Advertisement

Surgery Today

, Volume 45, Issue 4, pp 457–465 | Cite as

Corticosteroid treatment in the management of idiopathic granulomatous mastitis to avoid unnecessary surgery

  • Tulay Mizrakli
  • Mehmet Velidedeoglu
  • Mucahit Yemisen
  • Birgul Mete
  • Fahrettin Kilic
  • Halit Yilmaz
  • Tulin Ozturk
  • Resat Ozaras
  • Fatih AydoganEmail author
  • Asiye Perek
Original Article

Abstract

Purpose

Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory disease of the breast. It can mimic breast carcinoma clinically and radiologically, and usually affects females of childbearing age. There is no commonly accepted optimal treatment for IGM. In this study, we present the clinical and histopathological features and outcomes of the therapeutic management of IGM, as well as the clinical course of the disease when patients were treated with oral corticosteroids.

Methods

This retrospective study included 49 of 87 patients who met the required histological criteria for IGM who were followed up between January 2009 and December 2011. All patients had a disease-free follow-up period of at least 6 months. The data regarding the clinical features at presentation, laboratory values and the treatment modalities were obtained from the medical records of the patients.

Results

The mean age of the patients was 34.3 ± 4.37 years. Forty patients were treated with prednisolone, five were started on antituberculosis treatment, two received non-steroidal anti-inflammatory drugs, one received antibiotics and one underwent wide excision. All patients who received steroids responded well to the therapy.

Conclusion

Systemic therapy with corticosteroids is an effective and appropriate treatment option for IGM. It can provide complete disease resolution and prevent recurrence in the long term. A multidisciplinary approach including specialists in the fields of both general surgery and infectious diseases is essential for the diagnosis, treatment and follow-up of IGM.

