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Ma Q, Lu X, Qin X, Xu X, Fan M, Duan Y, Tu Z, Zhu J, Wang J, Zhang C. A sonogram radiomics model for differentiating granulomatous lobular mastitis from invasive breast cancer: a multicenter study. Radiol Med 2023; 128:1206-1216. [PMID: 37597127 DOI: 10.1007/s11547-023-01694-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/28/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE To construct a nomogram based on sonogram features and radiomics features to differentiate granulomatous lobular mastitis (GLM) from invasive breast cancer (IBC). MATERIALS AND METHODS A retrospective collection of 213 GLMs and 472 IBCs from three centers was divided into a training set, an internal validation set, and an external validation set. A radiomics model was built based on radiomics features, and the RAD score of the lesion was calculated. The sonogram radiomics model was constructed using ultrasound features and RAD scores. Finally, the diagnostic efficacy of the three sonographers with different levels of experience before and after combining the RAD score was assessed in the external validation set. RESULTS The RAD score, lesion diameter, orientation, echogenicity, and tubular extension showed significant differences in GLM and IBC (p < 0.05). The sonogram radiomics model based on these factors achieved optimal performance, and its area under the curve (AUC) was 0.907, 0.872, and 0.888 in the training, internal, and external validation sets, respectively. The AUCs before and after combining the RAD scores were 0.714, 0.750, and 0.830 and 0.834, 0.853, and 0.878, respectively, for sonographers with different levels of experience. The diagnostic efficacy was comparable for all sonographers when combined with the RAD score (p > 0.05). CONCLUSION Radiomics features effectively enhance the ability of sonographers to discriminate between GLM and IBC and reduce interobserver variation. The nomogram combining ultrasound features and radiomics features show promising diagnostic efficacy and can be used to identify GLM and IBC in a noninvasive approach.
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Affiliation(s)
- Qianqing Ma
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Shushan District, Hefei, 230022, Anhui, China
| | - Xiaofeng Lu
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Shushan District, Hefei, 230022, Anhui, China
| | - Xiachuan Qin
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Shushan District, Hefei, 230022, Anhui, China
- Department of Ultrasound, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University Nan Chong), Sichuan, China
| | - Xiangyi Xu
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Shushan District, Hefei, 230022, Anhui, China
| | - Min Fan
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yayang Duan
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Shushan District, Hefei, 230022, Anhui, China
| | - Zhengzheng Tu
- Anhui Provincial Key Laboratory of Multimodal Cognitive Computation, School of Computer Science and Technology, Anhui University, Hefei, China
| | - Jianhui Zhu
- Anhui Provincial Key Laboratory of Multimodal Cognitive Computation, School of Computer Science and Technology, Anhui University, Hefei, China
| | - Junli Wang
- Department of Ultrasound, The Second People's Hospital of Wuhu, No.259 Jiuhuashan Road, Jinghu District, Wuhu, 241001, Anhui, China.
| | - Chaoxue Zhang
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Shushan District, Hefei, 230022, Anhui, China.
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Azzam MI, Alnaimat F, Al-Nazer MW, Awad H, Odeh G, Al-Najar M, Alsayed S, El-Asir L, Addasi R, Melhem JM, Sweiss NJ. Idiopathic granulomatous mastitis: clinical, histopathological, and radiological characteristics and management approaches. Rheumatol Int 2023; 43:1859-1869. [PMID: 37347273 DOI: 10.1007/s00296-023-05375-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/15/2023] [Indexed: 06/23/2023]
Abstract
Idiopathic Granulomatous Mastitis (IGM) is an infrequent, benign breast disease that primarily affects women during their childbearing years and can be mistaken for breast cancer. This study aimed to review the clinical, radiological, and histopathological findings of patients with IGM in addition to management and outcome. Retrospective cross-sectional study of biopsy-confirmed IGM at an academic medical center and a private hospital in Amman, Jordan. Fifty-four patients were included, with a mean age of 37.0 ± 9.04 years, mostly presenting with a breast lump (n = 52, 96.3%) and breast pain (n = 45 patients, 84.9%). Approximately half of the patients (51.9%) were parous, and 50% had breastfed for an average duration of 30.37 ± 22.38 months. Most of the patients had either solitary or multiple abscesses on breast ultrasound. Histopathological analysis (n = 35) showed mostly either moderate inflammation (n = 16, 45.7%) or severe inflammation (n = 14, 40%). Two-thirds of the patients underwent surgical interventions at the time of diagnosis, mostly incision and drainage (n = 16, 29%) or surgical excision (n = 7, 13%), and no mastectomies were performed. The most common medical treatment included a combination of antibiotics, corticosteroids, and methotrexate (n = 21, 38.8%). After follow-up, 31 patients remained in remission, 3 experienced relapses, and 3 had a chronic course. The use of corticosteroids was significantly associated with remission (p = 0.035). The presentation and demographics of IGM patients in Jordan were consistent with the existing literature. Prospective research is needed to explore different treatment options and disease outcomes.
