Archives of Gynecology and Obstetrics

, Volume 284, Issue 5, pp 1189–1195 | Cite as

Is methotrexate an acceptable treatment in the management of idiopathic granulomatous mastitis?

  • Sami Akbulut
  • Zulfu Arikanoglu
  • Ayhan Senol
  • Nilgun Sogutcu
  • Murat Basbug
  • Erhan Yeniaras
  • Yusuf Yagmur
General Gynecology

Abstract

Purpose

The treatment of choice for idiopathic granulomatous mastitis (IGM) has not yet been established. There are limited data on the use of methotrexate (MTX) in the treatment of IGM. Herein, we investigated the role of MTX in the treatment of IGM patients.

Methods

We present four new cases of IGM treated with MTX and a review of the English language literature concerning the use of MTX in the treatment of IGM.

Results

We prospectively investigated the clinicopathological features of four female patients (aged 28–37 years) who were multiparous and had used oral contraceptives. The patients were administered 7.5–15 mg MTX over 2–6 months. No recurrence was detected during the follow-up period of 4–8 months. In five published studies on MTX use in IGM, data were available for 12 patients aged 21–40 years. In nine patients, treatment was changed to MTX because of a lack of response to steroids, recurrence or steroid-induced diabetes mellitus. Steroids were used in combination with MTX as an initial treatment choice in three patients. Satisfactory results were achieved in ten patients treated with MTX, and only two demonstrated recurrence despite the treatment and underwent mastectomy.

Conclusion

MTX in the present cases of IGM was effective, prevented complications and limited corticosteroid side effects.

