & Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
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Aydin I, Kesicioglu T, Vural S, Sengul I, Yilmaz K, Sengul D. Idiopathic Granulomatous Lobular Mastitis: An Imitation of Breast Carcinoma. Cureus 2021; 13:e15206. [PMID: 34055560 PMCID: PMC8148625 DOI: 10.7759/cureus.15206] [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] [Indexed: 11/28/2022] Open
Abstract
Since idiopathic granulomatous lobular mastitis, also known as idiopathic granulomatous mastitis or granulomatous lobulitis, was first described by Kessler and Wolloch in 1972, no consensus on the ideal and definitive treatment for this phenomenon has been reached thus far. Idiopathic granulomatous lobular mastitis mostly frequently observed in women of childbearing age within a few years of pregnancy with a higher incidence in patients of Hispanic, Native American, Middle Eastern, and African descent. This entity, per se, is a rare, benign, chronic inflammatory breast condition of unknown aetiology mimicking two common breast disorders. The first is breast inflammations or infection, such as cystic neutrophilic granulomatous mastitis; granulomatous mastitis due to Corynebacterium;other infections with granulomas, mycobacteria, fungi, cat scratch disease, and Brucella; granulomatosis with polyangiitis (Wegener's granulomatosis); sarcoidosis; and squamous metaplasia of lactiferous ducts. The second is breast carcinoma in some challenging cases. Of note, no consensus, per se, has been declared on its therapeutic management. The following vignette case described in this report involves idiopathic granulomatous lobular mastitis imitating breast carcinoma. It is important to note that, the aetiology of idiopathic granulomatous lobular mastitis is unknown, its diagnosis is difficult, and physicians should be vigilant and aware of this condition in order of abstaining from an overtreatment for malignancy or overlooking a true malignancy.
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Affiliation(s)
- Ismail Aydin
- General Surgery, Giresun University Faculty of Medicine, Giresun, TUR
| | - Tugrul Kesicioglu
- General Surgery, Giresun University Faculty of Medicine, Giresun, TUR
| | - Selahattin Vural
- General Surgery, Giresun University Faculty of Medicine, Giresun, TUR
| | - Ilker Sengul
- Endocrine Surgery, General Surgery, Giresun University Faculty of Medicine, Giresun, TUR
| | - Kivanc Yilmaz
- Pathology, Ministry of Health-Giresun University Education and Research Hospital, Giresun, TUR
| | - Demet Sengul
- Pathology, Giresun University Faculty of Medicine, Giresun, TUR
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Guirguis MS, Adrada B, Santiago L, Candelaria R, Arribas E. Mimickers of breast malignancy: imaging findings, pathologic concordance and clinical management. Insights Imaging 2021; 12:53. [PMID: 33877461 PMCID: PMC8058137 DOI: 10.1186/s13244-021-00991-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/23/2021] [Indexed: 12/18/2022] Open
Abstract
Many benign breast entities have a clinical and imaging presentation that can mimic breast cancer. The purpose of this review is to illustrate the wide spectrum of imaging features that can be associated with benign breast diseases with an emphasis on the suspicious imaging findings associated with these benign conditions that can mimic cancer. As radiologic-pathologic correlation can be particularly challenging in these cases, the radiologist’s familiarity with these benign entities and their imaging features is essential to ensure that a benign pathology result is accepted as concordant when appropriate and that a suitable management plan is formulated.
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Affiliation(s)
- Mary S Guirguis
- Breast Imaging Department, MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX, 77030-4009, USA.
| | - Beatriz Adrada
- Breast Imaging Department, MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX, 77030-4009, USA
| | - Lumarie Santiago
- Breast Imaging Department, MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX, 77030-4009, USA
| | - Rosalind Candelaria
- Breast Imaging Department, MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX, 77030-4009, USA
| | - Elsa Arribas
- Breast Imaging Department, MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX, 77030-4009, USA
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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: 36] [Impact Index Per Article: 9.0] [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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11
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Granulomatous mastitis, erythema nodosum and arthritis syndrome: case-based review. Rheumatol Int 2021; 41:1175-1181. [PMID: 33649961 DOI: 10.1007/s00296-021-04820-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/20/2021] [Indexed: 10/22/2022]
Abstract
Granulomatous mastitis (GM) is a rare form of inflammatory breast condition associated with unilateral or bilateral breast pain, swelling and mass formation. Although the disease pathogenesis remains unknown, several reports have associated GM with manifestations such as erythema nodosum and occasionally with arthritis, suggesting that GM might have an autoimmune disease component. We aim to describe two cases of coexistence of GM, erythema nodosum, and arthritis. We also conducted a literature review to comprehensively assess and describe the characteristics of patients with GM, erythema nodosum, and arthritis, and identify effective treatment options. A literature review was conducted using PubMed and EMBASE, and 14 case reports/series were retrieved, with a total number of 29 patients. All patients are women and unilateral breast involvement was evident in the majority of patients. Nine patients (31%) presented with arthritis, 6 patients (20.7%) had a fever, and 6 patients (20.7%) developed the symptoms during pregnancy. All patients had normal chest radiograph and tissue cultures were negative. In most of the cases (n = 25, 86.2%), symptom improvement was observed with glucocorticoids and four patients (13.8%) underwent surgical treatment for the GM. Given the clinical characteristics of patients with GM, with erythema nodosum, with or without arthritis, and the positive response to glucocorticoids, we propose that the described phenotype represents an underrecognized systemic autoimmune disease that could be designated by the acronym "GMENA" (granulomatous mastitis, erythema nodosum, arthritis) syndrome. Further studies are needed to elucidate the pathogenesis of the syndrome.