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Affiliation(s)
- Muayad I Azzam
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Fatima Alnaimat
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, University of Jordan, Amman, 11942, Jordan.
| | | | - Heyam Awad
- Department of Pathology, School of Medicine, University of Jordan, Amman, 11942, Jordan
| | - Ghada Odeh
- Department of General Surgery, School of Medicine, University of Jordan, Amman, 11942, Jordan
| | - Mahasen Al-Najar
- Department of Radiology and Nuclear Medicine, School of Medicine, University of Jordan, Amman, 11942, Jordan
| | - Suzan Alsayed
- Department of Rheumatology, Abdali Hospital, Amman, Jordan
| | - Layal El-Asir
- Women's Health and Breast Center, Abdali Hospital, Amman, Jordan
| | - Rami Addasi
- Department of General Surgery, School of Medicine, University of Jordan, Amman, 11942, Jordan
| | - Jamal Masad Melhem
- Department of General Surgery, School of Medicine, University of Jordan, Amman, 11942, Jordan
| | - Nadera J Sweiss
- Division of Rheumatology, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
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Wang YT, Tang YQ, Xu JY, Bian XM. The Disease Experience of Women with Granulomatous Lobular Mastitis. A Qualitative Interview Study. J Inflamm Res 2023; 16:4347-4361. [PMID: 37791120 PMCID: PMC10544261 DOI: 10.2147/jir.s419347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 08/25/2023] [Indexed: 10/05/2023] Open
Abstract
Background The incidence of granulomatous lobular mastitis (GLM) is increasing year by year, and the breast wounds of women patients with GLM can develop into abscesses, fistulas, sinuses, and sometimes orange-like degeneration similar to malignant tumors, which seriously affects the quality of life of women patients with GLM. In China, breast wounds in women patients with GLM have not been better managed. Therefore, the purpose of this study is to explore the disease experience of women patients with GLM, to provide a basis for the development of precise intervention and support strategies for women patients with GLM, and to further improve the quality of nursing management and enrich the research types of GLM. Methods In this study, 10 cases of GLM women patients from a tertiary hospital in Hangzhou, Zhejiang Province were selected by purposive sampling. After obtaining the informed consent of GLM women patients, semi-structured interviews were conducted with GLM women patients using the interview outline to collect qualitative data. The interview was recorded, transcribed verbatim in the local language, and then translated into English, and the content analysis method was used to analyze the data. The Consolidated Criteria for Reporting Qualitative Research (CORE-Q) checklist follows the report 's findings. Results Our study identified six themes: (a) Perception of the disease, (b) Emotional discomfort (c) Variety of changes (d) Lack of specific skills (e) Coping strategies adopted to rebuild health, (f) Expectation. Conclusion The experience of women with GLM is characterized by diversity and specificity. After experiencing physical trauma, most patients use support systems to change negative attitudes and rebuild physical and mental health. Family, hospital and society should be fully linked to strengthen the prevention of GLM and the popularization of nursing management knowledge; nurses should provide targeted nursing services. Nursing leaders should improve the medical security system, broaden the medical channels, and reduce the pain experience and pressure of patients.
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Affiliation(s)
- Yan Ting Wang
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Ya Qin Tang
- Department of Nursing, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Jia Yuan Xu
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Xue Mei Bian
- Department of Nursing, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
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Fattahi AS, Amini G, Sajedi F, Mehrad-Majd H. Factors Affecting Recurrence of Idiopathic Granulomatous Mastitis: A Systematic Review. Breast J 2023; 2023:9947797. [PMID: 37794976 PMCID: PMC10547579 DOI: 10.1155/2023/9947797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 08/12/2023] [Accepted: 09/03/2023] [Indexed: 10/06/2023]
Abstract
Idiopathic granulomatous mastitis is a rare and benign disease that primarily affects young women of reproductive age. Various factors have been suggested as possible causes, including pregnancy, breastfeeding, history of taking birth control pills, hyperprolactinemia, smoking, and history of trauma. Due to unknown etiology, opinions on its treatment have varied, resulting in differing recurrence rates and side effects. Therefore, conducting a comprehensive systematic review and meta-analysis can aid in understanding the causes and recurrence of the disease, thereby assisting in the selection of effective treatment and improving the quality of life. A systematic literature review was conducted using predefined search terms to identify eligible studies related to risk factors and recurrence up to June 2022 from electronic databases. Data were extracted and subjected to meta-analysis when applicable. A total of 71 studies with 4735 patients were included. The mean age of the patients was 34.98 years, and the average mass size was 4.64 cm. About 3749 of these patients (79.17%) were Caucasian. Patients who mentioned a history of pregnancy were 92.65% with 76.57%, 22.7%, and 19.7% having a history of breastfeeding, taking contraceptive pills, and high prolactin levels, respectively. Around 5.6% of patients had previous trauma. The overall recurrence rate was 17.18%, with recurrence rates for treatments as follows: surgery (22.5%), immunosuppressive treatment (14.7%), combined treatment (14.9%), antibiotic treatment (6.74%), and observation (9.4%). Only antibiotic and expectant treatments had significant differences in recurrence rates compared to other treatments (p value = 0.023). In conclusion, factors such as Caucasian race, pregnancy and breastfeeding history, and use of contraceptive hormone are commonly associated with the disease recurrence. Treatment should be tailored based on symptom severity and patient preference, with surgery or immunosuppressive options for recurrence.
