Abstract
Purpose
To outline the demographics, clinical presentation, imaging features, and treatment modalities observed among a series of patients diagnosed with biopsy-proven granulomatous mastitis (GM).
Method
Following approval by institutional review board, retrospective chart review was performed on patients with biopsy-proven granulomatous mastitis at our institution in the period from January 2013 until October 2017.
Results
A total of 90 patients were identified: 87 women and 3 men. The mean age was 35 years, mostly women in their reproductive age. In our study, patients with GM were more likely to be Hispanic compared to the general population. Sixty-three percent of patients were within 5 years of previous pregnancy. Painful palpable mass-like lesion was the most common physical finding. Breast ultrasound (US) was performed in all patients, and most commonly showed a hypoechoic irregular-shaped mass. Mammography (MG) showed asymmetry or irregular mass as the main finding. Definitive diagnosis was obtained by imaging-guided core needle biopsies in 94.4%. Conservative management was preferred, and only one patient underwent surgery.
Conclusion
Although clinical and radiological findings of patients with GM may mimic those of breast carcinoma, our study showed that women of childbearing age, especially among Hispanic ethnicity with a recent history of pregnancy or high prolactin level and newly tender mass-like lesion, in addition to new focal asymmetry on mammogram and heterogeneous hypoechoic irregular-shaped mass on ultrasound exam, should raise concern for GM. Non-invasive approach and clinical follow-up were the preferred treatment method.
Similar content being viewed by others
References
Kessler E, Wolloch Y (1972) Granulomatous mastitis: a lesion clinically simulating carcinoma. Am J Clin Pathol 58(6):642–646
Lacambra M et al (2011) Granulomatous mastitis: the histological differentials. J Clin Pathol 64(5):405–411
Bakaris S et al (2006) Granulomatous mastitis including breast tuberculosis and idiopathic lobular granulomatous mastitis. Can J Surg 49(6):427–430
Aghajanzadeh M et al (2015) Granulomatous mastitis: presentations, diagnosis, treatment and outcome in 206 patients from the north of Iran. Breast 24(4):456–460
Freeman CM et al (2017) Idiopathic granulomatous mastitis: a diagnostic and therapeutic challenge. Am J Surg 214(4):701–706
Sam KQ et al (2017) Granulomatous mastitis in a transgender patient. J Radiol Case Rep 11(2):16–22
Sheybani F et al (2016) Idiopathic granulomatous mastitis: long-discussed but yet-to-be-known. Autoimmunity 49(4):236–239
Tse GM et al (2004) Granulomatous mastitis: a clinicopathological review of 26 cases. Pathology 36(3):254–257
Hovanessian Larsen LJ et al (2009) Granulomatous lobular mastitis: imaging, diagnosis, and treatment. AJR Am J Roentgenol 193(2):574–581
Kiyak G et al (2014) Management of idiopathic granulomatous mastitis: dilemmas in diagnosis and treatment. BMC Surg 14:66
Fazzio RT et al (2016) Idiopathic granulomatous mastitis: imaging update and review. Insights Imaging 7(4):531–539
Memis A et al (2002) Granulomatous mastitis: imaging findings with histopathologic correlation. Clin Radiol 57(11):1001–1006
Joseph KA, Luu X, Mor A (2014) Granulomatous mastitis: a New York public hospital experience. Ann Surg Oncol 21(13):4159–4163
Oran E et al (2013) Management of idiopathic granulomatous mastitis diagnosed by core biopsy: a retrospective multicenter study. Breast J 19(4):411–418
Yabanoğlu H et al (2015) A comparative study of conservative versus surgical treatment protocols for 77 patients with idiopathic granulomatous mastitis. Breast J 21(4):363–369
Atak T et al (2015) Strategies to treat idiopathic granulomatous mastitis: retrospective analysis of 40 patients. Breast Dis 35(1):19–24