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Maranhão N, Maranhão B. Practical considerations for evaluation of images of the breast during pregnancy and lactation. Radiol Bras 2021; 54:VII-VIII. [PMID: 33574635 PMCID: PMC7863715 DOI: 10.1590/0100-3984.2021.54.1e2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Norma Maranhão
- Member of the National Mammography Commission of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), Director of Lucilo Maranhão Diagnósticos, Recife, PE, Brazil. E-mail:
| | - Beatriz Maranhão
- Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Director of Lucilo Maranhão Diagnósticos, Recife, PE, Brazil. E-mail:
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Manogna P, Dev B, Joseph LD, Ramakrishnan R. Idiopathic granulomatous mastitis—our experience. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-019-0126-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Abstract
Background
Idiopathic granulomatous mastitis (IGM) is a rare benign chronic inflammatory condition of the breast and is most commonly seen in women of childbearing age. The etiology is uncertain, and an autoimmune association has been suggested with the diagnosis usually made by exclusion. The clinical and radiological features often mimic that of breast cancer and hence confirmed early diagnosis is required to avoid misdiagnosis and unnecessary delay in the treatment.
Results
The most common clinical presentation of granulomatous mastitis is unilateral palpable breast lump with or without associated pain. The typical ultrasound finding is an ill-defined, irregular heterogeneous, predominantly hypoechoic lesion with multiple tentacles. Histologic features show a well-defined non-necrotizing epitheloid granulomas along with Langhans type giant cells.
Conclusion
Imaging features mimic that of breast cancer, and final diagnosis of granulomatous mastitis always requires specific pathologic findings while excluding other causes.
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Rosas CHDS, Góes ACDA, Saltão LM, Tanaka AMDS, Marques EF, Bitencourt AGV. Pregnancy-lactation cycle: how to use imaging methods for breast evaluation. Radiol Bras 2020; 53:405-412. [PMID: 33304009 PMCID: PMC7720671 DOI: 10.1590/0100-3984.2019.0071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Pregnancy and lactation constitute states of intense hormonal variation with secretory and structural changes in the breast parenchyma. These changes translate into important features on breast imaging, as well as the emergence of specific benign and malignant lesions. This literature review aims to discuss the safety of the use of breast imaging methods (mammography, ultrasound, and magnetic resonance imaging) during the pregnancy-lactation cycle, and to present the expected physiological changes and imaging appearance of the main breast diseases that may occur in this period, such as galactocele, lactating adenoma, fibroadenoma, puerperal mastitis, and pregnancy-associated breast cancer.
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15
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Ennasser H, Raoudi JE, Taheri H, Saadi H, Mimouni A. [Idiopathic granulomatous mastitis: 4 case-reports and literature review]. Pan Afr Med J 2020; 37:128. [PMID: 33425161 PMCID: PMC7755357 DOI: 10.11604/pamj.2020.37.128.25301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/26/2020] [Indexed: 11/11/2022] Open
Abstract
Idiopathic granulomatous mastitis is a rare benign inflammatory mastopathy. Histological examination of the surgical biopsy can confirm the diagnosis and thus exclude carcinomatous mastitis. Although its etiologies are undeterminated and it occurs mainly in young women, its idiopathic nature is confirmed after exclusion of the other causes of granulomatous disease. Medical treatment is based on antibiotic therapy and anti-inflammatory drugs. Patients with complicated forms are treated with surgery. We here report four cases of idiopathic granulomatous mastitis whose data were collected in the Department of Gynecology and Obstetrics at the University Hospital MED VI of Oujda (Morocco).
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Affiliation(s)
- Hind Ennasser
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Mohammed VI Oujda, Oujda, Maroc
| | - Jamal Eddine Raoudi
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Mohammed VI Oujda, Oujda, Maroc
| | - Hafsa Taheri
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Mohammed VI Oujda, Oujda, Maroc
| | - Hanane Saadi
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Mohammed VI Oujda, Oujda, Maroc
| | - Ahmed Mimouni
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Mohammed VI Oujda, Oujda, Maroc
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16
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Gupta N, Vats M, Garg M, Dahiya DS. Bilateral idiopathic granulomatous mastitis. BMJ Case Rep 2020; 13:13/8/e234979. [PMID: 32868320 DOI: 10.1136/bcr-2020-234979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
A 35-year-old woman presented to the surgery outpatient department with a lump in her right breast for 2 months and pain for 1 month. After clinical examination and relevant investigations, we kept a working diagnosis of antibioma. The lump was excised under local anaesthesia and biopsy was sent. However, histopathological examination reported multiple non-caseating granulomas without acid-fast bacilli. Two months later, she developed a sinus with serous discharge at the scar site. At the same time, she developed pain in the left upper breast, which subsequently progressed to an abscess. Incision and drainage of the abscess was done, but the wound did not heal, and a discharging sinus appeared at the site. Finally, a diagnosis of idiopathic granulomatous mastitis was made, after excluding all other causes, and the patient was prescribed oral steroids. She recovered fully after 8 months and there is no recurrence till date.
