DOI: http://dx.doi.org/10.18203/2349-2902.isj20190818

Clinicopathological study of granulomatous lobular mastitis

Sapna Goel, Kanwar Singh Goel

Abstract


Background: Granulomatous lobular mastitis is an uncommon disease. This condition may resemble malignancy and tuberculosis. It is characterised by granulomatous inflammation with multinucleated giant cells, epithelioid histiocytes. The inflammation is centred on lobules. The purpose of this study is to review the clinical and pathological aspects in 8 cases of granulomatous lobular mastitis and review of pertinent literature.

Methods: This is a prospective observational study. A total of 8 patients were studied. Investigations done. Patient were treated by erythromycin 250mg qid, tinidazole 500mg bid, for 7 days and steroids for two months. The lumps were excised, sinuses were excised and abscesses were drained, and oral steroids were given. Follow-up was done for 6 months.

Results: Most of the patients were multiparous and lactating, with age range from 18 to 36 years. Clinically the lesion was felt as malignant in 3 patients and benign in 5 patients. Most patients were using contraceptive pills. There was suppuration in 3 patients and sinuses were found in 2 patients. Histopathological examination revealed granulomatous inflammation centred on lobules.

Conclusions: The diagnosis of granulomatous lobular mastitis should be made very carefully to avoid any confusion with malignancy, tuberculosis, fungal infection, sarcoidosis, mammary duct ectasia, cystic changes in breast with over palpation and puerperal mastitis with over palpation. Though it is rare disease, but complete understanding by pathologist and surgeon is required for improving its identification.

Keywords


Abscess, Granulomatous, Histopathology, Lobular, Mastitis, Malignancy, Sinuses, Tuberculous

Full Text:

PDF

References


Going JJ, Anderson TJ, Wilkinson S, Chetty U. Granulomatous lobular mastitis. J Clin Pathol. 1987 May 1;40(5):535-40.

Rowe P. Granulomatous mastitis associated with a pituitary prolactinoma. Br J Clin Pract. 1984;38:32-4.

DeHertogh DA, Rossof AH, Harris AA, Economou SG. Prednisone management of granulomatous mastitis. New Eng J Med. 1980 Oct 2;303(14):799-800.

Carmalt HL, Ramsey-Stewart G. Granulomatous mastitis. Med J Asut. 1981;1:356-9.

Koelmeyer TD, MacCormic DEM. Granulomatous mastitis. Aust NZ J Surg 1976;46:173-6.

Brown KL, Tang PH. Postlactational tumoral granulomatous mastitis: a localized immune phenomenon. Am J Surg. 1979 Aug 1;138(2):326-9.

Fletcher A, Magrath IM, Riddell RH, Talbot IC. Granulomatous mastitis: a report of seven cases. J Clin Pathol. 1982 Sep 1;35(9):941-5.

Cohen C. Granulomatous mastitis-a review of 5 cases. South African Med J. 1977 Jul 1;52(1):14-6.

Davies JD, Burton PA. Postpartum lobular granulomatous mastitis. J Clin Pathol. 1983 Mar;36(3):363.

Miliauskas JR, Pieterse AS, Williams RS. Granulomatous lobular mastitis. Aust N Z J Surg. 1995 Feb;65(2):139-41.

Banerjee A, Green B, Burke M. Tuberculous and granulomatous mastitis. Practitioner. 1989 May;233(1469):754-6.

Kfoury H, Al LB. Granulomatous lobular mastitis: A clinicopathological study of 112 cases. Ann Saudi Med. 1997 Jan;17(1):43-6.

Going JJ, Anderson TJ, Wilkinson S, Chetty U. Granulomatous lobular mastitis. J Clin Pathol. 1987 May 1;40(5):535-40.

Studdy PR, Lapworth RU, Bird RO. Angiotensin-converting enzyme and its clinical significance--a review. J Clin Pathol. 1983 Aug 1;36(8):938-47.

Imoto S, Kitaya T, Kodama T, Hasebe T, Mukai K. Idiopathic granulomatous mastitis: case report and review of the literature. Japanese J Clin Oncol. 1997 Aug 1;27(4):27-7.

Kumarasinghe MP, Amarasekera LR. Granulomatous mastitis--a well defined entity. Ceylon Medical Journal. 1990 Dec;35(4):143-5.

Jorgensen MB, Nielsen DM. Diagnosis and treatment of granulomatous mastitis. Am J Med. 1992 Jul 1;93(1):97-101.

Donn MD, Rebbeck P, Wilson C, Andgilks CB. Idiopathic granulomatous mastitis. Arch Path Lab Med. 1994;118:822-5.