Abstract
Objectives
To review clinical presentation, revisit patient demographics and imaging findings in granulomatous mastitis and determine the optimal biopsy method for diagnosis.
Methods
A retrospective study was performed to review the clinical presentation, imaging findings and biopsy methods in patients with granulomatous mastitis. Twenty-seven patients with pathology-proven granulomatous mastitis were included.
Results
The average age at presentation was 38.0 years (range, 21–73 years). Seven patients were between 48 and 73 years old. Twenty-four patients presented with symptoms and three patients were asymptomatic. Nineteen patients were imaged with mammography demonstrating mammographically occult lesions as the predominant finding. Twenty-six patients were imaged with ultrasound and the most common finding was a mass lesion. Pathological diagnosis was made by image-guided biopsy in 44 % of patients. The imaging features of granulomatous mastitis on mammography are infrequently described.
Conclusions
Our study demonstrates that granulomatous mastitis can occur in postmenopausal or asymptomatic patients, although previously reported exclusively in young women with palpable findings. Presentation on mammography as calcifications requiring mammographically guided vacuum-assisted biopsy has not been previously described. The diagnosis of granulomatous mastitis can easily be made by image-guided biopsy and surgical excision should be reserved for definitive treatment.
Key Points
• Characterizes radiographic appearance of granulomatous mastitis in postmenopausal or asymptomatic patients.
• Granulomatous mastitis can present exclusively as calcifications on mammography.
• The diagnosis of granulomatous mastitis is made by image-guided biopsy techniques.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Kessler E, Wooloch Y (1972) Granulomatous mastitis: a lesion clinically simulating carcinoma. Am J Clin Path 58:642–646
Han BK, Choe YH, Park JM, Moon WK, Ko YH, Yang JH (1999) Granulomatous mastitis: mammographic and sonographic appearances. AJR 173:317–320
Tuncbilek N, Karakas HM, Okten OO (2004) Imaging of granulomatous mastitis: assessment of three cases. Breast 13:510–514
Abrikossoff A (1926) Über Myome, ausgehend von der quergestreiften willkürlichen Muskulatur [About myomas originating from striated musculature]. Virchows Arch A Pathol Anat Histopathol 260:215–233 (in German)
Adeniran A, Al-Ahmadie H, Mahoney MC, Robinson-Smith TM (2004) Granular cell tumor of the breast: a series of 17 cases and review of the literature. Breast J 10:528–531
Dursun M, Yilmaz S, Yahyayev A, Salmaslioglu A, Yavuz E, Igci A (2012) Multimodality imaging features of idiopathic granulomatous mastitis: outcome of 12 years of experience. Radiol Med 117:529–538
Memis A, Bilgen I, Usten EE, Ozdemir N, Erhan Y, Kapac M (2002) Granulomatous mastitis: imaging findings with histopathologic correlation. Clin Radiol 57:1001–1006
Al-Kkawari HAT, Al-Manfouhi HA, Madda JP, Kovacs A, Sheikh M, Roberts O (2011) Radiologic features of granulomatous mastitis. Breast J 17:645–650
Martinez-Parra D, Nevado-Santos M, Melendez-Guerrero B, Garcia-Solano J, Hierro-Guilmain CC, Perez-Guillermo M (1997) Utility of fine-needle aspiration in the diagnosis of granulomatous lesions of the breast. Diagn Cytopathol 17:108–114
Going JJ, Anderson TJ, Wilkinson S, Chetty U (1987) Granulomatous lobular mastitis. J Clin Pathol 40:535–540
Larsen LJH, Peyvandi B, Klipfel N, Grant E, Iyengar G (2009) Granulomatous lobular mastitis: Imaging, diagnosis and treatment. AJR 193:574–581
Kok KYY, Telisinghe PU (2010) Granulomatous mastitis: presentation, treatment and outcome in 43 patients. Surgeon 8:197–201
Patel RA, Strickland P, Sankara IR, Pinkston G, Wilkliffe M, Rodriguez M (2009) Idiopathic granulomatous mastitis: case reports and review of literature. J Gen Intern Med 25:270–273
Afridi SP, Memon A, Shafiq-ur-Rahman, Memon A (2010) Granulomatous mastitis: a case series. J Coll Physicians Surg Pak 20:365–368
Gupta RK (2010) Fine needle aspiration cytology of granulomatous mastitis. Acta Cytol 54:138–141
Yang WR, Edeiken-Monroe B, Sneige N, Fornage BD (2006) Sonographic and mammographic appearances of granular cell tumors of the breast with pathological correlation. J Clin Ultrasound 34:153–158
Cohen C (1977) Granulomatous mastitis. A review of 5 cases. S Afr Med J 52:14–16
Boarki K, Labib M (2010) Imaging findings in idiopathic lobular granulomatous mastitis. Case report and review of literature. Gulf J Oncol 7:46–52
Jorgensen MD, Nielsen DM (1992) Diagnosis and treatment of granulomatous mastitis. Am J Med 93:97–101
Bes C, Soy M, Seref V, Sengul N, Yilmaz F (2010) Erythema nodosum associated with granulomatous mastitis: report of two cases. Rheumatol Int 30:1523–1525
Acknowledgments
The scientific guarantor of this publication is A. Jill Leibman. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was not required because due to the study design, which was a retrospective chart review. Written informed consent was not required for this study due to study design which only required a retrospective chart review without modification of diagnostic or therapeutic regimen. Animals were not used in this study. Study subjects or cohorts have not been previously reported. Methodology: retrospective, observational, multicentre study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Handa, P., Leibman, A.J., Sun, D. et al. Granulomatous mastitis: changing clinical and imaging features with image-guided biopsy correlation. Eur Radiol 24, 2404–2411 (2014). https://doi.org/10.1007/s00330-014-3273-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-014-3273-z