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Affiliation(s)
- Asieh Sadat Fattahi
- Endoscopic and Minimally Invasive Research Center, Department of Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ghasem Amini
- Endoscopic and Minimally Invasive Research Center, Department of Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Sajedi
- Department of Persian Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hassan Mehrad-Majd
- Clinical Research Development Unit, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [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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Sarkar DK, Banerjee R, Gupta S, Singhal AK, Halder A. Management of idiopathic granulomatous mastitis: a prospective study. Ann R Coll Surg Engl 2023; 105:218-224. [PMID: 35638904 PMCID: PMC9974337 DOI: 10.1308/rcsann.2022.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Idiopathic granulomatous mastitis (IGM) is an evolving problem with varied presentation. No definite treatment guidelines are available at present that may reduce rate of recurrence. Current evidence suggests a ductal pathology behind IGM, which leads to periductal mastitis, leakage and sinus/fistula formation. Thus, excision of the sinus/fistulous tract with en-bloc wide local excision (WLE) of the lesion could be curative. The objective of this study was to look for the basic aetiology of IGM and evaluate the effectiveness of WLE with total or partial duct excision as a curative approach. METHODS An institutional prospective comparative study was conducted over 4 years (2015-2019), in which 59 cases of IGM were randomly divided into three groups. After necessary investigations, patients in group A received steroid therapy, those in group B received WLE and patients in group C received WLE with total or partial duct excision as the mode of treatment. Postoperative follow-up was between 6 months and 3 years. RESULTS Histopathological examination (HPE) was found to be the most suitable diagnostic procedure. Patients in group B showed the highest rate of recurrence (73.6%), followed by group A (35.0%) and group C (5.0%). Patients in group C had a significantly lower chance of recurrence compared with both group A and group B (p < 0.05). HPE reports of excised ducts from patients in group C showed ductal disruption and leakage along with periductal granuloma in 70% of cases. CONCLUSIONS The presence of duct granuloma indicates the association of ductal pathology in IGM. IGM is therefore a disease of the mammary ducts and en-bloc duct excision is curative in non-responding cases.
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Affiliation(s)
- DK Sarkar
- IPGME&R & SSKM Hospital, Kolkata, India
| | | | - S Gupta
- Midnapore Medical College and Hospital, Midnapore, India
| | | | - A Halder
- IPGME&R & SSKM Hospital, Kolkata, India
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Zhang HJ, Ding PP, Zhang XS, Wang XC, Sun DW, Bu QA, Li XQ. MAC mediates mammary duct epithelial cell injury in plasma cell mastitis and granulomatous mastitis. Int Immunopharmacol 2022; 113:109303. [DOI: 10.1016/j.intimp.2022.109303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/01/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022]
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Muacevic A, Adler JR. A Case of a Female Patient Presenting With Idiopathic Granulomatous Mastitis With Superimposed Enterococcus Avium Infection. Cureus 2022; 14:e29997. [PMID: 36381742 PMCID: PMC9636988 DOI: 10.7759/cureus.29997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2022] [Indexed: 01/25/2023] Open
Abstract
Idiopathic granulomatous mastitis (IGM) is defined as an uncommon, benign, chronic inflammatory disease of unknown etiology that affects the breast and can mimic breast cancer. It usually manifests as a solid, ill-defined breast lump in postpartum women of reproductive age. Furthermore, because it lacks a particular radiographic finding, core biopsy and histology are the only ways to make a conclusive diagnosis. There is no agreement on the best way to treat IGM. Ideally, a multidisciplinary approach should be used to weigh the benefits and drawbacks of each treatment option, with options such as observation, antibiotics, surgery, and medication therapy being examined (steroids and immunosuppressants). In this report, we review a case of a patient who had IGM with superimposed Enterococcus avium infection. To our knowledge, such a report is considered unprecedented in the Middle East. A literature review on IGM will be presented, as well as the clinical presentation, association with bacterial infection, treatment, and pathological and radiographic findings.
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Yücesoy C, Aydın ZB, Fidan N, Bozkurt B, Karabacak H, Eraslan Ö, Han Ü. Radiologic Features of Idiopathic Granulomatous Mastitis and Emphasis on Analysis of Socioeconomic Status: Over 5 Years of Experience. Indian J Surg 2021. [DOI: 10.1007/s12262-021-03138-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Kafadar MT, Bahadır MV, Girgin S. Low-Dose Methotrexate Use in Idiopathic Granulomatous Mastitis: An Alternative Treatment Method. Breast Care (Basel) 2021; 16:402-407. [PMID: 34602947 DOI: 10.1159/000513879] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/18/2020] [Indexed: 01/20/2023] Open
Abstract
Background Idiopathic granulomatous mastitis (IGM) is a rare, recurrent and progressive breast disease with an unknown etiology. Patients with IGM will probably face stressful, time-consuming treatment procedures with side effects due to medications. There are different treatment modalities in clinical use including medical and surgical interventions. Objective The aim of this study was to present the results of using the combination therapy of low-dose methotrexate (MTX) and steroid in IGM. Methods Seventeen patients diagnosed with IGM and treated with MTX were included into the study. Low-dose MTX at 5 mg/week and 8 mg/day prednisone were given for 2-3 months. Results After 2-3 months of treatment, 10 patients exhibited (58.5%) complete, 3 patients (17.6%) partial recovery, and no response to the treatment process was observed in 4 patients (23.5%). No side effects of MTX and recurrent events were noted in any of the patients. Conclusion Low-dose MTX and prednisone treatment for IGM patients, who did not respond to steroids alone, should be considered as an alternative treatment method instead of surgical intervention.