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Affiliation(s)
- Nikhil Gupta
- Department of Surgery, PGIMER, Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Manu Vats
- Department of Surgery, PGIMER, Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Mradul Garg
- Department of Minimal Invasive, GI and Bariatric Surgery, Metro Heart Institute with Multispeciality, Faridabad, India
| | - Davinder Singh Dahiya
- Department of Advanced Laparoscopy, Gastrointestinal and Bariatric Surgery, Noble Heart Super Speciality Hospital, Rohtak, India
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17
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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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Hu J, Huang X. Combining ultrasonography and mammography to improve diagnostic accuracy of plasma cell mastitis. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2020; 28:555-561. [PMID: 32333573 DOI: 10.3233/xst-190607] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To evaluate the diagnostic value of ultrasonography and mammography for plasma cell mastitis. METHODS The ultrasonographic and mammographic images of 111 women with histopathologically confirmed plasma cell mastitis were retrospectively analyzed. The diagnostic accuracy of the two imaging methods was compared. RESULTS Ultrasonography identified 91 out of 111 (82.0%) patients with plasma cell mastitis, while the other twenty (18.0%) patients were misdiagnosed. Mammography identified 83 (74.8%) out of 111 patients with plasma cell mastitis. Nineteen (17.1%) patients were misdiagnosed. There was no significant difference between the diagnostic accuracy of using two imaging tests (P = 0.127). Mammography clouds identified 11 out of 20 patients who were not diagnosed by ultrasonography. Meanwhile, 19 of the 28 cases misdiagnosed with mammography were correctly identified by ultrasonography. Overall, 91.9% (102/111) of the patients were identified by the combination of ultrasonography and mammography, which yielded statistically significant higher accuracy than using each single test only (P < 0.05). CONCLUSIONS In diagnosis of plasma cell mastitis, high-frequency ultrasonography and mammography should be combined to improve the diagnostic accuracy.
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Affiliation(s)
- Jun Hu
- Department of Ultrasound, Chonggang General Hospital, Chongqing, China
- Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoling Huang
- Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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19
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Marshall L, Cleaver D, Cleaver L, Cleaver J. Mastitis to mastectomy: a rare, unresponsive postpartum eruption. Int J Dermatol 2019; 59:e92-e95. [PMID: 31498886 DOI: 10.1111/ijd.14640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 07/31/2019] [Accepted: 08/09/2019] [Indexed: 12/01/2022]
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20
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Alrayes A, Almarzooq R, Abdulla HA. Surgical treatment of granulomatous mastitis: Our experience in Bahrain. Breast J 2019; 25:958-962. [DOI: 10.1111/tbj.13378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/08/2019] [Accepted: 02/11/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Amal Alrayes
- Department of Surgery Salmaniya Medical Complex Manama Bahrain
| | - Raed Almarzooq
- Department of Surgery Salmaniya Medical Complex Manama Bahrain
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21
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Maione C, Palumbo VD, Maffongelli A, Damiano G, Buscemi S, Spinelli G, Fazzotta S, Gulotta E, Buscemi G, Lo Monte AI. Diagnostic techniques and multidisciplinary approach in idiopathic granulomatous mastitis: a revision of the literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:11-15. [PMID: 30889150 PMCID: PMC6502167 DOI: 10.23750/abm.v90i1.6607] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 04/10/2018] [Indexed: 12/23/2022]
Abstract
Idiopathic granulomatous mastitis (IGM) is a chronic benign inflammatory disease of the breast that may mimic breast cancer. It is most common in parous young fertile women, although it can occur in nulliparous women and in men. IGM is an idiopathic disease due to the influence of some environmental factors in genetically predisposed subjects. Several pathogenic hypothesis have been proposed in the last years (autoimmune, hormonal, infective genesis). IGM presents as a painful palpable mass located in one of the two udders. The skin is usually normal but could present signs of inflammation with or without lymph nodes involvement. Ultrasonography, mammography, magnetic resonance can be diagnosed an IGM, but pathognomonic radiological signs has not yet reported in literature. Biopsy findings show granulomatous lesion centered on the breast lobule, as in granulomatous mastitis induced by tuberculosis or sarcoidosis. The aim of this review of literature is to verify the development of new advanced diagnostic techniques and multidisciplinary approach for this condition. In the last years innovative approaches have modified IGM diagnosis and therapy, avoiding surgery in most of cases, introducing a more conservative medical approach based on recent etiopathological hypothesis. (www.actabiomedica.it)
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22
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Sarigoz T, Ertan T, Topuz O, Sevim Y, Cihan Y. Role of digital infrared thermal imaging in the diagnosis of breast mass: A pilot study. INFRARED PHYSICS & TECHNOLOGY 2018; 91:214-219. [DOI: 10.1016/j.infrared.2018.04.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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23
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Severs FJ, Guevara L, Sam KQ, Roark A, Benveniste AP, Ebuoma L. Granulomatous Mastitis of the Breast: A Malicious Mimic. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2018; 34:223-228. [DOI: 10.1177/8756479317750107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
Granulomatous mastitis (GM) is a rare and benign condition of the breast. The condition most commonly affects women of childbearing age and is commonly associated with pregnancy, breastfeeding, and oral contraceptive use. The symptoms and imaging characteristics of GM often mimic those of breast carcinomas. Imaging findings tend to be less pronounced by mammography, and GM can be mammographically occult, making sonography important in identifying the condition. Proper identification of this entity is important to prevent misdiagnosis and/or delayed treatment. The diagnosis is commonly made by tissue sampling under ultrasound guidance.