Keywords

Idiopathic granulomatous mastitis Corticosteroid Breast neoplasms 

References

  1. 1.
    Kessler E, Wolloch Y. Granulomatous mastitis: a lesion clinically simulating carcinoma. Am J Clin Pathol. 1972;58:642–6.PubMedGoogle Scholar
  2. 2.
    Cohen C. Granulomatous mastitis. A review of 5 cases. South Afr Med J. Suid-Afrikaanse tydskrif vir geneeskunde. 1977;52:14–6.Google Scholar
  3. 3.
    Erhan Y, Veral A, Kara E, Ozdemir N, Kapkac M, Ozdedeli E, et al. A clinicopathologic study of a rare clinical entity mimicking breast carcinoma: idiopathic granulomatous mastitis. Breast. 2000;9:52–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Pouchot J, Foucher E, Lino M, Barge J, Vinceneux P. Granulomatous mastitis: an uncommon cause of breast abscess. Arch Intern Med. 2001;161:611–2.CrossRefPubMedGoogle Scholar
  5. 5.
    Carmalt HL, Ramsey-Stewart G. Granulomatous mastitis. Med J Austr. 1981;1:356–9.Google Scholar
  6. 6.
    Yau FM, Macadam SA, Kuusk U, Nimmo M, Van Laeken N. The surgical management of granulomatous mastitis. Ann Plast Surg. 2010;64:9–16.CrossRefPubMedGoogle Scholar
  7. 7.
    Hovanessian Larsen LJ, Peyvandi B, Klipfel N, Grant E, Iyengar G. Granulomatous lobular mastitis: imaging, diagnosis, and treatment. AJR Am J Roentgenol. 2009;193:574–81.CrossRefPubMedGoogle Scholar
  8. 8.
    Belaabidia B, Essadki O, el Mansouri A, Squalli S. Idiopathic granulomatous mastitis: apropos of 8 cases and review of the literature. Gynecologie Obstetrique Fertilite. 2002;30:383–9.CrossRefGoogle Scholar
  9. 9.
    Rowe PH. Granulomatous mastitis associated with a pituitary prolactinoma. Brit J Clin Practice. 1984;38:32–4.Google Scholar
  10. 10.
    Cserni G, Szajki K. Granulomatous lobular mastitis following drug-induced galactorrhea and blunt trauma. Breast J. 1999;5:398–403.CrossRefPubMedGoogle Scholar
  11. 11.
    Donn W, Rebbeck P, Wilson C, Gilks CB. Idiopathic granulomatous mastitis. A report of three cases and review of the literature. Arch Pathol Lab Med. 1994;118:822–5.PubMedGoogle Scholar
  12. 12.
    Mirsaeidi SM, Masjedi MR, Mansouri SD, Velayati AA. Tuberculosis of the breast: report of 4 clinical cases and literature review. East Mediter Health J. La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit. 2007;13:670–6.Google Scholar
  13. 13.
    Maffini F, Baldini F, Bassi F, Luini A, Viale G. Systemic therapy as a first choice treatment for idiopathic granulomatous mastitis. J Cutan Pathol. 2009;36:689–91.CrossRefPubMedGoogle Scholar
  14. 14.
    Kim J, Tymms KE, Buckingham JM. Methotrexate in the management of granulomatous mastitis. ANZ J Surg. 2003;73:247–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Raj N, Macmillan RD, Ellis IO, Deighton CM. Rheumatologists and breasts: immunosuppressive therapy for granulomatous mastitis. Rheumatology. 2004;43:1055–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Katz U, Molad Y, Ablin J, Ben-David D, Paran D, Gutman M, et al. Chronic idiopathic granulomatous mastitis. Ann N Y Acad Sci. 2007;1108:603–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Schmajuk G, Genovese MC. First report of idiopathic granulomatous mastitis treated with methotrexate monotherapy. J Rheumatol. 2009;36:1559–60.CrossRefPubMedGoogle Scholar
  18. 18.
    Sato N, Yamashita H, Kozaki N, Watanabe Y, Ohtsuka T, Kuroki S, et al. Granulomatous mastitis diagnosed and followed up by fine-needle aspiration cytology, and successfully treated by corticosteroid therapy: report of a case. Surg Today. 1996;26:730–3.CrossRefPubMedGoogle Scholar
  19. 19.
