A 10-year retrospective study of 43 female patients presenting with idiopathic granulomatous mastitis
DOI:
https://doi.org/10.18203/2349-2902.isj20243538Keywords:
Benign breast diseases, Histopathology, Hispanic women, Idiopathic granulomatous mastitis, Inflammatory breast diseaseAbstract
Background: Idiopathic Granulomatous Mastitis (IGM) is a rare inflammatory breast condition affecting middle aged women. IGM typically presents as a unilateral, painful and challenging-to-treat breast mass, with a high recurrence rate. Common treatments include corticosteroids and antibiotics, with surgical excision reserved for resistant cases. However, the absence of a standardized treatment protocol leads to variability in management across different settings and providers.
Methods: We present a case series of 43 patients diagnosed with IGM at a community hospital in New York, aiming to facilitate early recognition and treatment of this rare condition. This study identifies risk factors and reviews best practices in imaging and treatment, emphasizing the importance of considering IGM in the differential diagnosis, particularly in cases of recurrent disease.
Results: The sample comprised 43 patients with an average age of 34.65 years, 31 (72%) of whom were Hispanic. The most commonly reported symptoms were pain, mass, erythema, and swelling. In all cases, IGM was confirmed by histopathological examination. Treatment modalities included incision and drainage (I and D), corticosteroids, antibiotics, methotrexate and surgical intervention.
Conclusions: IGM is a rare condition often mistaken for breast cellulitis, abscess or carcinoma. Maintaining a high index of suspicion is crucial, particularly in Hispanic women who may be at increased risk. Histopathological diagnosis is essential to prevent unnecessary surgical interventions and antibiotic use, thereby reducing recurrence rates. Early initiation of corticosteroids or alternatives like methotrexate can optimize patient outcomes and reduce healthcare costs.
References
Kessler E, Wolloch Y: Granulomatous mastitis: a lesion clinically simulating carcinoma. AM J Clin Pathol. 1972;58:642–6.
Wolfrum A, Kümmel S, Theuerkauf I, Pelz E, Reinisch M. Granulomatous mastitis: a therapeutic and diagnostic challenge. Breast Care (Basel). 2018;13(6):413-8.
Centers for disease control and prevention: Idiopathic granulomatous mastitis in Hispanic women – Indian, 2006–2008. MMWR Morb Mortal Wkly Rep. 2009;58:1317–21.
Kayahan M, Kadioglu H, Muslumanoglu M. Management of patients with granulomatous mastitis: analysis of 31 cases. Breast Care (Basel) 2012;7:226–30.
Somala M, Statz A, Lacross JS, Lassinger BK,. Granulomatous mastitis: a 10-year experience from a large inner city county hospital. J Surg Res. 2013;184(1):299-303.
Taylor GB, Paviour SD, Musaad S, Jones WO, Holland DJ, A clinicopathological review of 34 cases of inflammatory breast disease showing an association between corynebacterium infection and granulomatous mastitis. Pathol. 2003;35(2):31-5.
Nguyen MH, Molland JG, Kennedy S, Gray TJ, Limaye S. Idiopathic granulomatous mastitis: case series and clinical review. Intern Med J. 2021;51(11):1791-7.
Wong SCY, Poon RWS, Chen JHK, Tse H, Lo JYC, Ng TK, et al. Corynebacterium kroppenstedtii Is an Emerging Cause of Mastitis Especially in Patients With Psychiatric Illness on Antipsychotic Medication. Open Forum Infect Dis. 2017;6;4(2):96.
Yukawa, M., Watatani, M., Isono, S. Management of granulomatous mastitis: a series of 13 patients who were evaluated for treatment without corticosteroids. International surgery, 2015;100(5):774–82.
Çalış, H., Kilitçi, A. (2018). Granulomatous Mastitis Concurrence with Breast Cancer. European journal of breast health. 14(1):58–60.
Yilmaz E, Lebe B, Usal C, Balci P. Mammographic and sonographic findings in the diagnosis of idiopathic granulomatous mastitis. Eur Radiol. 2001;11(1):2236–40.
Holla S, Amberkar MB, Kamath A, Kamal Kishore MK, Ommurugan B. Risperidone induced granulomatous mastitis secondary to hyperprolactinemia in a non-pregnant woman-a rare case reported in a bipolar disorder. J Clin Diagn Res. 2017;11:1–3.
Lin CH, Hsu CW, Tsao TY, Chou J. Idiopathic granulomatous mastitis associated with risperidone-induced hyperprolactinemia. Diagn Pathol 2012;7:2.
Uysal E, Soran A, Sezgin E. Factors related to recurrence of idiopathic granulomatous mastitis: what do we learn from a multicentre study. ANZ J Surg. 2018;88:635-9.
Rodin JH, -Bureau GP, Hugol D, Gompel A. Management of granulomatous mastitis: a series of 14 patients. Gynecological Endocrinol. 2012;11:921-4.
Sakurai K, Fujisaki S, Enomoto K. Evaluation of follow-up strategies for corticosteroid therapy of idiopathic granulomatous mastitis. Surg Today. 2011;41:333–7.