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Affiliation(s)
- Frederick J. Severs
- Department of Diagnostic and Interventional Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Lindsey Guevara
- Department of Diagnostic and Interventional Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Kenny Q. Sam
- Department of Diagnostic and Interventional Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Ashley Roark
- Department of Diagnostic and Interventional Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Ana Paula Benveniste
- Department of Diagnostic and Interventional Radiology, Baylor College of Medicine, Houston, TX, USA
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24
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Granulomatous diseases of the breast and axilla: radiological findings with pathological correlation. Insights Imaging 2018; 9:59-71. [PMID: 29404980 PMCID: PMC5825314 DOI: 10.1007/s13244-017-0587-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 12/05/2017] [Accepted: 12/13/2017] [Indexed: 12/04/2022] Open
Abstract
Objectives This article reviews our experience and describes the literature findings of granulomatous diseases of the breast and axilla. Methods After approval of the Institutional Review Board was obtained, the surgical pathological records from January 2000 to January 2017 were searched for the keyword granulomatous. Clinical, imaging and histology findings were reviewed by both a fellowship-trained radiologist and a breast-imaging consultant radiologist, reviewing 127 patients (age range, 32–86 years; 126 women and 1 man). Results Most common causes of granulomatous lesions of the breast and axilla included silicone granulomas 33% (n = 42), fat necrosis 29% (n = 37) and suture granulomas 11% (n = 14). In 16% (n = 20), no cause could be found and clinical history was consistent with idiopathic granulomatous mastitis. Other granulomatous aetiologies included granulomatous infections, sarcoidosis and Sjögren’s syndrome. Causes of axillary granulomatous disease were similar to the breast; however, a case of cat-scratch disease was found that only involved the axillary lymph nodes. They can have a variable appearance on imaging and may mimic malignancy with irregular masses seen on mammography, ultrasound and magnetic resonance imaging. Fistulas to the skin and nipple retraction can suggest chronicity and a granulomatous aetiology. Combination of clinical history, laboratory and imaging findings can be diagnostic. Conclusions Granulomatous processes of the breast are rare. The diagnosis can, however, be made if there is relevant history (prior trauma, silicone breast implants, lactation), laboratory (systemic or infectious processes) and imaging findings (fistula, nipple retraction). Recognising these entities is important for establishing pathological concordance after biopsy and for preventing unnecessary treatment. Teaching points Breast granulomatous are rare but can mimic breast carcinoma on imaging Imaging with clinical and laboratory findings can correctly diagnosis specific granulomatous breast diseases Recognition of the imaging findings allows appropriate pathological concordance and treatment
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25
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Abstract
Idiopathic granulomatous lobular matitis (IGLM) is a rare non-specific inflammatory disease of the breast. Although IGLM is completely benign, it is easily confused with cancer due to progressive breast lump with firmly unilateral and discrete mass, nipple retraction and sinus formation. Patients with IGLM are usually associated with inflammation of the overlying skin. This study aimed to investigate the clinical characteristics of IGLM, treatment options and prognosis. From January 2010 to February 2015, 75 IGLM patients in our hospital were included, with an average age of 35.9 ± 10.0 (range 21-61) years. Most of them were parous. The main clinical characteristic was the presence of a large, irregular and painful mass. Hypoechoic lobulated, irregular tubular or oval shaped masses were detected by breast gland ultrasound. Ill-defined mass, enlarged axillary lymph nodes, asymmetric density, and architectural distortion were found by breast molybdenum palladium X-ray. Diagnosis of IGLM was confirmed with histological examination. The majority (60/75) of the IGLM patients received surgical treatment, including lumpectomy, abscess drainage or mastectomy. Antibiotics were used after surgery. The disease recurred in three patients during the follow-up period. Our study suggested that IGLM diagnosis more depends on CNB and postoperative histopathological examination, and surgery and symptomatic treatment can completely remove the lesions, in order to cure the disease.
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Affiliation(s)
- Jieqing Li
- a Department of Breast Surgery, Tianjin Central Hospital of Gynecology and Obstetrics , Tianjin , China
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26
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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: 52] [Impact Index Per Article: 6.5] [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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27
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Sam KQ, Severs FJ, Ebuoma LO, Chandandeep NS, Sedgwick EL. Granulomatous Mastitis in a Transgender Patient. J Radiol Case Rep 2017; 11:16-22. [PMID: 28580069 PMCID: PMC5443635 DOI: 10.3941/jrcr.v11i2.2934] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Granulomatous mastitis is a rare and benign inflammatory condition of the breast most commonly affecting women of child-bearing age as well as patients on oral contraceptives. This condition is important to identify due to its diagnostic mimicry of malicious entities such as breast carcinoma. Clinical and radiological findings are nonspecific and may overlap with breast carcinomas, thus pathologic confirmation is often necessary for definitive diagnosis. Although cases of granulomatous mastitis have been described in cisgender females, there have been no reported cases in the transgender patient, a growing patient population with few imaging guidelines. Transgender patients are at risk of developing this breast entity due to the use of long-term hormone treatments or presence of residual breast tissue. A trial of antibiotics or steroids may be administered. However, surgical treatment is often necessary in recurrent or refractory cases.