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Affiliation(s)
- Mehmet Tolga Kafadar
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Mehmet Veysi Bahadır
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Sadullah Girgin
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
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Awomolo AM, Louis-Jacques A, Crowe S. Idiopathic granulomatous mastitis diagnosed during pregnancy associated with successful breastfeeding experience. BMJ Case Rep 2021; 14:e241232. [PMID: 34413030 PMCID: PMC8378369 DOI: 10.1136/bcr-2020-241232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 11/04/2022] Open
Abstract
Idiopathic granulomatous mastitis (IGM) is a rare benign breast condition with a course that is often rapidly progressive and slow to resolve. There is no consensus on management, especially during pregnancy and lactation. A 30-year-old at 33 weeks presented with mastalgia, induration and galactorrhoea in the left breast. There was no improvement with antibiotics. Initial workup was negative, and a core needle biopsy showed findings consistent with the diagnosis of IGM. She was treated with steroids antepartum. She was co-managed by rheumatology and her obstetrician/breastfeeding medicine specialist postpartum. She was treated with azathioprine, breastfed exclusively for 6 months and continued breastfeeding through the first year. A multidisciplinary team approach is crucial in diagnosing, treating, and facilitating successful breastfeeding in patients with IGM.
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Affiliation(s)
- Adeola M Awomolo
- Obstetrics and Gynecology, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Adetola Louis-Jacques
- Obstetrics and Gynecology, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Susan Crowe
- Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
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Akbulut S, Sahin TT. Comment on idiopathic granulomatous mastitis: A systematic review of 3060 patients. Int J Surg Case Rep 2021; 85:106250. [PMID: 34362684 PMCID: PMC8369293 DOI: 10.1016/j.ijscr.2021.106250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 07/27/2021] [Indexed: 02/07/2023] Open
Affiliation(s)
- Sami Akbulut
- Department of Surgery, Liver Transplant Institute, Inonu University Faculty of Medicine, 244280 Malatya, Turkey.
| | - Tevfik Tolga Sahin
- Department of Surgery, Liver Transplant Institute, Inonu University Faculty of Medicine, 244280 Malatya, Turkey
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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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Akalın Ç, Altaş H, Akçay Çelik M. White Blood Count Can Be a Practical Guide for the Differential Diagnosis of Breast Abscess and Idiopathic Granulomatous Mastitis. Cureus 2020; 12:e10468. [PMID: 33083171 PMCID: PMC7566977 DOI: 10.7759/cureus.10468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction and aim Idiopathic granulomatous mastitis (IGM) is an inflammatory disease of the breast and has the same symptoms and radiologic imaging as breast abscess (BA). The aim of this study is to evaluate the use of inflammatory markers as white blood count (WBC), C-reactive protein (CRP), and neutrophil to lymphocyte ratio (NLR) as a potentially useful tool for the differential diagnosis of BA and IGM. Methods In this retrospective study, we analyzed 31 patients with IGM and 47 patients with BA between January 2013 and April 2020. Age, symptoms, symptomatic breast side, microbiological culture, complete blood count, and C-reactive protein (CRP) values of patients were analyzed. Receiver operating characteristic (ROC) curve analysis was used to define the optimal cut-off for WBC, CRP, and NLR. Results WBC was significantly higher in the BA group compared to the IGM group (11.45 vs. 9.78; p=0.042), but no difference was found for CRP and NLR between these groups (p=0.146, p=0.081, respectively). In ROC analysis results in BA group, cut-off values, the best sensitivity and specificity for WBC, CRP, and NLR were 8.46 × 103/μL (81%-70%), 1.5 mg/dl (77-76%), and 2.93 (70-82%), respectively. For IGM group, cut-off values, the best sensitivity and specificity for WBC, CRP and NLR were 8.49 × 103/μL (74-70%), 1.5 mg/dl (61-76%) and 2.29 (64-72%), respectively. Conclusion This study showed that CRP and NLR cannot be used as a useful tool for differential diagnosis of IGM; furthermore, WBC is a parameter that can act as a practical guide for the differential diagnosis of BA and IGM.
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Affiliation(s)
- Çağrı Akalın
- General Surgery, Ordu University, Training and Research Hospital, Ordu, TUR
| | - Hilal Altaş
- Radiology, Ordu University, Faculty of Medicine, Ordu, TUR
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15
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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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16
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Azizi A, Prasath V, Canner J, Gharib M, Sadat Fattahi A, Naser Forghani M, Sajjadi S, Farhadi E, Vasigh M, Kaviani A, Omranipour R, Habibi M. Idiopathic granulomatous mastitis: Management and predictors of recurrence in 474 patients. Breast J 2020; 26:1358-1362. [PMID: 32249491 DOI: 10.1111/tbj.13822] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/03/2020] [Accepted: 03/10/2020] [Indexed: 01/23/2023]
Abstract
Idiopathic Granulomatous Mastitis (IGM) is an uncommon inflammatory disease of the breast, with similar presentations as breast cancer and a relatively high recurrence rate. We reviewed the demographics, clinical presentations, and treatment modalities of a large cohort of patients in Iran. Most of the patients had history of pregnancy and breastfeeding. The most common clinical finding was pain and a palpable mass, respectively. Most of the patients received medical treatment, and about half of the patients had surgery. The recurrence rate was 24.8%, and breast skin lesions were associated with a significantly higher odds of recurrence.
