Idiopathic granulomatous mastitis masquerading as carcinoma of the breast: A case report and review of the literature

Dept. of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA.
International Seminars in Surgical Oncology 02/2007; 4(4):21. DOI: 10.1186/1477-7800-4-21
Source: PubMed


Idiopathic granulomatous mastitis is an uncommon, benign entity with a diagnosis of exclusion. The typical clinical presentation of idiopathic granulomatous mastitis often mimics infection or malignancy. As a result, histopathological confirmation of idiopathic granulomatous mastitis combined with exclusion of infection, malignancy and other causes of granulomatous disease is absolutely necessary.
We present a case of a young woman with idiopathic granulomatous mastitis, initially mistaken for mastitis as well as breast carcinoma, and successfully treated with a course of corticosteroids.
There is no clear clinical consensus regarding the ideal therapeutic management of idiopathic granulomatous mastitis. Treatment options include expectant management with spontaneous remission, corticosteroid therapy, immunosuppressive agents and extensive surgery for refractory cases.

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Available from: Brian J O'Hara, Oct 10, 2015
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    • "Known etiologies of CM are diverse and include diabetes, lupus erythematosus, Mycobacterium tuberculosis, Staphylococcus aureus, and Candida albicans, as well as several species of Corynebacterium and other rare syndromes and infections [3] [4] [5]. Several other suspected predisposing or related diseases have been mentioned in the literature, including Weber- Christian disease, Sjogren's syndrome, hyperprolactinemia, IgG4 sclerosing disease, immune response to local trauma, and even cat scratch disease [6] [7] [8] [9] [10]. "
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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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    • "The primary presentation is a firm breast mass, frequently associated with local pain and eventually skin ulcerations, abscesses and fistulae develop [3,5]. The clinical presentation frequently mimics breast abscess, infective mastitis and breast cancer [6]. Histopathological study is required to make the diagnosis, and findings include noncaseating granulomatous lobulitis making it imperative to rule out other granulomatous diseases. "
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    ABSTRACT: Background Idiopathic granulomatous mastitis is a rare, benign, inflammatory chronic condition of unclear etiology. This case is reported because it illustrates how idiopathic granulomatous mastitis can mimic other diseases, making it difficult to associate the presenting symptoms and the correct diagnosis; This disease is a challenge for clinicians to diagnose, manage and avoid iatrogenic complications, and requires consultation with experts in several specialties. Case presentation The patient was 30 years old, South-American, eleven weeks pregnant, and with an apparent infectious mastitis. She presented with progressive worsening of her breast symptoms and multiple negative laboratory tests. She suffered different side effects from several prescribed treatments and endured a prolonged recovery. The article emphasizes the need for ruling out common pathologies to arrive at the correct diagnosis such as bacterial and fungal infections; granulomatous conditions like tuberculosis and sarcoidosis; and inflammatory breast carcinoma. It also describes frequently used pharmacological and supplementary forms of treatment for patients with this condition. Conclusion Idiopathic granulomatous mastitis is a rare unusual condition of unknown etiology. Pathological confirmation is required for its diagnosis and optimal management is still unclear. The presentation and management of this case is intended to advance its awareness to physicians from different specialties.
    BMC Research Notes 03/2013; 6(1):95. DOI:10.1186/1756-0500-6-95
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    • "IGLM is a rare chronic non-specific inflammatory lesion of the breast that can clinically mimic breast cancer. Originally described by Kessler and Wolloch in 1972, it is characterized by the presence of epitheloid and multinucleated giant cell granulomas limited to the mammary lobules with micro-abscesses in the absence of obvious etiology [9]. Local or systemic irritants as well as undetected infective causes may result in damage to the ductal epithelium. "
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    ABSTRACT: Idiopathic granulomatous lobular mastitis (IGLM) is a rare chronic inflammatory disease of the breast with obscure etiology that mimics invasive carcinoma both clinically and radiologically. The treatment of IGLM remains controversial. The aim of proper management is to use a combination of medical and surgical treatment of this benign condition to achieve a good cosmetic result and low recurrence rate. A retrospective analysis of 19 patients with IGLM is performed based on the findings of clinical, radiological, and pathological examinations. The results of two treatments are presented: medical treatment with oral corticosteroids, and consecutive surgical excision after a follow-up period of 20 months (range, 6-75 months). The majority of patients treated in this paper were young (mean, 34 years) parous women with a history of hormonal medication use. The main clinical finding is large, irregular, and painful mass. Hypoechoic lobulated, irregular tubular or oval shaped masses had been imaged by ultrasound. Mammographic findings were an ill-defined mass, enlarged axillary lymph nodes, asymmetric density, and architectural distortion. Diagnoses of IGLM had been established by cytological or histological examination. Symptoms subside and inflammatory changes regressed with medical treatment. The remaining lesions were excised by consecutive breast conserving surgery. The disease recurred in one patient during the follow-up period. IGLM is an inflammatory breast disease found in young women who present with a large painful irregular mass, which mimics carcinoma, as a physical change. Breast imaging modalities are not helpful to differentiate IGLM from invasive cancer. The correct diagnosis is established by cytological or histological examination. Medical treatment with corticosteroids provides significant regression of the inflammatory disease, allowing more conservative surgery. Consecutive surgical excision of the remaining lesions with good cosmetic results provides definitive treatment and reduces the risk of recurrence.
    03/2012; 15(1):119-23. DOI:10.4048/jbc.2012.15.1.119
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