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Affiliation(s)
- Kenny Q Sam
- Department of Diagnostic and Interventional Radiology, Baylor College of Medicine, Houston, USA
| | - Frederick J Severs
- Department of Diagnostic and Interventional Radiology, Baylor College of Medicine, Houston, USA
| | - Lilian O Ebuoma
- Department of Diagnostic and Interventional Radiology, Baylor College of Medicine, Houston, USA
| | - Nagi S Chandandeep
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, USA
| | - Emily L Sedgwick
- Department of Diagnostic and Interventional Radiology, Baylor College of Medicine, Houston, USA
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28
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AKIN M, KARABACAK H, ESENDAĞLI G, YAVUZ A, GÜLTEKİN S, DİKMEN K, BOSTANCI H. Coexistence of idiopathic granulomatous mastitis and erythemanodosum: successful treatment with corticosteroids. Turk J Med Sci 2017; 47:1590-1592. [DOI: 10.3906/sag-1611-100] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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29
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de Holanda AAR, Gonçalves AKDS, de Medeiros RD, de Oliveira AMG, Maranhão TMDO. Ultrasound findings of the physiological changes and most common breast diseases during pregnancy and lactation. Radiol Bras 2016; 49:389-396. [PMID: 28057965 PMCID: PMC5210035 DOI: 10.1590/0100-3984.2015.0076] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Because of the physiological changes that occur during pregnancy and lactation,
diagnostic ultrasound of the breast during these periods is a challenge for
physicians. Therefore, a comprehensive understanding of imaging, anatomy, and
physiology of the breast is important to effectively diagnosing diseases that
can arise in women who are pregnancy or lactating. The aim of this article was
to review the physiological changes that occur in the breasts during pregnancy
and lactation, as well as to describe the main features of the breast diseases
that occur most frequently during these periods.
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Affiliation(s)
- Antônio Arildo Reginaldo de Holanda
- MSc, Doctoral Student in the Graduate Program in Health Sciences at the Universidade Federal do Rio Grande do Norte (UFRN), Physician at the Maternidade Escola Januário Cicco, Natal, RN, Brazil
| | - Ana Katherine da Silveira Gonçalves
- PhD, Associate Professor in the Department of Obstetrics and Gynecology at the Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil
| | - Robinson Dias de Medeiros
- PhD, Adjunct Professor in the Department of Obstetrics and Gynecology at the Universidade Federal do Rio Grande do Norte (UFRN), Physician at the Maternidade Escola Januário Cicco, Natal, RN, Brazil
| | | | - Técia Maria de Oliveira Maranhão
- PhD, Full Professor in the Department of Obstetrics and Gynecology at the Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil
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30
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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: 25] [Impact Index Per Article: 2.8] [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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31
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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: 79] [Impact Index Per Article: 8.8] [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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Poyraz N, Emlik GD, Batur A, Gundes E, Keskin S. Magnetic Resonance Imaging Features of Idiopathic Granulomatous Mastitis: A Retrospective Analysis. IRANIAN JOURNAL OF RADIOLOGY 2016; 13:e20873. [PMID: 27853486 PMCID: PMC5106557 DOI: 10.5812/iranjradiol.20873] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 11/14/2014] [Accepted: 11/24/2014] [Indexed: 11/16/2022]
Abstract
Background Granulomatous mastitis is a rare and benign inflammatory breast disease that may clinically and radiologically mimic breast cancer. Objectives The aim of this study was to evaluate the features of idiopathic granulomatous mastitis (IGM) on breast magnetic resonance imaging (MRI) with mammographic and sonographic findings. Patients and Methods A retrospective analysis was conducted on 20 patients with IGM who had been diagnosed by needle core or excisional biopsy at a single institution between 2006 and 2012. All of the patients underwent MRI for suspicious breast findings prior to biopsy. MRI examinations were performed on a 1.5 T scanner. The MRI findings were evaluated in accordance with the breast imaging-reporting and data system (BI-RADS) MRI lexicon established by the American College of Radiology. Results MRI detected a total of 29 lesions in the 20 patients. Fourteen of these lesions were seen as mass enhancements, with the remaining 15 identified as non-mass enhancements (NMEs). The median size of all lesions was 3.6 cm (range, 0.7 - 6.7 cm). The most frequently observed features were masses with a round shape (9 out of 14, 64%), smooth contour (11 out of 14, 78%), and a rim enhancement pattern (10 out of 14, 71%). The most common features of the 15 NME lesions were segmental distribution (6 out of 15, 40%) and heterogeneous enhancement patterns (8 out of 15, 53%). The time-intensity curves of the dynamic studies showed benign type one signal intensity (persistent enhancement pattern) in the majority of lesions (10 out of 20, 50%). Conclusion Our study suggests that breast MRI findings of IGM have a wide spectrum. Rim enhancement patterns are frequently seen on contrast enhanced images, but the imaging findings are nonspecific and cannot be used definitively to distinguish between benign and malignant lesions.
