Idiopathic granulomatous mastitis: A diagnostic and therapeutic challenge

Idiopathic granulomatous mastitis: A diagnostic and therapeutic challenge

Idiopathic granulomatous mastitis is a rare benign breast disease of women of reproductive age. It usually presents as a painful mass. Since the etiology is unclear, directed diagnosis and management is lacking. This is a retrospective chart review of 14 patients, over twelve years (2004–2016), iden...

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Bibliographic Details
Published in:The American journal of surgery Vol. 214; no. 4; pp. 701 - 706
Main Authors: Freeman, C.M., Xia, B.T., Wilson, G.C., Lewis, J.D., Khan, S., Lee, S.J., Lower, E.E., Edwards, M.J., Shaughnessy, E.A.
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01-10-2017
Elsevier Limited
Subjects:
Adrenal Cortex Hormones - therapeutic use
Adult
Age
Antibiotics
Biopsy
Breast
Breast cancer
Chemotherapy
Combined Modality Therapy
Corticoids
Corticosteroids
Corynebacterium
Diagnosis
Diagnostic Imaging
Diagnostic systems
Etiology
Female
Granulomatous mastitis
Granulomatous Mastitis - diagnostic imaging
Granulomatous Mastitis - drug therapy
Granulomatous Mastitis - surgery
Humans
Literature reviews
Management
Mastitis
Methotrexate
Microorganisms
Middle Aged
Pathology
Patients
Pregnancy
Retrospective Studies
Risk Factors
Sarcoidosis
Surgery
Treatment
Treatment Outcome
Tuberculosis
Womens health
Granulomatous mastitis
Treatment
NSAIDS
Breast
mg
Management
Diagnosis
IGM
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Description
Summary:Idiopathic granulomatous mastitis is a rare benign breast disease of women of reproductive age. It usually presents as a painful mass. Since the etiology is unclear, directed diagnosis and management is lacking. This is a retrospective chart review of 14 patients, over twelve years (2004–2016), identified through query of pathology findings. Two asymptomatic patients were diagnosed after oncologic breast resection following neoadjuvant chemotherapy. The remaining twelve patients were young (31.7 years, range 23–43 years), predominantly non-white (50% African/African-American, 36% Hispanic, 7% Asian), pregnant within the last five years (86%), with no prior granulomatous disease. Evaluation included breast imaging, microbial cultures and staining, and biopsy. Treatment included antibiotics (57%), corticosteroids (21%), methotrexate (7%), and/or surgery (71%). Imaging suggests segmental masses, possibly abscess. Granulomatous mastitis is uncommon, and difficult to diagnose and manage. We review our experience, the literature, and propose an algorithm for diagnosis and management. •Idiopathic granulomatous mastitis (IGM) is challenging to treat since the etiology is unclear.•Those diagnosed with IGM tend to be young, within five years post-partum, and present with a persistent painful mass.•Excision of the mass is successful in halting the process in approximately 85% of the patients.•Corticosteroids may conserve breast tissue in patients with a sterile abscess and no contraindications to immunosuppression.
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ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2017.07.002