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Affiliation(s)
- Armina Azizi
- Department of General Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Vishnu Prasath
- Department of General Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Joseph Canner
- Department of General Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | | | | | | | - Effat Farhadi
- Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahtab Vasigh
- Breast Disease Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Ahmad Kaviani
- Breast Disease Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Ramesh Omranipour
- Breast Disease Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Mehran Habibi
- Department of General Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
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Goulabchand R, Hafidi A, Van de Perre P, Millet I, Maria ATJ, Morel J, Le Quellec A, Perrochia H, Guilpain P. Mastitis in Autoimmune Diseases: Review of the Literature, Diagnostic Pathway, and Pathophysiological Key Players. J Clin Med 2020; 9:jcm9040958. [PMID: 32235676 PMCID: PMC7231219 DOI: 10.3390/jcm9040958] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 12/13/2022] Open
Abstract
Mastitis frequently affects women of childbearing age. Of all the pathological breast conditions requiring specific management, autoimmune mastitis is in the third position after infection and breast cancer. The aim of this literature review was to make a comprehensive description of autoimmune diseases targeting the mammary gland. Four main histological patterns of autoimmune mastitis are described: (i) lymphocytic infiltrates; (ii) ductal ectasia; (iii) granulomatous mastitis; and (iv) vasculitis. Our literature search found that all types of autoimmune disease may target the mammary gland: organ-specific diseases (diabetes, thyroiditis); connective tissue diseases (such as systemic erythematosus lupus or Sjögren’s syndrome); vasculitides (granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, giant cell arteritis, polyarteritis nodosa, Behçet’s disease); granulomatous diseases (sarcoidosis, Crohn’s disease); and IgG4-related disease. Cases of breast-specific autoimmune diseases have also been reported, including idiopathic granulomatous mastitis. These breast-limited inflammatory diseases are sometimes the first symptom of a systemic autoimmune disease. Although autoimmune mastitis is rare, it is probably underdiagnosed or misdiagnosed. Early diagnosis may allow us to detect systemic diseases at an earlier stage, which could help to initiate a prompt, appropriate therapeutic strategy. In case of suspected autoimmune mastitis, we hereby propose a diagnostic pathway and discuss the potential pathophysiological pathways leading to autoimmune breast damage.
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Affiliation(s)
- Radjiv Goulabchand
- St Eloi Hospital, Department of Internal Medicine and Multi-Organic Diseases, Local Referral Center for Systemic and Autoimmune Diseases, 80 Avenue Augustin Fliche, F-34295 Montpellier, France; (R.G.); (A.T.J.M.); (A.L.Q.)
- Internal Medicine Department, Caremeau University Hospital, 30029 Nimes, France
- Montpellier School of Medicine, University of Montpellier, 34967 Montpellier, France (I.M.); (J.M.); (H.P.)
- Inserm U1183, Institute for Regenerative Medicine and Biotherapy, St Eloi Hospital, 80 Avenue Augustin Fliche, 34295 Montpellier, France
| | - Assia Hafidi
- Montpellier School of Medicine, University of Montpellier, 34967 Montpellier, France (I.M.); (J.M.); (H.P.)
- Gui de Chauliac Hospital, Pathology Department, 80 Avenue Augustin Fliche, 34295 Montpellier, France
| | - Philippe Van de Perre
- Pathogenesis and Control of Chronic Infections, Univ Montpellier, INSERM, EFS, Montpellier University Hospital, 34394 Montpellier, France;
| | - Ingrid Millet
- Montpellier School of Medicine, University of Montpellier, 34967 Montpellier, France (I.M.); (J.M.); (H.P.)
- Lapeyronie Hospital, Montpellier University, Medical Imaging Department, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France
| | - Alexandre Thibault Jacques Maria
- St Eloi Hospital, Department of Internal Medicine and Multi-Organic Diseases, Local Referral Center for Systemic and Autoimmune Diseases, 80 Avenue Augustin Fliche, F-34295 Montpellier, France; (R.G.); (A.T.J.M.); (A.L.Q.)
- Montpellier School of Medicine, University of Montpellier, 34967 Montpellier, France (I.M.); (J.M.); (H.P.)
- Inserm U1183, Institute for Regenerative Medicine and Biotherapy, St Eloi Hospital, 80 Avenue Augustin Fliche, 34295 Montpellier, France
| | - Jacques Morel
- Montpellier School of Medicine, University of Montpellier, 34967 Montpellier, France (I.M.); (J.M.); (H.P.)