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Affiliation(s)
- Necdet Poyraz
- Department of Radiology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
- Corresponding author: Necdet Poyraz, Department of Radiology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey. Tel: +90-5334931774, Fax: +90-3322237967, E-mail:
| | - Ganime Dilek Emlik
- Department of Radiology, School of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Abdussamet Batur
- Department of Radiology, School of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Ebubekir Gundes
- Department of General Surgery, Agri State Hospital, Agri, Turkey
| | - Suat Keskin
- Department of Radiology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
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Sripathi S, Ayachit A, Bala A, Kadavigere R, Kumar S. Idiopathic granulomatous mastitis: a diagnostic dilemma for the breast radiologist. Insights Imaging 2016; 7:523-9. [PMID: 27164916 PMCID: PMC4956625 DOI: 10.1007/s13244-016-0497-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 04/12/2016] [Accepted: 04/22/2016] [Indexed: 02/07/2023] Open
Abstract
Background Idiopathic granulomatous mastitis is a chronic inflammatory disease of the breast, which is often difficult to differentiate both clinically and radiologically from infectious aetiologies such as tuberculosis, fungal infections, and also from malignancy, thus posing a diagnostic dilemma. We present a pictorial review of the commonly encountered imaging findings in idiopathic granulomatous mastitis on mammography and ultrasound. Materials and methods Mammographic and ultrasound findings of histopathologically proven cases of granulomatous mastitis are discussed. Conclusion Idiopathic granulomatous mastitis has varied and non-specific appearances on ultrasound and mammography. Histopathology is essential to establish diagnosis. Teaching Points • Idiopathic granulomatous mastitis often poses a diagnostic dilemma for the radiologist by mimicking malignancy. • It has varied and non-specific appearances on mammography and ultrasound. • Histopathology is mandatory to establish the diagnosis and decide management.
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Affiliation(s)
- Smiti Sripathi
- Department of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal, Karnataka, India.
| | - Anurag Ayachit
- Department of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal, Karnataka, India
| | - Archana Bala
- Department of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal, Karnataka, India
| | - Rajagopal Kadavigere
- Department of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal, Karnataka, India
| | - Sandeep Kumar
- Department of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal, Karnataka, India
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Bilal A, Badar Albadar F, Bashir Barlas N. Granulomatous Mastitis: Imaging of Temporal Evolution. SCIENTIFICA 2016; 2016:3737528. [PMID: 27051554 PMCID: PMC4802017 DOI: 10.1155/2016/3737528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 02/08/2016] [Indexed: 06/05/2023]
Abstract
Aim. To assess the temporal imaging evolution of granulomatous mastitis and to review imaging findings. Material and Methods. Retrospective review of imaging data of 10 patients with biopsy proven granulomatous mastitis. The patients were divided into 3 groups according to their initial imaging presentation. Temporal evolution of imaging findings was observed separately for each group. Ratios, proportions, and percentages were used for data analysis. Results. Upon initial presentation, 75% of women who underwent mammogram showed an area of mass like architectural distortion. 25% demonstrated focal asymmetry. Complex cystic lesion was seen 40%. Multiple abscesses with sinus tract formation tracking into surrounding tissues were seen in 2 cases. Four out of 10 patients presented as edematous changes. Three out of this group progressed to develop complex cystic lesions/abscess formation. 25% presenting with complex cystic lesions or abscess at presentation showed spontaneous resolution. The remainder needed surgical treatment. The patients with abscess formation and sinus tract formation needed surgical management. Conclusion. Initial imaging findings in granulomatous mastitis can be variable but the eventual course and outcome is similar in most patients with surgical management required in most cases.
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Affiliation(s)
- Ahmed Bilal
- Department of Medical Imaging, King Khalid University Hospital, Riyadh 61421, Saudi Arabia
| | - Fahad Badar Albadar
- Department of Medical Imaging, King Khalid University Hospital, Riyadh 61421, Saudi Arabia
| | - Nauman Bashir Barlas
- Northumbria HealthCare NHS Foundation Trust, Wansbeck General Hospital, Ashington NE63 9JJ, UK
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Lee EJ, Han SH, Kang BJ, Kim SH. Imaging and Pathologic Characterization of the Skin Thickening or Enhancement under the Breast MRI. ACTA ACUST UNITED AC 2016. [DOI: 10.13104/imri.2016.20.1.9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Eun Jae Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Hee Han
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bong Joo Kang
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Hun Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Aghajanzadeh M, Hassanzadeh R, Alizadeh Sefat S, Alavi A, Hemmati H, Esmaeili Delshad MS, Emir Alavi C, Rimaz S, Geranmayeh S, Najafi Ashtiani M, Habibzadeh SM, Rasam K, Massahniya S. Granulomatous mastitis: Presentations, diagnosis, treatment and outcome in 206 patients from the north of Iran. Breast 2015; 24:456-60. [PMID: 25935828 DOI: 10.1016/j.breast.2015.04.003] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 03/31/2015] [Accepted: 04/08/2015] [Indexed: 02/08/2023] Open
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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: 29] [Impact Index Per Article: 2.9] [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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Inflammatory diseases of the non-lactating female breasts. Int J Surg 2015; 13:8-11. [DOI: 10.1016/j.ijsu.2014.11.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 11/18/2014] [Accepted: 11/21/2014] [Indexed: 11/20/2022]
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Altintoprak F, Kivilcim T, Ozkan OV. Aetiology of idiopathic granulomatous mastitis. World J Clin Cases 2014; 2:852-858. [PMID: 25516860 PMCID: PMC4266833 DOI: 10.12998/wjcc.v2.i12.852] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 07/07/2014] [Accepted: 10/10/2014] [Indexed: 02/05/2023] Open
Abstract
Idiopathic granulomatous mastitis is a rare chronic inflammatory lesion of the breast that can clinically and radiographically mimic breast carcinoma. The most common clinical presentation is an unilateral, discrete breast mass, nipple retraction and even a sinus formation often associated with an inflammation of the overlying skin. The etiology of idiopathic granulomatous mastitis is still obscure. Its treatment remains controversial. The cause may be the autoimmune process, infection, a chemical reaction associated with oral contraceptive pills, or even lactation. Various factors, including hormonal imbalance, autoimmunity, unknown microbiological agents, smoking and α 1-antitrypsin deficiency have been suggested to play a role in disease aetiology. In this review, causing factors in the aetiology of idiopathic granulomatous mastitis are reviewed in detail.
