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; 4:21. DOI: 10.1186/1477-7800-4-21
Source: PubMed

ABSTRACT 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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    ABSTRACT: Idiopathic granulomatous mastitis is a rare chronic inflammatory lesion of the breast that can clinically and radiographically mimic breast carcinoma. The most common clinical presentation is an unilateral, discrete breast mass, nipple retraction and even a sinus formation often associated with an inflammation of the overlying skin. The etiology of idiopathic granulomatous mastitis is still obscure. Its treatment remains controversial. The cause may be the autoimmune process, infection, a chemical reaction associated with oral contraceptive pills, or even lactation. Various factors, including hormonal imbalance, autoimmunity, unknown microbiological agents, smoking and α 1-antitrypsin deficiency have been suggested to play a role in disease aetiology. In this review, causing factors in the aetiology of idiopathic granulomatous mastitis are reviewed in detail.
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    ABSTRACT: Idiopathic Granulomatous Mastitis (IGM) is a rare chronic inflammatory breast disease that is usually difficult to distinguish from cancer. Most patients have a troublesome course of recurrence infection, sinus formation and disfigurement. The aim of this work is to identify clinical, radiological, and pathological characteristics of 14 patients with recurrent IGM and to evaluate surgical treatment followed by methotrexate therapy in these patients. This study included 14 patients presented at the surgery outpatient clinic of the National Cancer Institute with recurrent breast lesions during the period of January 2006 to December 2007. They had a previous pathological diagnosis of idiopathic granulomatous mastitis. The patients' ages ranged between 25 and 38 years with a median age of 33.5 years. Ten patients (71.4%) presented by a recurrent breast mass (two of them with signs of inflammation), four patients (28.6%) presented by an abscess with a discharging sinus. Patients were subjected to mammosonography and cytopathological examination by fine needle aspiration cytology and bacteriological and serological studies to exclude other causes of granulomatous mastitis. Surgical intervention was in the form of complete excision of the lesion and sinus tract if present. Detailed pathological examination was done for the lesions. Patients were subjected to methotrexate therapy with an immunomodulatory dose of 10 mg/week; two weeks after surgery for six months duration. Follow up after cessation of therapy included clinical and radiological examination. Ten cases (71.4%) maintained remission and healing without recurrence during the follow up period. Two cases (14.2%) had minor relapses and two patients (14.2%) dropped follow up. The use of methotrexate after surgery in cases of recurrent IGM may be a potentially effective alternative to steroid therapy avoiding associated complications and may help achieve healing and maintain remission.
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    Meme Sagligi Dergisi / Journal of Breast Health 01/2014; 10(1):30-34. DOI:10.5152/tjbh.2014.1907

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