Idiopathic Granulomatous Mastitis: A 25-Year Experience

Department of Academic Surgery, Wythenshawe Hospital, University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom.
Journal of the American College of Surgeons (Impact Factor: 4.45). 03/2008; 206(2):269-73. DOI: 10.1016/j.jamcollsurg.2007.07.041
Source: PubMed

ABSTRACT Idiopathic granulomatous mastitis (IGM) is a rare, benign, chronic inflammatory condition of the breast that can mimic inflammatory breast cancer and periductal mastitis (PDM). Eighteen patients with a histopathologic diagnosis of IGM, seen over a period of 25 years, were retrospectively reviewed and compared with 133 patients with PDM and 100 normal patients.
The unit's pathology database and clinic letters for this time period were used to identify patients who had presented with IGM. A retrospective review of the notes was used to extract reproductive factors, cigarette smoking habits, and ethnicities that were recorded at presentation. These were compared with data from a similar group of patients with PDM and a control group.
All IGM patients were women. Median age was 36 years (range 18 to 67 years) compared with 52 years (range 20 to 77 years) for PDM patients (p < 0.001). Seventeen percent of IGM patients were smokers at the time of presentation, as compared with 60% of PDM patients (p < 0.001). Although parity was similar for all groups, 10 IGM patients (56%) had given birth in the last 5 years, compared with 6 (5%) PDM patients (p < 0.001) and 20 (20%) in the control group (p=0.0194). Two IGM patients had recurrences after pregnancy. The course of IGM varied from 11 to 105 weeks and was not affected by any treatment modalities.
IGM patients are younger, have given birth more recently, and are less likely to be Caucasian as compared with PDM patients. IGM is not related to smoking and can recur. Treatment should be supportive.

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Available from: Bilal Alkhaffaf, Jan 04, 2014
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    • "The largest series we identified involved 54 patients with CM [11]. The only exception is one small retrospective case-control study of 18 cases of GM [14]. Therefore, a major gap seems to exist in the literature regarding epidemiological study of chronic mastitis. "
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    ABSTRACT: Chronic mastitis is a prolonged inflammatory breast disease, and little is known about its etiology. We identified 85 cases and 112 controls from 5 hospitals in Morocco and Egypt. Cases were women with chronic mastitis (including periductal, lobular, granulomatous, lymphocytic, and duct ectasia with mastitis). Controls had benign breast disease, including fibroadenoma, benign phyllodes, and adenosis. Both groups were identified from histopathologically diagnosed patients from 2008 to 2011, frequency-matched on age. Patient interviews elicited demographic, reproductive, breastfeeding, and clinical histories. Cases had higher parity than controls (OR = 1.75, 1.62-1.90) and more reported history of contraception use (OR = 2.73, 2.07-3.61). Cases were less likely to report wearing a bra (OR = 0.56, 0.47-0.67) and less often used both breasts for breastfeeding (OR = 4.40, 3.39-5.72). Chronic mastitis cases were significantly less likely to be employed outside home (OR = 0.71, 0.60-0.84) and more likely to report mice in their households (OR = 1.63, 1.36-1.97). This is the largest case-control study reported to date on risk factors for chronic mastitis. Our study highlights distinct reproductive risk factors for the disease. Future studies should further explore these factors and the possible immunological and susceptibility predisposing conditions.
    11/2013; 2013:184921. DOI:10.1155/2013/184921
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    • "IGM is considered a relatively rare disease [3]. This condition was first termed as granulomatous lobular mastitis by Going et al. in 1987 after a lobule-centered distribution of the breast lesion was noted on histological examination [8]. "
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    ABSTRACT: Idiopathic granulomatous mastitis (IGM) is a relatively rare condition and may commonly mimic carcinoma. Clinically and radiologically, these lesions could be misdiagnosed as carcinoma and histopathology is the most definitive method of diagnosis and to differentiate it from other granulomatous conditions such as sarcoidosis and Wegener's granulomatosis. We report two cases of IGM presenting with ill-defined indurated mass, peau d'orange and ulcerative lesions clinically mimicking carcinoma. They were successfully treated with corticosteroids. Even abscesses can be aspirated and avoid surgery. A high index of suspicion is necessary to diagnose this condition to prevent unnecessary mastectomy.
    Breast disease 01/2010; 31(1):57-60. DOI:10.3233/BD-2009-0294
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    ABSTRACT: Background Idiopathic granulomatous mastitis (IGM) is a rare, benign and chronic inflammatory condition of the breast. Clinically, it can mimic inflammatory breast cancer and is difficult to distinguish from tuberculous mastitis and sarcoidosis. Diagnosis of IGM is usually by exclusion and confirmed by histopathological examination. The mainstays of treatment described in current literature are antibiotics, systemic steroids and immunosuppressants. Case report We present a case of IMG treated with topical steroids only, with no side effects or relapse. Results and Conclusions Till now, there are no specific guidelines for the management of idiopathic granulomatous mastitis. It varies from expectant management, steroid treatment till surgical intervention. Topical steroids were used as alternative to systemic preparations with the potential benefit of avoiding the side effects of long-term systemic steroid therapy.
    European Surgery 10/2012; 44(5). DOI:10.1007/s10353-012-0155-y · 0.26 Impact Factor
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