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Brouwer A, Degrieck N, Rasschaert M, Lockefeer F, Huizing M, Tjalma W. Tuberculous mastitis presenting as a lump: a mimicking disease in a pregnant woman case report and review of literature. Acta Clin Belg 2014; 69:389-94. [PMID: 25056489 DOI: 10.1179/2295333714y.0000000048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Tuberculosis (TB) of the breast is a rare entity, and can be confused with many other breast disorders, like mamma carcinoma or inflammatory breast cancer. When finding granulomatous mastitis (GM) on histology, it is important to make a differential diagnosis and seek actively for clues on the presence of tuberculosis, sarcoidosis, Wegener's granulomatosis, or idiopathic granulomatous mastitis, since treatment strategies differ and maltreatment has major implications on morbidity and mortality. An extensive clinical evaluation, laboratory work up, and imaging will lead in most cases to the right diagnosis. Anti-tuberculous therapy is the core treatment for breast TB, and surgery is indicated for extensive or persistent residual disease. Here we present a case of tuberculous mastitis and a review of literature on GM.
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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: 38] [Impact Index Per Article: 3.5] [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: 34] [Impact Index Per Article: 3.1] [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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Granulomatous mastitis: changing clinical and imaging features with image-guided biopsy correlation. Eur Radiol 2014; 24:2404-11. [PMID: 24962828 DOI: 10.1007/s00330-014-3273-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/25/2014] [Accepted: 06/03/2014] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To review clinical presentation, revisit patient demographics and imaging findings in granulomatous mastitis and determine the optimal biopsy method for diagnosis. METHODS A retrospective study was performed to review the clinical presentation, imaging findings and biopsy methods in patients with granulomatous mastitis. Twenty-seven patients with pathology-proven granulomatous mastitis were included. RESULTS The average age at presentation was 38.0 years (range, 21-73 years). Seven patients were between 48 and 73 years old. Twenty-four patients presented with symptoms and three patients were asymptomatic. Nineteen patients were imaged with mammography demonstrating mammographically occult lesions as the predominant finding. Twenty-six patients were imaged with ultrasound and the most common finding was a mass lesion. Pathological diagnosis was made by image-guided biopsy in 44 % of patients. The imaging features of granulomatous mastitis on mammography are infrequently described. CONCLUSIONS Our study demonstrates that granulomatous mastitis can occur in postmenopausal or asymptomatic patients, although previously reported exclusively in young women with palpable findings. Presentation on mammography as calcifications requiring mammographically guided vacuum-assisted biopsy has not been previously described. The diagnosis of granulomatous mastitis can easily be made by image-guided biopsy and surgical excision should be reserved for definitive treatment. KEY POINTS • Characterizes radiographic appearance of granulomatous mastitis in postmenopausal or asymptomatic patients. • Granulomatous mastitis can present exclusively as calcifications on mammography. • The diagnosis of granulomatous mastitis is made by image-guided biopsy techniques.
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Breast diseases during pregnancy and lactation. Obstet Gynecol Sci 2013; 56:143-59. [PMID: 24327995 PMCID: PMC3784111 DOI: 10.5468/ogs.2013.56.3.143] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 04/15/2013] [Accepted: 04/17/2013] [Indexed: 11/26/2022] Open
Abstract
Breast is a typical female sexual physiologic organ that is influenced by steroid hormone from menarche until menopause. Therefore various diseases can be developed by continuous action of estrogen and progesterone. Breast diseases are mainly categorized as benign and malignant. It is very important to distinguish the malignancy from breast diseases. However, it is very difficult to diagnose malignancy in pregnant and lactating women even though the same breast diseases took place. Therefore, we will review breast diseases such as breast carcinoma during pregnancy and lactation.
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Al-Jarrah A, Taranikanti V, Lakhtakia R, Al-Jabri A, Sawhney S. Idiopathic Granulomatous Mastitis: Diagnostic strategy and therapeutic implications in Omani patients. Sultan Qaboos Univ Med J 2013; 13:241-7. [PMID: 23862029 PMCID: PMC3706113 DOI: 10.12816/0003229] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 12/09/2012] [Accepted: 12/30/2012] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES Idiopathic granulomatous mastitis (IGM) is a rare benign disorder of the breast whose aetiology is controversial, and is often misdiagnosed clinically and radiologically as mammary malignancy; as a result, it may be incorrectly treated. Although no standard treatment is available for this chronic disease, surgery with or without corticosteroids has been tried with controversial results. This study discusses the clinical presentation, diagnosis, management, recurrence, and follow-up data of IGM with a review of relevant literature. METHODS From 2009-2012, the Breast Unit at Sultan Qaboos University Hospital, Oman, conducted a clinical study on 20 patients with breast lumps. Their clinical and radiological examinations were indeterminate, and a diagnosis of granulomatous mastitis was established only by histopathology. RESULTS The majority of the patients were cases of unknown aetiology, who presented with a unilateral breast mass. A few patients had a mass with an abscess, along with axillary lymphadenopathy. A total of 4 patients were suspected of malignancy using radiology. In all patients, sterilised pus was sent for culture and sensitivity. Microscopy showed the characteristic pattern of granulomatous inflammation. All patients were treated with antibiotics for 6 weeks, and the mean follow-up period was 15 months (11-33 months). All patients had complete remission with no further recurrence. CONCLUSION This single largest study of cases of IGM in Oman highlights the pitfalls in diagnosing this non-neoplastic disease of unknown aetiology and uncertain pathogenesis. It emphasises IGM's excellent response to antibiotics, which is crucial, as IGM is a disease which is notoriously difficult and controversial to treat.