- Department of Rheumatology, CHU and University of Montpellier, 34295 Montpellier, France
| | - Alain Le Quellec
- St Eloi Hospital, Department of Internal Medicine and Multi-Organic Diseases, Local Referral Center for Systemic and Autoimmune Diseases, 80 Avenue Augustin Fliche, F-34295 Montpellier, France; (R.G.); (A.T.J.M.); (A.L.Q.)
- Montpellier School of Medicine, University of Montpellier, 34967 Montpellier, France (I.M.); (J.M.); (H.P.)
| | - Hélène Perrochia
- Montpellier School of Medicine, University of Montpellier, 34967 Montpellier, France (I.M.); (J.M.); (H.P.)
- Gui de Chauliac Hospital, Pathology Department, 80 Avenue Augustin Fliche, 34295 Montpellier, France
| | - Philippe Guilpain
- St Eloi Hospital, Department of Internal Medicine and Multi-Organic Diseases, Local Referral Center for Systemic and Autoimmune Diseases, 80 Avenue Augustin Fliche, F-34295 Montpellier, France; (R.G.); (A.T.J.M.); (A.L.Q.)
- Montpellier School of Medicine, University of Montpellier, 34967 Montpellier, France (I.M.); (J.M.); (H.P.)
- Inserm U1183, Institute for Regenerative Medicine and Biotherapy, St Eloi Hospital, 80 Avenue Augustin Fliche, 34295 Montpellier, France
- Correspondence: ; Tel.: +33-467-337332
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Martinez-Ramos D, Simon-Monterde L, Suelves-Piqueres C, Queralt-Martin R, Granel-Villach L, Laguna-Sastre JM, Nicolau MJ, Escrig-Sos J. Idiopathic granulomatous mastitis: A systematic review of 3060 patients. Breast J 2019; 25:1245-1250. [PMID: 31273861 DOI: 10.1111/tbj.13446] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 03/14/2019] [Accepted: 03/20/2019] [Indexed: 12/21/2022]
Abstract
Idiopathic granulomatous mastitis is a rare benign breast disease. A systematic review was designed. Clinical and therapeutic characteristics were analyzed. Human Development Index (HDI) was used to define two groups of study: group A (very high and high HDI) and group B (medium and low HDI). Corticosteroid therapy was done in 69% group A and 78% group B. Surgery was done in 63% in group A and 83% in group B. Antibiotics were used in 68% group A and 88% group B. There is no consensus about optimal treatment for granulomatous mastitis.
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Affiliation(s)
- David Martinez-Ramos
- General and Digestive Surgery Department, Hospital General Castellon, Castellon, Spain
| | - Laura Simon-Monterde
- General and Digestive Surgery Department, Hospital General Castellon, Castellon, Spain
| | | | - Raquel Queralt-Martin
- General and Digestive Surgery Department, Hospital General Castellon, Castellon, Spain
| | - Laura Granel-Villach
- General and Digestive Surgery Department, Hospital General Castellon, Castellon, Spain
| | | | - Maria Jesus Nicolau
- General and Digestive Surgery Department, Hospital General Castellon, Castellon, Spain
| | - Javier Escrig-Sos
- General and Digestive Surgery Department, Hospital General Castellon, Castellon, Spain
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19
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Kaviani A, Vasigh M, Omranipour R, Mahmoudzadeh H, Elahi A, Farivar L, Zand S. Idiopathic granulomatous mastitis: Looking for the most effective therapy with the least side effects according to the severity of the disease in 374 patients in Iran. Breast J 2019; 25:672-677. [PMID: 31087459 DOI: 10.1111/tbj.13300] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 09/10/2018] [Accepted: 09/13/2018] [Indexed: 12/01/2022]
Abstract
The goal of this study is to compare the response rate and the recurrence rate of available therapeutic modalities in the treatment of Idiopathic Granulomatous Mastitis (IGM). 374 patients with pathologically confirmed IGM, were included. They were subdivided into three levels of severity. Close observation had the best response rate with the lowest recurrence rate in mild to moderate cases. Severe cases were mostly treated by prednisolone or underwent surgery. The outcome of prednisolone use in severe cases was comparable to NSAIDs. Overall 9% were resistant to treatment and surgical intervention is still an option among them.
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Affiliation(s)
- Ahmad Kaviani
- Tehran University of Medical Sciences, Tehran, Iran.,Breast Disease Research Centre, TUMS, Tehran, Iran.,University of Montreal, Montreal, Canada
| | | | - Ramesh Omranipour
- Tehran University of Medical Sciences, Tehran, Iran.,Breast Disease Research Centre, TUMS, Tehran, Iran
| | - Habibollah Mahmoudzadeh
- Tehran University of Medical Sciences, Tehran, Iran.,Breast Disease Research Centre, TUMS, Tehran, Iran
| | - Ahmad Elahi
- Alborz University of Medical Sciences, Karaj, Iran
| | - Leila Farivar
- University of Miami School of Medicine, Miami, Florida
| | - Sanaz Zand
- Kaviani Breast Disease Institute, Tehran, Iran
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20
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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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21
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Affiliation(s)
- Monica D Agarwal
- Breast Imaging Section, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Shambhavi Venkataraman
- Breast Imaging Section, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Priscilla J Slanetz
- Breast Imaging Section, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA.