    Milward TM, Gough MH. Granulomatous lesions in the breast presenting as carcinoma. Surg Gynecol Obstet. 1970;130:478–82.PubMedGoogle Scholar
  20. 20.
    Kfoury H, Al Bhlal L. Granulomatous lobular mastitis: a clinicopathological study of 112 cases. Ann Saudi Med. 1997;17:43–6.PubMedGoogle Scholar
  21. 21.
    Lacambra M, Thai TA, Lam CC, Yu AM, Pham HT, Tran PV, et al. Granulomatous mastitis: the histological differentials. J Clin Pathol. 2011;64:405–11.CrossRefPubMedGoogle Scholar
  22. 22.
    Bani-Hani KE, Yaghan RJ, Matalka II, Shatnawi NJ. Idiopathic granulomatous mastitis: time to avoid unnecessary mastectomies. Breast J. 2004;10:318–22.CrossRefPubMedGoogle Scholar
  23. 23.
    Ahmed R, Sultan F. Granulomatous mastitis: a review of 14 cases. J Ayub Med Coll Abbottabad. 2006;18:52–4.PubMedGoogle Scholar
  24. 24.
    Al-Khaffaf B, Knox F, Bundred NJ. Idiopathic granulomatous mastitis: a 25-year experience. J Am Coll Surg. 2008;206:269–73.CrossRefPubMedGoogle Scholar
  25. 25.
    Lai EC, Chan WC, Ma TK, Tang AP, Poon CS, Leong HT. The role of conservative treatment in idiopathic granulomatous mastitis. Breast J. 2005;11:454–6.CrossRefPubMedGoogle Scholar
  26. 26.
    Ozel L, Unal A, Unal E, Kara M, Erdogdu E, Krand O, et al. Granulomatous mastitis: is it an autoimmune disease? Diagnostic and therapeutic dilemmas. Surg Today. 2012;42:729–33.CrossRefPubMedGoogle Scholar
  27. 27.
    Asoglu O, Ozmen V, Karanlik H, Tunaci M, Cabioglu N, Igci A, et al. Feasibility of surgical management in patients with granulomatous mastitis. Breast J. 2005;11:108–14.CrossRefPubMedGoogle Scholar
  28. 28.
    Ozturk E, Akin M, Can MF, Ozerhan I, Kurt B, Yagci G, et al. Idiopathic granulomatous mastitis. Saudi Med J. 2009;30:45–9.PubMedGoogle Scholar
  29. 29.
    Azlina AF, Ariza Z, Arni T, Hisham AN. Chronic granulomatous mastitis: diagnostic and therapeutic considerations. World J Surg. 2003;27:515–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Dursun M, Yilmaz S, Yahyayev A, Salmaslioglu A, Yavuz E, Igci A, et al. Multimodality imaging features of idiopathic granulomatous mastitis: outcome of 12 years of experience. Radiol Med (Torino). 2012;117:529–38.CrossRefGoogle Scholar
  31. 31.
    Baslaim MM, Khayat HA, Al-Amoudi SA. Idiopathic granulomatous mastitis: a heterogeneous disease with variable clinical presentation. World J Surg. 2007;31:1677–81.CrossRefPubMedGoogle Scholar
  32. 32.
    Kok KY, Telisinghe PU. Granulomatous mastitis: presentation, treatment and outcome in 43 patients. Surg. 2010;8:197–201.Google Scholar
  33. 33.
    Jayia P, Oberg E, Tuffaha H, Leff DR, Al-Mufti R, Hadjiminas D. Should we manage all cases of granulomatous mastitis conservatively? A 14 year experience. Breast J. 2013;19:215–6.CrossRefPubMedGoogle Scholar
  34. 34.
    Akbulut S, Arikanoglu Z, Senol A, Sogutcu N, Basbug M, Yeniaras E, et al. Is methotrexate an acceptable treatment in the management of idiopathic granulomatous mastitis? Arch Gynecol Obstet. 2011;284:1189–95.CrossRefPubMedGoogle Scholar
  35. 35.
    Gautier N, Lalonde L, Tran-Thanh D, Khoury ME, David J, Labelle M, et al. Chronic granulomatous mastitis: imaging, pathology and management. Eur J Radiol. 2013;82:e165–75.CrossRefPubMedGoogle Scholar
  36. 36.
    Davies JD, Burton PA. Postpartum lobular granulomatous mastitis. J Clin Pathol. 1983;36:363.CrossRefPubMedCentralPubMedGoogle Scholar
  37. 37.
    Going JJ, Anderson TJ, Wilkinson S, Chetty U. Granulomatous lobular mastitis. J Clin Pathol. 1987;40:535–40.CrossRefPubMedCentralPubMedGoogle Scholar
  38. 38.