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Affiliation(s)
- Adil Al-Jarrah
- Departments of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Varna Taranikanti
- Departments of Human & Clinical Anatomy, Sultan Qaboos University, Muscat, Oman
| | - Ritu Lakhtakia
- Pathology, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Asma Al-Jabri
- Departments of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Sukhpal Sawhney
- Radiology & Molecular Imaging, Sultan Qaboos University Hospital, Muscat, Oman
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Tan H, Li R, Peng W, Liu H, Gu Y, Shen X. Radiological and clinical features of adult non-puerperal mastitis. Br J Radiol 2013; 86:20120657. [PMID: 23392197 DOI: 10.1259/bjr.20120657] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To describe the radiological and clinical features of adult non-puerperal mastitis and to determine the most accurate method of preventing unnecessary surgical procedures. METHODS Clinical and imaging findings were retrospectively reviewed in 51 females with non-puerperal mastitis, which was confirmed by biopsy/surgical pathology. All 51 patients had pre-operative MRI; 45 patients also had sonograms and 25 also had mammograms, pre-operatively. RESULTS Of the 51 cases with non-puerperal mastitis, 94.1% (48/51) were confirmed as having acute or chronic inflammation, and the other 3 had plasma cell mastitis; areola papillaris inflammation was found in 39.2% (20/51) of the cases. Overall, 6 of the 25 cases that were examined with mammography and 2 of the 45 cases that were examined with sonography appeared normal, but all 51 lesions were positively identified on MRI. Asymmetrical density (12/25) on mammograms and solitary or separated/contiguous, clustered, hypoechoic mass-like lesions (31/45) on ultrasound were the most common signs of non-puerperal mastitis. On enhanced MRI, 90.2% (46/51) of patients showed non-mass-like enhanced lesions. Multiple regional enhancements in the pattern of distribution (32/46) and separated or contiguous, clustered, rim-like enhancements in the pattern of internal enhancement (29/46) were the most common manifestations in non-mass-like enhanced lesions. Of the 51 patients, mastitis Type 1 and Type 2 in the time-signal intensity curve were detected in 47.1% and 51.0% of the patients, respectively. The breast imaging reporting and data system categories with the highest number of patients were Category 0 (9/25) on mammography, Category 4a on sonography (18/45) and Category 4a on MRI (29/51). CONCLUSION The findings from mammography and ultrasound are non-specific; therefore, using MR can be helpful in the diagnosis, especially in the presence of non-mass-like enhancements that are multiple, regional, separated, or contiguous, clustered and rim-like. ADVANCES IN KNOWLEDGE Mastitis is often neglected because of the lack of typical clinical signs and symptoms. This study has assessed and described the clinical features and imaging findings of adult non-puerperal mastitis on mammograms, sonograms and MRI and found that MRI is more specific in the diagnosis of disease.
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Affiliation(s)
- H Tan
- Department of Radiology, Cancer Hospital/Institute & Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Kim MJ, Kim D, Jung W, Koo JS. Histological analysis of benign breast imaging reporting and data system categories 4c and 5 breast lesions in imaging study. Yonsei Med J 2012; 53:1203-10. [PMID: 23074123 PMCID: PMC3481383 DOI: 10.3349/ymj.2012.53.6.1203] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The objective of this study was to analyze the histology of breast lesions categorized as Breast Imaging Reporting and Data System (BI-RADS) 4c or 5 breast lesions during the imaging evaluation, but diagnosed as benign during the histological evaluation. MATERIALS AND METHODS We retrospectively reviewed 71 breast lesions categorized as BI-RADS 4c or 5 during imaging study, but diagnosed as benign upon histological evaluation. RESULTS Breast lesions were classified into six groups upon histological analysis: intraductal papilloma (18 cases), inflammatory group (15 cases), fibroepithelial tumor (14 cases), clustered microcalcification (10 cases), minimal histological alteration (10 cases), and adenosis (4 cases). Sclerosis and architectural complexity were associated with most of the biopsies that were morphologically similar to malignancy. CONCLUSION Among 71 cases categorized as 4c or 5 during the imaging study, but diagnosed as benign upon histological examination, intraductal papilloma was the most frequently identified histological lesion. These 71 cases exhibited histological characteristics of sclerosis and/or complex/complicated features that should be histologically differentiated from malignancy during evaluation.
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Affiliation(s)
- Min Jung Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Dokyung Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - WooHee Jung
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Ja Seung Koo
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
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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: 2.2] [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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