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22
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Abstract
Background: Mastitis is an inflammatory disorder in breast tissues due to bacterial factors, mycobacterial infections or autoimmune diseases. Idiopathic granulomatous mastitis (IGM) is a form of mastitis which may be affected by systematic diseases such as sarcoidosis, and infectious causes such as mycobacterium and fungus. This study evaluates the efficacy of medical therapy with a combination of corticosteroid and Azithromycin in patients with IGM. Materials and Methods: This study is a clinical trial research carried out in Alzahra Hospital (Isfahan, Iran) in 2013 on granulomatous mastitis patients. It was administered 250 mg of Azithromycin per 12 hour and 60 mg of Prednisolone per day within 2 weeks. Next, they took 40 mg/day within 8 weeks, and this dosage was tapered during 6 months and the patients clinically and radiologically followed up. The studied patients were examined within 1 week, 2 weeks, 1 month, 3 months, and 6 months, from the beginning of treatment. Results: This study investigated granulomatous mastitis patients in Alzahra hospital in 2013. The mean age of these patients was 33.6 ± 8.9, and their age range was 18–56 years old. Among 26 studied patients, 24 persons (92.3%) according to follow-up the patients by physical examination and sonography responded to treatment of corticosteroid and Azithromycin. The remaining (7.7%) underwent surgery. Treatment periods in case of drug use were respectively, 8.5 ± 0.71 months. Conclusion: Treatment with corticosteroid and Azithromycin is an effective and appropriate treatment for IGM.
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Affiliation(s)
- Marzieh Salehi
- Department of Infectious Diseases, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Salehi
- Student Research Center, Dentistry School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nader Kalbasi
- Department of Oral and maxillofacial Pathology, Dentistry School, Khorasgan University, Isfahan, Iran
| | - Atousa Hakamifard
- Department of Infectious Diseases, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hassan Salehi
- Department of Infectious Diseases, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Mahdi Salehi
- Department of Oral and maxillofacial Pathology, Dentistry School, Khorasgan University, Isfahan, Iran
| | - Jalil Sharifian
- Dentistry School, Isfahan University of Medical Sciences, Isfahan, Iran
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23
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Helal TEA, Shash LS, Saad El-Din SA, Saber SM. Idiopathic Granulomatous Mastitis: Cytologic and Histologic Study of 65 Egyptian Patients. Acta Cytol 2016; 60:438-444. [PMID: 27607182 DOI: 10.1159/000448800] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 07/28/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND The etiology of idiopathic granulomatous mastitis (IGM) is unknown, and it is commonly misdiagnosed clinically and/or radiologically as breast cancer. The role of fine-needle aspiration cytology (FNAC) in its diagnosis is still a matter of debate. The aim of the current study is to assess the value of FNAC in the diagnosis of IGM, and to search for the presence of bacteria in IGM with cystic vacuoles, which was described recently by a few authors. MATERIALS AND METHODS Retrospective study of cytologic smears and histologic tissue sections of 65 Egyptian IGM cases was done along with microbiologic testing. A comparison of the frequency of IGM in Egypt to that of other populations was also made. RESULTS IGM has typical FNA features which can easily exclude malignancy. Histologically, cystic vacuoles were encountered in 35 out of 65 cases (53.9%), with only 6 (17.14%) of these cases showing Gram-positive bacilli (GPB). The frequency of IGM in Egypt is comparable to those in other Middle Eastern countries but much higher than in Western countries. CONCLUSION IGM is a common breast disease in Egypt. FNAC in IGM has a high diagnostic accuracy. This study supports the few recent studies that have detected GPB in IGM with cystic vacuoles. Thus, bacteriologic examination in such cases may affect the treatment strategy.
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Affiliation(s)
- Thanaa El A Helal
- Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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24
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Oztekin PS, Durhan G, Nercis Kosar P, Erel S, Hucumenoglu S. Imaging Findings in Patients with Granulomatous Mastitis. Iran J Radiol 2016; 13:e33900. [PMID: 27853497 PMCID: PMC5107257 DOI: 10.5812/iranjradiol.33900] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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25
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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: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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26
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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: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Cheng L, Reddy V, Solmos G, Watkins L, Cimbaluk D, Bitterman P, Ghai R, Gattuso P. Mastitis, a Radiographic, Clinical, and Histopathologic Review. Breast J 2015; 21:403-9. [DOI: 10.1111/tbj.12430] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Lin Cheng
- Department of Pathology; Rush University Medical Center; Chicago Illinois
| | - Vijaya Reddy
- Department of Pathology; Rush University Medical Center; Chicago Illinois
| | - Gene Solmos
- Department of Pathology; Rush University Medical Center; Chicago Illinois
| | - Latanja Watkins
- Department of Pathology; Rush University Medical Center; Chicago Illinois
| | - David Cimbaluk
- Department of Pathology; Rush University Medical Center; Chicago Illinois
| | - Pincas Bitterman
- Department of Pathology; Rush University Medical Center; Chicago Illinois
| | - Ritu Ghai
- Department of Pathology; Rush University Medical Center; Chicago Illinois
| | - Paolo Gattuso
- Department of Pathology; Rush University Medical Center; Chicago Illinois
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Abstract
Granulomatous mastitis (GM) of the breast is a rare benign inflammatory disease and its presentation closely mimics breast cancer. Its diagnosis is mainly based on histology and there is no consensus agreement regarding its management. We report a case of a 60-year-old woman presenting with a right breast lump associated with a history of rheumatoid arthritis and raised rheumatoid factor. Following triple assessment (history and examination, imaging and biopsy), GM was diagnosed and she was treated conservatively.
