European Radiology

, Volume 24, Issue 10, pp 2404–2411 | Cite as

Granulomatous mastitis: changing clinical and imaging features with image-guided biopsy correlation

  • Priyanka HandaEmail author
  • A. Jill Leibman
  • Derek Sun
  • Maria Abadi
  • Aryeh Goldberg



To review clinical presentation, revisit patient demographics and imaging findings in granulomatous mastitis and determine the optimal biopsy method for diagnosis.


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.


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.


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.


Granulomatous mastitis Core needle biopsy Mammography Ultrasound, mammary Breast neoplasms 



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.


  1. 1.
    Kessler E, Wooloch Y (1972) Granulomatous mastitis: a lesion clinically simulating carcinoma. Am J Clin Path 58:642–646PubMedGoogle Scholar
  2. 2.
    Han BK, Choe YH, Park JM, Moon WK, Ko YH, Yang JH (1999) Granulomatous mastitis: mammographic and sonographic appearances. AJR 173:317–320PubMedCrossRefGoogle Scholar
  3. 3.
    Tuncbilek N, Karakas HM, Okten OO (2004) Imaging of granulomatous mastitis: assessment of three cases. Breast 13:510–514PubMedCrossRefGoogle Scholar
  4. 4.
    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)CrossRefGoogle Scholar
  5. 5.
    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 10:528–531PubMedCrossRefGoogle Scholar
  6. 6.
    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 117:529–538PubMedCrossRefGoogle Scholar
  7. 7.
    Memis A, Bilgen I, Usten EE, Ozdemir N, Erhan Y, Kapac M (2002) Granulomatous mastitis: imaging findings with histopathologic correlation. Clin Radiol 57:1001–1006PubMedCrossRefGoogle Scholar
  8. 8.
    Al-Kkawari HAT, Al-Manfouhi HA, Madda JP, Kovacs A, Sheikh M, Roberts O (2011) Radiologic features of granulomatous mastitis. Breast J 17:645–650CrossRefGoogle Scholar
  9. 9.
    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 17:108–114PubMedCrossRefGoogle Scholar
  10. 10.
    Going JJ, Anderson TJ, Wilkinson S, Chetty U (1987) Granulomatous lobular mastitis. J Clin Pathol 40:535–540PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Larsen LJH, Peyvandi B, Klipfel N, Grant E, Iyengar G (2009) Granulomatous lobular mastitis: Imaging, diagnosis and treatment. AJR 193:574–581CrossRefGoogle Scholar
  12. 12.
    Kok KYY, Telisinghe PU (2010) Granulomatous mastitis: presentation, treatment and outcome in 43 patients. Surgeon 8:197–201PubMedCrossRefGoogle Scholar
  13. 13.
    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 25:270–273PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Afridi SP, Memon A, Shafiq-ur-Rahman, Memon A (2010) Granulomatous mastitis: a case series. J Coll Physicians Surg Pak 20:365–368PubMedGoogle Scholar
  15. 15.
    Gupta RK (2010) Fine needle aspiration cytology of granulomatous mastitis. Acta Cytol 54:138–141PubMedCrossRefGoogle Scholar
  16. 16.
    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 34:153–158PubMedCrossRefGoogle Scholar
  17. 17.
    Cohen C (1977) Granulomatous mastitis. A review of 5 cases. S Afr Med J 52:14–16PubMedGoogle Scholar
  18. 18.
    Boarki K, Labib M (2010) Imaging findings in idiopathic lobular granulomatous mastitis. Case report and review of literature. Gulf J Oncol 7:46–52Google Scholar
  19. 19.
    Jorgensen MD, Nielsen DM (1992) Diagnosis and treatment of granulomatous mastitis. Am J Med 93:97–101PubMedCrossRefGoogle Scholar
  20. 20.
    Bes C, Soy M, Seref V, Sengul N, Yilmaz F (2010) Erythema nodosum associated with granulomatous mastitis: report of two cases. Rheumatol Int 30:1523–1525PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • Priyanka Handa
    • 1
    Email author
  • A. Jill Leibman
    • 1
  • Derek Sun
    • 1
  • Maria Abadi
    • 2
  • Aryeh Goldberg
    • 2
    • 3
  1. 1.Department of RadiologyJacobi Medical CenterBronxUSA
  2. 2.Department of PathologyJacobi Medical CenterBronxUSA
  3. 3.Feinberg School of MedicineNorthwestern UniversityChicagoUSA

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