Keywords

Methotrexate Idiopathic granulomatous mastitis Breast 

Abbreviations

GM

Granulomatous mastitis

IGM

Idiopathic granulomatous mastitis

DM

Diabetes mellitus

US

Ultrasonography

MG

Mammography

MRI

Magnetic resonance imaging

MTX

Methotrexate

OCs

Oral contraceptive

TB

Tuberculosis

References

  1. 1.
    Erozgen F, Ersoy YE, Akaydin M, Memmi N, Celik AS, Celebi F, Guzey D, Kaplan R (2010) Corticosteroid treatment and timing of surgery in idiopathic granulomatous mastitis confusing with breast carcinoma. Breast Cancer Res Treat 123(2):447–452PubMedCrossRefGoogle Scholar
  2. 2.
    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
  3. 3.
    Kok KY, Telisinghe PU (2010) Granulomatous mastitis: presentation, treatment and outcome in 43 patients. Surgeon 8(4):197–201PubMedCrossRefGoogle Scholar
  4. 4.
    Maffini F, Baldini F, Bassi F, Luini A, Viale G (2009) Systemic therapy as a first choice treatment for idiopathic granulomatous mastitis. J Cutan Pathol 36(6):689–691PubMedCrossRefGoogle Scholar
  5. 5.
    Kim J, Tymms KE, Buckingham JM (2003) Methotrexate in the management of granulomatous mastitis. ANZ J Surg 73(4):247–249PubMedCrossRefGoogle Scholar
  6. 6.
    Raj N, Macmillan RD, Ellis IO, Deighton CM (2004) Rheumatologists and breasts: immunosuppressive therapy for granulomatous mastitis. Rheumatology (Oxford) 43(8):1055–1056CrossRefGoogle Scholar
  7. 7.
    Katz U, Molad Y, Ablin J, Ben-David D, Paran D, Gutman M, Langevitz P (2007) Chronic idiopathic granulomatous mastitis. Ann NY Acad Sci 1108:603–608PubMedCrossRefGoogle Scholar
  8. 8.
    Schmajuk G, Genovese MC (2009) First report of idiopathic granulomatous mastitis treated with methotrexate monotherapy. J Rheumatol 36(7):1559–1560PubMedCrossRefGoogle Scholar
  9. 9.
    Patel RA, Strickland P, Sankara IR, Pinkston G, Many W Jr, Rodriguez M (2010) Idiopathic granulomatous mastitis: case reports and review of literature. J Gen Intern Med 25(3):270–273PubMedCrossRefGoogle Scholar
  10. 10.
    Kuba S, Yamaguchi J, Ohtani H, Shimokawa I, Maeda S, Kanematsu T (2009) Vacuum-assisted biopsy and steroid therapy for granulomatous lobular mastitis: report of three cases. Surg Today 39(8):695–699PubMedCrossRefGoogle Scholar
  11. 11.
    Attar SM (2010) Adverse effects of low dose methotrexate in rheumatoid arthritis patients. A hospital-based study. Saudi Med J 31(8):909–915Google Scholar
  12. 12.
    Ocal K, Dag A, Turkmenoglu O, Kara T, Seyit H, Konca K (2010) Granulomatous mastitis: clinical, pathological features, and management. Breast J 16(2):176–182PubMedCrossRefGoogle Scholar
  13. 13.
    Donn W, Rebbeck P, Wilson C, Gilks CB (1994) Idiopathic granulomatous mastitis. A report of three cases and review of the literature. Arch Pathol Lab Med 118(8):822–825PubMedGoogle Scholar
  14. 14.
    Yip CH, Jayaram G, Swain M (2000) The value of cytology in granulomatous mastitis: a report of 16 cases from Malaysia. Aust NZ J Surg 70(2):103–105CrossRefGoogle Scholar
  15. 15.
    Yau FM, Macadam SA, Kuusk U, Nimmo M, Van Laeken N (2010) The surgical management of granulomatous mastitis. Ann Plast Surg 64(1):9–16PubMedCrossRefGoogle Scholar
  16. 16.
    Bani-Hani KE, Yaghan RJ, Matalka II, Shatnawi NJ (2004) Idiopathic granulomatous mastitis: time to avoid unnecessary mastectomies. Breast J 10(4):318–322PubMedCrossRefGoogle Scholar
  17. 17.
    Tse GM, Poon CS, Ramachandram K, Ma TK, Pang LM, Law BK, Chu WC, Tang AP, Cheung HS (2004) Granulomatous mastitis: a clinicopathological review of 26 cases. Pathology 36(3):254–257PubMedCrossRefGoogle Scholar
  18. 18.
    Lai EC, Chan WC, Ma TK, Tang AP, Poon CS, Leong HT (2005) The role of conservative treatment in idiopathic granulomatous mastitis. Breast J 11(6):454–456PubMedCrossRefGoogle Scholar
  19. 19.
    Ozturk E, Akin M, Can MF, Ozerhan I, Kurt B, Yagci G, Tufan T (2009) Idiopathic granulomatous mastitis. Saudi Med J 30(1):45–49PubMedGoogle Scholar
  20. 20.
    Diesing D, Axt-Fliedner R, Hornung D, Weiss JM, Diedrich K, Friedrich M (2004) Granulomatous mastitis. Arch Gynecol Obstet 269(4):233–236PubMedCrossRefGoogle Scholar
  21. 21.
    Olfatbakhsh A, Beheshtian T, Djavid GE (2008) Granulomatous mastitis, erythema nodosum, and oligoarthritis in a pregnant woman. Breast J 14(6):588–590PubMedCrossRefGoogle Scholar
  22. 22.
    Schelfout K, Tjalma WA, Cooremans ID, Coeman DC, Colpaert CG, Buytaert PM (2001) Observations of an idiopathic granulomatous mastitis. Eur J Obstet Gynecol Reprod Biol 97(2):260–262PubMedCrossRefGoogle Scholar
  23. 23.
    Su FH, Liu SC, Suen JH, Chen DS, Sister Mary Ann Lou (2005) Idiopathic granulomatous mastitis: a case successfully treated with a minimum dose of a steroid. Chang Gung Med J 28(6):431–435PubMedGoogle Scholar
  24. 24.
    Baslaim MM, Khayat HA, Al-Amoudi SA (2007) Idiopathic granulomatous mastitis: a heterogeneous disease with variable clinical presentation. World J Surg 31(8):1677–1681PubMedCrossRefGoogle Scholar
  25. 25.