    Brown KL, Tang PH. Postlactational tumoral granulomatous mastitis: a localized immune phenomenon. Am J Surg. 1979;138:326–9.CrossRefPubMedGoogle Scholar
  39. 39.
    Taghizadeh R, Shelley OP, Chew BK, Weiler-Mithoff EM. Idiopathic granulomatous mastitis: surgery, treatment, and reconstruction. Breast J. 2007;13:509–13.CrossRefPubMedGoogle Scholar
  40. 40.
    Heer R, Shrimankar J, Griffith CD. Granulomatous mastitis can mimic breast cancer on clinical, radiological or cytological examination: a cautionary tale. Breast. 2003;12:283–6.CrossRefPubMedGoogle Scholar
  41. 41.
    Erozgen F, Ersoy YE, Akaydin M, Memmi N, Celik AS, Celebi F, et al. Corticosteroid treatment and timing of surgery in idiopathic granulomatous mastitis confusing with breast carcinoma. Breast Cancer Res Treat. 2010;123:447–52.CrossRefPubMedGoogle Scholar
  42. 42.
    Ocal K, Dag A, Turkmenoglu O, Kara T, Seyit H, Konca K. Granulomatous mastitis: clinical, pathological features, and management. Breast J. 2010;16:176–82.CrossRefPubMedGoogle Scholar
  43. 43.
    Olfatbakhsh A, Beheshtian T, Djavid GE. Granulomatous mastitis, erythema nodosum, and oligoarthritis in a pregnant woman. Breast J. 2008;14:588–90.CrossRefPubMedGoogle Scholar
  44. 44.
    Fletcher A, Magrath IM, Riddell RH, Talbot IC. Granulomatous mastitis: a report of seven cases. J Clin Pathol. 1982;35:941–5.CrossRefPubMedCentralPubMedGoogle Scholar
  45. 45.
    Imoto S, Kitaya T, Kodama T, Hasebe T, Mukai K. Idiopathic granulomatous mastitis: case report and review of the literature. Jpn J Clin Oncol. 1997;27:274–7.CrossRefPubMedGoogle Scholar
  46. 46.
    Neel A, Hello M, Cottereau A, Graveleau J, De Faucal P, Costedoat-Chalumeau N, et al. Long-term outcome in idiopathic granulomatous mastitis: a western multicentre study. QJM. 2013;106:433–41.CrossRefPubMedGoogle Scholar
  47. 47.
    Neel A, Hello M, Cottereau A, Graveleau J, De Faucal P, Costedoat-Chalumeau N, et al. Long-term outcome in idiopathic granulomatous mastitis: a western multicentre study. QJM. 2013.Google Scholar
  48. 48.
    Diallo R, Frevel T, Poremba C, Cirkel U, Metze D, Dockhorn-Dworniczak B. Lupus vulgaris as the etiology of tuberculous mastitis. Der Pathologe. 1997;18:67–70.CrossRefPubMedGoogle Scholar
  49. 49.
    Gupta D, Rajwanshi A, Gupta SK, Nijhawan R, Saran RK, Singh R. Fine needle aspiration cytology in the diagnosis of tuberculous mastitis. Acta Cytol. 1999;43:191–4.CrossRefPubMedGoogle Scholar
  50. 50.
    Ponce de Leon D, Acevedo-Vasquez E, Alvizuri S, Gutierrez C, Cucho M, Alfaro J, et al. Comparison of an interferon-gamma assay with tuberculin skin testing for detection of tuberculosis (TB) infection in patients with rheumatoid arthritis in a TB-endemic population. J Rheumatol. 2008;35:776–81.PubMedGoogle Scholar
  51. 51.
    Tse GM, Poon CS, Ramachandram K, Ma TK, Pang LM, Law BK, et al. Granulomatous mastitis: a clinicopathological review of 26 cases. Pathology. 2004;36:254–7.CrossRefPubMedGoogle Scholar
  52. 52.
    Sakurai T, Oura S, Tanino H, Yoshimasu T, Kokawa Y, Kinoshita T, et al. A case of granulomatous mastitis mimicking breast carcinoma. Breast Cancer. 2002;9:265–8.CrossRefPubMedGoogle Scholar
  53. 53.
    Yilmaz E, Lebe B, Usal C, Balci P. Mammographic and sonographic findings in the diagnosis of idiopathic granulomatous mastitis. Eur Radiol. 2001;11:2236–40.CrossRefPubMedGoogle Scholar
  54. 54.
    Memis A, Bilgen I, Ustun EE, Ozdemir N, Erhan Y, Kapkac M. Granulomatous mastitis: imaging findings with histopathologic correlation. Clin Radiol. 2002;57:1001–6.CrossRefPubMedGoogle Scholar
