Skip to main content

Advertisement

SpringerLink
Log in

What are the new findings with regard to the mysterious disease idiopathic granulomatous mastitis?

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

To review the demographic and clinical features and the success rates of treatment approaches for idiopathic granulomatous mastitis (IGM).

Methods

A total of 134 patients diagnosed with IGM pathologically and treated by a single breast surgeon were retrospectively analyzed.

Results

The time between the occurrence of symptoms and the last delivery was < 24 months in 25 (23.1%), 24–48 months in 51 (38.1%), and > 48 months in 52 (38.8%). The difference was statistically significant (p = 0.002). Although there was no significant difference, seasonal fluctuations were noticed, with the incidence being slightly higher during late spring and summer. Bilateral disease was present in 10 (7.5%) patients. Seven patients (5.2%) had erythema nodosum. The treatment approaches were conservative in 42, surgical procedures in 48, steroid treatment in 18, and surgical procedure + steroid treatment in 24. The median recovery time with conservative approaches was lower than that with surgical procedure + steroid treatment (p < 0.0001). Recurrence developed in 10 patients (7.7%).

Conclusion

Clinical differences were detected among the patients with IGM, and classification of patients by severity is needed to plan the optimal treatment approach. Seasonal fluctuations suggest the possibility of an immunological disease rather than a surgical disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Kessler E, Wolloch Y. Granulomatous mastitis: a lesion clinically simulating carcinoma. Am J Clin Pathol. 1972;58:642–6.

    Article  CAS  Google Scholar 

  2. Altintoprak F, Kivilcim T, Ozkan OV. Aetiology of idiopathic granulomatous mastitis. World J Clin Cases. 2014;2:852–8.

    Article  Google Scholar 

  3. Benson JR, Dumitru D. Idiopathic granulomatous mastitis: presentation, investigation and management. Future Oncol. 2016;12:1381–94.

    Article  CAS  Google Scholar 

  4. Koksal H. Human leukocyte antigens class I and II in patients with idiopathic granulomatous mastitis. Am J Surg. 2019;218:605–8.

    Article  Google Scholar 

  5. Akın M, Karabacak H, Esendağlı G, Yavuz A, Gultekin S, Dikme K, et al. Coexistence of idiopathic granulomatous mastitis and erythemanodosum: successful treatment with corticosteroids. Turk J Med Sci. 2017;47:1590–2.

    Article  Google Scholar 

  6. Salesi M, Karimifar M, Salimi F, Mahzouni P. A case of granulomatous mastitis with erythema nodosum and arthritis. Rheumatol Int. 2011;31:1093–5.

    Article  Google Scholar 

  7. Binesh F, Shiryazdi M, Bagher Owlia M, Azimi S. Idiopathic granulomatous mastitis, erythema nodosum and bilateral ankle arthritis in an Iranian woman. BMJ Case Rep. 2013; 2013: bcr2012007636.

  8. Zabetian S, Friedman BJ, McHargue C. A case of idiopathic granulomatous mastitis associated with erythema nodosum, arthritis, and reactive cough. JAAD Case Rep. 2016;2:125–7.

    Article  Google Scholar 

  9. Alungal J, Abdulla MC, Narayan R. Idiopathic granulomatous mastitis with erythema nodosum and polyarthritis. Reumatismo. 2016;68:97–9.

    Article  CAS  Google Scholar 

  10. Vural S, Ertop P, Ceyhan K, Şanli H. An unusual cause of oligoarthritis and erythema nodosum: idiopathic granulomatous mastitis. Arch Rheumatol. 2017;32:71–5.

    Article  Google Scholar 

  11. Letourneux C, Diemunsch P, Korganow AS, Akladios CY, Bellocq JP, Mathelin C. First report of granulomatous mastitis associated with Sjögren’s syndrome. World J Surg Oncol. 2013;11:268.

    Article  Google Scholar 

  12. Velidedeoglu M, Kilic F, Mete B, Yemisen M, Celik V, Gazioglu E, et al. Bilateral idiopathic granulomatous mastitis. Asian J Surg. 2016;39:12–20.

    Article  Google Scholar 

  13. Koksal H, Vatansev H, Artac H, Kadoglou N. The clinical value of interleukins-8, -10, and -17 in idiopathic granulomatous mastitis. Clin Rheumatol. 2020;39:1671–7.

    Article  Google Scholar 

  14. Saydam M, Yilmaz KB, Sahin M, Yanik H, Akinci M, Yilmaz I, et al. New findings on autoimmune etiology of idiopathic granulomatous mastitis: serum IL-17, IL-22 and IL-23 levels of patients. J Invest Surg. 2020. https://doi.org/10.1080/08941939.2020.1725190 ((published online ahead of print, 2020 Feb 11)).

    Article  PubMed  Google Scholar 

  15. Cohen C. Granulomatous mastitis: areview of 5 cases. S Afr Med J. 1977;52:14–6.

    CAS  PubMed  Google Scholar 

  16. Yaghan R, Hamouri S, Ayoub NM, Yaghan L, Mazahreh T. A proposal of a clinically based classification for idiopathic granulomatous mastitis. Asian Pac J Cancer Prev. 2019;20:929–34.

    Article  Google Scholar 

  17. Altintoprak F, Karakece E, Kivilcim T, Dikicier E, Cakmak G, Celebi F, et al. Idiopathic granulomatous mastitis: an autoimmune disease? Sci World J. 2013;2013:148727.