    Cserni G, Szajki K (1999) Granulomatous lobular mastitis following drug-induced galactorrhea and blunt trauma. Breast J 5(6):398–403PubMedCrossRefGoogle Scholar
  26. 26.
    Going JJ, Anderson TJ, Wilkinson S, Chetty U (1987) Granulomatous lobular mastitis. J Clin Pathol 40(5):535–540PubMedCrossRefGoogle Scholar
  27. 27.
    Asoglu O, Ozmen V, Karanlik H, Tunaci M, Cabioglu N, Igci A, Selcuk UE, Kecer M (2005) Feasibility of surgical management in patients with granulomatous mastitis. Breast J 11(2):108–114PubMedCrossRefGoogle Scholar
  28. 28.
    Güven HE, Pak I, Oral S (2006) Granulomatous mastitis: surgical outcomes. J Coll Physicians Surg Pak 16(6):431–433PubMedGoogle Scholar
  29. 29.
    Imoto S, Kitaya T, Kodama T, Hasebe T, Mukai K (1997) Idiopathic granulomatous mastitis: case report and review of the literature. Jpn J Clin Oncol 27(4):274–277PubMedCrossRefGoogle Scholar
  30. 30.
    Erhan Y, Veral A, Kara E, Ozdemir N, Kapkac M, Ozdedeli E, Yilmaz R, Koyuncu A, Erhan Y, Ozbal O (2000) A clinicopathologic study of a rare clinical entity mimicking breast carcinoma: idiopathic granulomatous mastitis. Breast 9(1):52–56PubMedCrossRefGoogle Scholar
  31. 31.
    Kfoury H, Al Bhlal L (1997) Granulomatous lobular mastitis: a clinicopathological study of 12 cases. Ann Saudi Med 17(1):43–46PubMedGoogle Scholar
  32. 32.
    Salesi M, Karimifar M, Salimi F, Mahzouni P (2009) A case of granulomatous mastitis with erythema nodosum and arthritis. Rheumatol Int (2009 Dec 11)Google Scholar
  33. 33.
    Al-Khaffaf BH, Shanks JH, Bundred N (2006) Erythema nodosum—an extramammary manifestation of granulomatous mastitis. Breast J 12(6):569–570PubMedCrossRefGoogle Scholar
  34. 34.
    Akcan A, Akyildiz H, Deneme MA, Akgun H, Aritas Y (2006) Granulomatous lobular mastitis: a complex diagnostic and therapeutic problem. World J Surg 30(8):1403–1409PubMedCrossRefGoogle Scholar
  35. 35.
    Azlina AF, Ariza Z, Arni T, Hisham AN (2003) Chronic granulomatous mastitis: diagnostic and therapeutic considerations. World J Surg 27(5):515–518PubMedCrossRefGoogle Scholar
  36. 36.
    Wilson JP, Massoll N, Marshall J, Foss RM, Copeland EM, Grobmyer SR (2007) Idiopathic granulomatous mastitis: in search of a therapeutic paradigm. Am Surg 73(8):798–802PubMedGoogle Scholar
  37. 37.
    Hovanessian Larsen LJ, Peyvandi B, Klipfel N, Grant E, Iyengar G (2009) Granulomatous lobular mastitis: imaging, diagnosis, and treatment. AJR Am J Roentgenol 193(2):574–581PubMedCrossRefGoogle Scholar
  38. 38.
    Afridi SP, Memon A, Shafiq-ur-Rahman, Memon A (2010) Granulomatous mastitis: a case series. J Coll Physicians Surg Pak 20(6):365–368Google Scholar
  39. 39.
    Sato N, Yamashita H, Kozaki N, Watanabe Y, Ohtsuka T, Kuroki S, Nakafusa Y, Ota M, Chijiiwa K, Tanaka M (1996) Granulomatous mastitis diagnosed and followed up by fine-needle aspiration cytology, and successfully treated by corticosteroid therapy: report of a case. Surg Today 26(9):730–733PubMedCrossRefGoogle Scholar
  40. 40.
    Hirata S, Saito T, Kiyanagi K, Kitada M, Yamazaki K, Sasajima T, Ohsaki Y, Miyokawa N (2003) Granulomatous mastitis diagnosed by core-needle biopsy and successfully treated with corticosteroid therapy: a case report. Breast Cancer 10(4):378–381PubMedCrossRefGoogle Scholar
  41. 41.
    Gupta RK (2010) Fine needle aspiration cytology of granulomatous mastitis: a study of 18 cases. Acta Cytol 54(2):138–141PubMedCrossRefGoogle Scholar
  42. 42.
    DeHertogh DA, Rossof AH, Harris AA, Economou SG (1980) Prednisone management of granulomatous mastitis. N Engl J Med 303(14):799–800PubMedCrossRefGoogle Scholar
  43. 43.
    Fletcher A, Magrath IM, Riddell RH, Talbot IC (1982) Granulomatous mastitis: a report of seven cases. J Clin Pathol 35(9):941–945PubMedCrossRefGoogle Scholar
  44. 44.
    Jorgensen MB, Nielsen DM (1992) Diagnosis and treatment of granulomatous mastitis. Am J Med 93(1):97–101PubMedCrossRefGoogle Scholar
  45. 45.
    Miliauskas JR, Pieterse AS, Williams RS (1995) Granulomatous lobular mastitis. Aust NZ J Surg 65(2):139–141CrossRefGoogle Scholar
  46. 46.
    Goldberg J, Baute L, Storey L, Park P (2000) Granulomatous mastitis in pregnancy. Obstet Gynecol 96(5):813–815PubMedCrossRefGoogle Scholar
  47. 47.
    Newnham MS, Shirley SE, McDonald AH (2001) Granulomatous lobular mastitis. A case report and review of the literature. West Indian Med J 50(3):236–238PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Sami Akbulut
    • 1
  • Zulfu Arikanoglu
    • 1
  • Ayhan Senol
    • 2
  • Nilgun Sogutcu
    • 3
  • Murat Basbug
    • 1
  • Erhan Yeniaras
    • 4
  • Yusuf Yagmur
    • 1
  1. 1.Department of SurgeryDiyarbakir Education and Research HospitalDiyarbakirTurkey
  2. 2.Department of RadiologyDiyarbakir Education and Research HospitalDiyarbakirTurkey
  3. 3.Department of PathologyDiyarbakir Education and Research HospitalDiyarbakirTurkey
  4. 4.Department of AnaesthesiologyDiyarbakir Education and Research HospitalDiyarbakirTurkey

Personalised recommendations