  55. 55.
    Han BK, Choe YH, Park JM, Moon WK, Ko YH, Yang JH, et al. Granulomatous mastitis: mammographic and sonographic appearances. AJR Am J Roentgenol. 1999;173:317–20.CrossRefPubMedGoogle Scholar
  56. 56.
    Gal-Gombos EC, Esserman LE, Odzer SL, Weisberg S, Wilson C, Poppiti RJ Jr. Granulomatous mastitis: diagnosis by ultrasound-guided core biopsy. Breast J. 2001;7:129–30.CrossRefPubMedGoogle Scholar
  57. 57.
    Boarki K, Labib M. Imaging findings in Idiopathic lobular granulomattous mastitis, case report and review of literature. Gulf J Oncol. 2010;(7):46–52.Google Scholar
  58. 58.
    Kuba S, Yamaguchi J, Ohtani H, Shimokawa I, Maeda S, Kanematsu T. Vacuum-assisted biopsy and steroid therapy for granulomatous lobular mastitis: report of three cases. Surg Today. 2009;39:695–9.CrossRefPubMedGoogle Scholar
  59. 59.
    Lin TL, Chi SY, Liu JW, Chou FF. Tuberculosis of the breast: 10 years’ experience in one institution. Intern J Tuberc Lung Dis. 2010;14:758–63.Google Scholar
  60. 60.
    Akcan A, Akyildiz H, Deneme MA, Akgun H, Aritas Y. Granulomatous lobular mastitis: a complex diagnostic and therapeutic problem. World J Surg. 2006;30:1403–9.CrossRefPubMedGoogle Scholar
  61. 61.
    Wilson JP, Massoll N, Marshall J, Foss RM, Copeland EM, Grobmyer SR. Idiopathic granulomatous mastitis: in search of a therapeutic paradigm. Amer Surg. 2007;73:798–802.Google Scholar
  62. 62.
    Hladik M, Schoeller T, Ensat F, Wechselberger G. Idiopathic granulomatous mastitis: successful treatment by mastectomy and immediate breast reconstruction. J Plastic Reconstr Aesth Surg. 2011;64:1604–7.CrossRefGoogle Scholar
  63. 63.
    Hugon-Rodin J, Plu-Bureau G, Hugol D, Gompel A. Management of granulomatous mastitis: a series of 14 patients. Gynecol Endocrinol. 2012;28:921–4.CrossRefPubMedGoogle Scholar
  64. 64.
    Gurleyik G, Aktekin A, Aker F, Karagulle H, Saglamc A. Medical and surgical treatment of idiopathic granulomatous lobular mastitis: a benign inflammatory disease mimicking invasive carcinoma. J Breast Cancer. 2012;15:119–23.CrossRefPubMedCentralPubMedGoogle Scholar
  65. 65.
    DeHertogh DA, Rossof AH, Harris AA, Economou SG. Prednisone management of granulomatous mastitis. N Engl J Med. 1980;303:799–800.CrossRefPubMedGoogle Scholar
  66. 66.
    Guven HE, Pak I, Oral S. Granulomatous mastitis: surgical outcomes. JCPSP. 2006;16:431–3.PubMedGoogle Scholar
  67. 67.
    Dixon JM, Chetty U. Diagnosis and treatment of granulomatous mastitis. Brit J Surg. 1995;82:1143–4.CrossRefPubMedGoogle Scholar
  68. 68.
    Ayeva-Derman M, Perrotin F, Lefrancq T, Roy F, Lansac J, Body G. Idiopathic granulomatous mastitis. Review of the literature illustrated by 4 cases. J Gynecol Obstet Biol Reprod. 1999;28:800–7.Google Scholar

Copyright information

© Springer Japan 2014

Authors and Affiliations

  • Tulay Mizrakli
    • 1
  • Mehmet Velidedeoglu
    • 1
  • Mucahit Yemisen
    • 2
  • Birgul Mete
    • 2
  • Fahrettin Kilic
    • 3
  • Halit Yilmaz
    • 3
  • Tulin Ozturk
    • 4
  • Resat Ozaras
    • 2
  • Fatih Aydogan
    • 1
    • 5
    Email author
  • Asiye Perek
    • 1
  1. 1.Department of General Surgery, Cerrahpasa Medical FacultyIstanbul UniversityIstanbulTurkey
  2. 2.Department of Infectious Diseases, Cerrahpasa Medical FacultyIstanbul UniversityIstanbulTurkey
  3. 3.Department of Radiology, Cerrahpasa Medical FacultyIstanbul UniversityIstanbulTurkey
  4. 4.Department of Pathology, Cerrahpasa Medical FacultyIstanbul UniversityIstanbulTurkey
  5. 5.Cerrahpasa Tip FakultesiIstanbulTurkey

Personalised recommendations