Moris D et al (2017) Is idiopathic granulomatous mastitis a surgical disease? The jury is still out. Ann Transl Med 5(15):309
Al-Khaffaf B, Knox F, Bundred NJ (2008) Idiopathic granulomatous mastitis: a 25-year experience. J Am Coll Surg 206(2):269–273
(CDC) (2009) C.f.D.C.a.P., Idiopathic granulomatous mastitis in Hispanic women - Indiana, 2006–2008. MMWR Morb Mortal Wkly Rep 58(47):1317–1321
Altintoprak F, Kivilcim T, Ozkan OV (2014) Aetiology of idiopathic granulomatous mastitis. World J Clin Cases 2(12):852–858
Destek S et al. (2017) Pituitary Adenoma and Hyperprolactinemia Accompanied by Idiopathic Granulomatous Mastitis. Case Rep Endocrinol 3974291
Goldberg J et al (2000) Granulomatous mastitis in pregnancy. Obstet Gynecol 96(5 Pt 2):813–815
Laghzaoui Boukaidi M et al (2000) [Granulomatous recurrent mastitis during pregnancy]. J Gynecol Obstet Biol Reprod (Paris) 29(1):102–104
Uysal E et al (2017) Factors related to recurrence of idiopathic granulomatous mastitis: what do we learn from a multicentre study? ANZ J Surg 88(6):635–639
Omranipour R, Mohammadi SF, Samimi P (2013) Idiopathic granulomatous lobular mastitis—report of 43 cases from iran; introducing a preliminary clinical practice guideline. Breast Care (Basel) 8(6):439–443
Yilmaz E et al (2001) Mammographic and sonographic findings in the diagnosis of idiopathic granulomatous mastitis. Eur Radiol 11(11):2236–2240
Tewari M, Shukla HS (2005) Breast tuberculosis: diagnosis, clinical features & management. Indian J Med Res 122(2):103–110
Seo HR et al (2012) Differential diagnosis in idiopathic granulomatous mastitis and tuberculous mastitis. J Breast Cancer 15(1):111–118
Longman CF et al (2017) Imaging features and diagnosis of tuberculosis of the breast. Clin Radiol 72(3):217–222
Yilmaz R et al (2016) Magnetic resonance imaging features of idiopathic granulomatous mastitis: is there any contribution of diffusion-weighted imaging in the differential diagnosis? Radiol Med 121(11):857–866
Dursun M et al (2012) Multimodality imaging features of idiopathic granulomatous mastitis: outcome of 12 years of experience. Radiol Med 117(4):529–538
Gunduz Y et al (2014) Effect of topical steroid treatment on idiopathic granulomatous mastitis: clinical and radiologic evaluation. Breast J 20(6):586–591
Akcan A et al (2014) Idiopathic granulomatous mastitis: comparison of wide local excision with or without corticosteroid therapy. Breast Care (Basel) 9(2):111–115
Gautier N et al (2013) Chronic granulomatous mastitis: Imaging, pathology and management. Eur J Radiol 82(4):e165–e175
Giovane R et al (2015) Treatment for and clinical characteristics of granulomatous mastitis. Obstet Gynecol 126(2):449–450
Wilson JP et al (2007) Idiopathic granulomatous mastitis: in search of a therapeutic paradigm. Am Surg 73(8):798–802
Lai EC et al (2005) The role of conservative treatment in idiopathic granulomatous mastitis. Breast J 11(6):454–456
Kayahan M, Kadioglu H, Muslumanoglu M (2012) Management of patients with granulomatous mastitis: analysis of 31 cases. Breast Care (Basel) 7(3):226–230
Asoglu O et al (2005) Feasibility of surgical management in patients with granulomatous mastitis. Breast J 11(2):108–114
Bani-Hani KE et al (2004) Idiopathic granulomatous mastitis: time to avoid unnecessary mastectomies. Breast J 10(4):318–322
Funding
The authors did not receive funding.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
This article does not contain any studies with human participants or animals. The study was approved by the institutional review board for a retrospective chart review.
Rights and permissions
About this article
Cite this article
Barreto, D.S., Sedgwick, E.L., Nagi, C.S. et al. Granulomatous mastitis: etiology, imaging, pathology, treatment, and clinical findings. Breast Cancer Res Treat 171, 527–534 (2018). https://doi.org/10.1007/s10549-018-4870-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10549-018-4870-3