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Affiliation(s)
| | - Hiam Ali
- Royal Stoke University Hospital, Stoke-on-Trent, UK
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29
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Abstract
INTRODUCTION Idiopathic granulomatous mastitis (IGM) is a rare benign breast disease, which can be protracted, disfiguring and may be linked to an underlying autoimmune disorder. The clinical presentation may mimic bacterial mastitis or carcinoma. AIMS To review the mode of presentation, diagnosis, management, resolution and incidence of IGM in three tertiary breast centres and propose guidelines for management. METHODS The breast and anatomical databases of three centres were reviewed from January 2000 to December 2013 to identify patients with histological diagnosis of IGM. Clinical and demographic characteristics were retrieved and treatment modalities and time to resolution were recorded. RESULTS Seventeen patients were identified with a median age of 40. The majority of patients were premenopausal, multiparous and presented with a mass. All patients had initial treatment as infectious mastitis. The diagnosis was made by core biopsy in 71%. Eleven patients required immunosuppressive treatment with steroids and four of these patients required a steroid-sparing agent because of steroidal side effects, recurrence or persistence of symptoms. The median time to resolution was 3 months (0-24 months). One patient had subsequent systemic Wegener's granulomatosis diagnosed. CONCLUSIONS Idiopathic granulomatosis mastitis requires histological confirmation, close monitoring, exclusion of underlying systemic autoimmune conditions and judicious use of steroids and steroid-sparing agents such as methotrexate. It has a protracted course with some patients relapsing quickly upon cessation of steroids.
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Affiliation(s)
- Anita Skandarajah
- Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Combined Breast Service, The Royal Melbourne and Women's Hospitals, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Leah Marley
- Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
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30
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Abstract
BACKGROUND Granulomatous mastitis is an uncommon chronic inflammatory breast condition that is characterized by granulomatous inflammation. Granulomatous mastitis presents a challenging clinical scenario, because it can mimic carcinoma. The etiology and optimal treatment remain unclear. We report our experience with granulomatous mastitis patients who presented to our clinic within the past 2 years and describe their response to our treatment modalities. METHODS Our clinic records were reviewed for the diagnosis of granulomatous mastitis. Charts were used to collect clinical data, patients were reinter viewed, and physicians completed detailed reports on their management of these cases. All cases were diagnosed with granulomatous mastitis based on histological findings and by ruling out other etiologies. RESULTS Twenty-four patients were identified. The mean age was 34 years. Fifty-three percent of our patients emigrated from Mexico. Most patients were treated with prednisone and/or methotrexate with overall response rate greater than 80 %. Cases that failed to improve were treated with other modalities, including antituberculosis drugs. CONCLUSIONS Granulomatous mastitis remains a difficult entity to diagnose and to treat. The clinical course of patients often is prolonged. Exclusion of other causes of granulomatous conditions is essential before initiating anti-inflammatory treatment.
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Affiliation(s)
- Kathie-Ann Joseph
- Department of Surgery, Bellevue Hospital Center, NYU Langone School of Medicine, New York, NY, USA,
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31
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Omranipour R, Mohammadi SF, Samimi P. Idiopathic granulomatous lobular mastitis - report of 43 cases from iran; introducing a preliminary clinical practice guideline. Breast Care (Basel) 2014; 8:439-43. [PMID: 24550752 DOI: 10.1159/000357320] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND We aimed to report a large series of idiopathic granulomatous lobular mastitis (IGLM) from Iran and sketch preliminary clinical practice guidelines (CPG) for approaching an inflammatory breast mass. PATIENTS AND METHODS In a retrospective records review, 43 consecutive IGLM cases were studied. Data on baseline, clinical, imaging, and pathologic characteristics were collected. RESULTS The mean age of the women was 33.5 years. All but 1 were married and had given birth. 16% had a cancer-like presentation. Inflammatory signs, architectural distortion, and a nodular pattern were the most common findings clinically, mammographically and ultrasonographically, respectively. 29.5% of the pathological reports indicated necrosis which was more common in younger subjects (p = 0.016); microabscesses were associated with a shorter lactation course (p = 0.006). Corticosteroids had been used as the initial treatment modality in 51%, immunosuppressive agents had not been administered, and a 16% relapse rate was recorded. We recognized the need for a multidisciplinary approach covering radiology, oncology, and surgery to best handle diagnostic and therapeutic issues and manage relevant infections as well as the major differential diagnosis, i.e. malignancy. CONCLUSION We hypothesized that a shorter lactation period may cause more milk stasis and extravasation and be contributory to IGLM. CPGs are needed to incorporate the needed multidisciplinary approach and to standardize IGLM care. We present one such guideline.
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Affiliation(s)
- Ramesh Omranipour
- Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Parisa Samimi
- Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
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