Abstract
Idiopathic granulomatous mastitis (IGM) is an uncommon chronic inflammatory lesion of the breast with an uncertain optimal treatment regimen, the physical examination, and radiologic features of which may be confused with breast carcinoma. In this study, we aimed to describe the clinicopathologic characteristics of 33 patients who admitted to our breast policlinic and took the diagnosis of granulomatous (idiopathic and non-idiopathic) mastitis, and report the place of corticosteroids and the timing of surgery in the treatment of patients with IGM. The clinical features of 33 patients who presented to our breast policlinic with the complaint of breast mass and reached the final diagnosis of GM between March 2005 and October 2009 were reported. The most common symptoms were mass (n: 27) and pain (n: 11). Ultrasonography (USG) and biopsy were performed in all of the patients. Mammography (MMG) was performed in 9, and magnetic resonance imaging (MRI) in 10 patients. The diagnosis of idiopathic lobular granulomatous mastitis (ILGM) was made in 25 patients and tuberculous mastitis (non-idiopathic GM) in the remaining 8 patients. Twenty-four patients received steroid treatment except one who was pregnant. After giving birth, she also received steroids. One of the patients who developed recurrence after 11 months repeated the steroid therapy. Eight patients with tuberculous mastitis were placed on a regimen of antituberculosis therapy for 6 months. In the diagnosis of IGM, physical examination, USG, MMG, and even MRI alone may sometimes not be enough. They should be discussed altogether and the treatment should begin after definitive histopathologic result. Fine needle aspiration biopsy for cytology will result in a high level of diagnostic accuracy, however, core biopsy will reinforce the exact result. Corticosteroid therapy has been shown to be efficacious for IGM, but in the existence of complications such as abscess formation, fistulae, and persistent wound infection, surgical treatment has been the first method of choice.
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References
Donn W, Rebbek P, Wilson C, Gilks CB (1994) Idiopathic granulomatous mastitis. A report of three cases and review of the literature. Arch Pathol Lab Med 118:822–825
Akcan A, Akyildiz H, Deneme MA, Akgun H, Aritas Y (2006) Granulomatous lobular mastitis: a complex diagnostic and therapeutic problem. World J Surg 30(8):1403–1409
Lee JH, Oh KK, Kim EK, Kwack KS, Jung WH, Lee HK (2006) Radiologic and clinical features of idiopathic granulomatous lobular mastitis mimicking advanced breast cancer. Yonsei Med J 47(1):78–84
Imoto S, Kitaya T, Kodama T, Hasebe T, Mukai K (1997) Idiopathic granulomatous mastitis: case report and review of the literature. Jpn J Clin Oncol 27(4):274–277
Yılmaz E, Lebe B, Usal C, Balci P (2001) Mammographic and sonographic findings in the diagnosis of idiopathic granulomatous mastitis. Eur Radiol 11:2236–2240
Kessler E, Wolloch Y (1972) Granulomatous mastitis: a lesion clinically simulating carcinoma. Am J Clin Pathol 58:642–646
Tuncbilek N, Karakas HM, Okten OO (2004) Imaging of granulomatous mastitis: assessment of three cases. Breast 13:510–514
Going JJ, Anderson TJ, Wilkinson S, Chetty U (1987) Granulomatous lobular mastitis. J Clin Pathol 40:535–540
Heer R, Shrimankar J, Griffith CDM (2003) Granulomatous mastitis can mimic breast cancer on clinical, radiological or cytological examination: a cautionary tale. Breast 12:283–286
Fletcher A, Magrath IM, Riddell RH, Talbot IC (1982) Granulomatous mastitis: a report of seven cases. J Clin Pathol 35(9):941–945
Tse GM, Poon CS, Law BK, Pang LM, Chu WC, Ma TK (2003) Fine needle aspiration cytology of granulomatous mastitis. J Clin Pathol 56(7):519–521
Han BK, Choe YH, Park JM, Moon WK, Ko YH, Yang JH, Nam SJ (1999) Granulomatous mastitis: mammographic and sonographic appearances. AJR 173:317–320
Brown KL, Tang PHL (1979) Postlactational tumoral granulomatous mastitis: a localized immune phenomenon. Am J Surg 138:326–329
Ayeva-Derman M, Perrotin F, Lefrancq T, Roy F, Lansac J, Body G (1999) Idiopathic granulomatous mastitis. Review of the literature illustrated by 4 cases. J Gynecol Obstet Biol Reprod 28(8):800–807
Memis A, Bilgen I, Ustun EE, Ozdemir N, Erhan Y, Kapkac M (2002) Granulomatous mastitis: imaging findings with histopathologic correlation. Clin Radiol 57:1001–1006
Kara E, Ozer C, Apaydin FD (2003) Abse formasyonu gösteren idiyopatik granülomatöz mastit. Tani Girisim Radyol 9:116–117
Erhan Y, Veral A, Kara E, Ozdemir N, Kapkac M, Ozdedeli E, Yilmaz R, Koyuncu A, Erhan Y, Ozbal O (2000) A clinicopathologic study of a rare clinical entity mimicking breast carcinoma: idiopathic granulomatous mastitis. Breast 9:52–56
Wilson JP, Chapman SW (1990) Tuberculous mastitis. Chest 98(6):1505–1509
Coşkun T, Kara E, Kaya Y, Güler Y, Kandiloğlu AR, Göktan C (2006) Granülomatöz mastit: Cerrahi Tedavi-Rekurrens İlişkisi. Meme Sağlığı Dergisi (J Br Health) 2(1):26–30
Kocaoglu M, Somuncu I, Ors F, Bulakbasi N, Tayfun C, Ilkbahar S (2004) Imaging findings in idiopathic granulomatous mastitis: a review with emphasis on magnetic resonance imaging. J Comput Assist Tomogr 28(5):635–641
Sakurai T, Oura S, Tanino H, Yoshimasu T, Kokawa Y, Kinoshita T, Okamura Y (2002) A case of granulomatous mastitis mimicking breast carcinoma. Breast Cancer 9:265–268
Sato N, Yamashita H, Kozaki N, Watanabe Y, Ohtsuka T, Kuroki S, Nakafusa Y, Ota M, Chijiiwa K, Tanaka M (1996) Granulomatous mastitis diagnosed and followed up by fine-needle aspiration cytology, and successfully treated by corticosteroid therapy: report of a case. Surg Today 26:730–733
Asoglu O, Ozmen V, Karanlik H, Tunaci M, Cabioglu N, Igci A, Selcuk UE, Kecer M (2005) Feasibility of surgical management in patients with granulomatous mastitis. Breast J 11(2):108–114
Elsiddig KE, Khalil EA, Elhag IA, Elsafi ME, Suleiman GM, Elkhidir IM, Hussein AM, El-Hassan AM (2003) Granulomatous mammary disease: ten years’ experience with fine needle aspiration cytology. Int J Tuberc Lung Dis 7(4):365–369
DeHertogh DA, Rossof AH, Harris AA, Economou SG (1980) Prednisone management of granulomatous mastitis. N Engl J Med 303(14):799–800
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Erozgen, F., Ersoy, Y.E., Akaydin, M. et al. Corticosteroid treatment and timing of surgery in idiopathic granulomatous mastitis confusing with breast carcinoma. Breast Cancer Res Treat 123, 447–452 (2010). https://doi.org/10.1007/s10549-010-1041-6
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DOI: https://doi.org/10.1007/s10549-010-1041-6