    Google Scholar 

  18. Sheybani F, Naderi HR, Gharib M, Sarvghad M, Mirfeizi Z. Idiopathic granulomatous mastitis: long-discussed but yet-to-be-known. Autoimmunity. 2016;49:236–9.

    Article  CAS  Google Scholar 

  19. Ozel L, Unal A, Unal E, Kara M, Erdoğdu E, Krand O, et al. Granulomatous mastitis: is it an autoimmune disease? Diagnostic and therapeutic dilemmas. Surg Today. 2012;42:729–33.

    Article  CAS  Google Scholar 

  20. Çetin K, Sıkar HE, Göret NE, Rona G, Barisik NO, Kucuk HF, et al. Comparison of topical, systemic, and combined therapy with steroids on idiopathic granulomatous mastitis: a prospective randomized study. World J Surg. 2019;43:2865–73.

    Article  Google Scholar 

  21. Gulluoglu BM. Idiopathic granulomatous mastitis: do we really regard it as a surgical disease anymore? World J Surg. 2015;39:2724–5.

    Article  Google Scholar 

  22. Martinez-Ramos D, Simon-Monterde L, Suelves-Piqueres C, Queralt-Martin R, Granel-Villach L, Laguna-Sastre JM, et al. Idiopathic granulomatous mastitis: a systematic review of 3060 patients. Breast J. 2019;25:1245–50.

    Article  Google Scholar 

  23. Uysal E, Soran A, Sezgin E, Granulomatous Mastitis Study Group. Factors related to recurrence of idiopathic granulomatous mastitis: what do we learn from a multicentre study? ANZ J Surg. 2018;88:635–9.

    Article  Google Scholar 

  24. Azizi A, Prasath V, Canner J, Gharib M, Sadat Fattahi A, Naser Forghani M, et al. Idiopathic granulomatous mastitis: management and predictors of recurrence in 474 patients. Breast J. 2020. https://doi.org/10.1111/tbj.13822 (published online ahead of print, 2020 Apr 5).

    Article  PubMed  Google Scholar 

  25. Cohn J. Thrombocytopenia in childhood: an evaluation of 433 patients. Scand J Haematol. 1976;16:226–40.

    Article  CAS  Google Scholar 

  26. Kühne T, Imbach P, Bolton-Maggs PH, Berchtold W, Blanchette V, Buchanan GR, Intercontinental childhood ITP study group. Newly diagnosed idiopathic thrombocytopenic purpura in childhood: an observational study. Lancet. 2001;358:2122–5.

    Article  Google Scholar 

  27. Moulis G, Guénin S, Limal N, Michel M, Bierling P, Godeau B, et al. Seasonal variations of incident primary immune thrombocytopenia in adults: an ecological study. Eur J Intern Med. 2017;37:e26–8. https://doi.org/10.1016/j.ejim.2016.09.025.

    Article  PubMed  Google Scholar 

  28. Çiftci F, Abdurrahman İ, Tatar Z. The effect of corticosteroid treatment on bilateral idiopathic granulomatous mastitis. Turk J Surg. 2015;33:113–5.

    Article  Google Scholar 

  29. Irkorucu O. Granulomatous mastitis: we need a useful classification system. Am J Surg. 2018;216:642.

    Article  Google Scholar 

  30. Bouton ME, Jayaram L, O’Neill PJ, Hsu CH, Komenaka IK. Management of idiopathic granulomatous mastitis with observation. Am J Surg. 2015;210:258–62.

    Article  Google Scholar 

  31. Yuksekdag S, Yildiz A, Yildirak K, Ayranci G, Cibiroglu E, Ezberci F, et al. Conservative management of 154 patients with idiopathic granulomatous mastitis: simple is better? Ann Ital Chir. 2020;91:154–60.

    PubMed  Google Scholar 

  32. Kıvılcım T, Altıntoprak F, Memiş B, Ferhatoğlu MF, Kartal A, Dikicier E, et al. Role of bacteriological agents in idiopathic granulomatous mastitis: real or not? Eur J Breast Health. 2018;15:32–6.

    Article  Google Scholar 

  33. Gunduz Y, Altintoprak F, Tatli Ayhan L, Kivilcim T, Celebi F. Effect of topical steroid treatment on idiopathic granulomatous mastitis: clinical and radiologic evaluation. Breast J. 2014;20:586–91.

    Article  CAS  Google Scholar 

  34. Montazer M, Dadashzadeh M, Moosavi Toomatari SE. Comparison of the outcome of low dose and high-dose corticosteroid in the treatment of idiopathic granulomatous mastitis. Asian Pac J Cancer Prev. 2020;21:993–6.

    Article  CAS  Google Scholar 

  35. Cetin K, Sıkar HE, Goret NE, Rona G, Barisik NO, Kuçuk HF, et al. Comparison of topical, systemic, and combined therapy with steroids on idiopathic granulomatous mastitis: a prospective randomized study. World J Surg. 2019;43:2865–73.

    Article  Google Scholar 

  36. Toktas O, Konca C, Trabulus DC, Soyder A, Koksal H, Karanlik H, et al. A novel first-line treatment alternative for noncomplicated idiopathic granulomatous mastitis: combined intralesional steroid injection with topical steroid administration. Breast Care. 2020. https://doi.org/10.1159/000507951.

    Article  PubMed  Google Scholar 

  37. Co M, Cheng VCC, Wei J, Wong SCY, Chan SMS, Shek T, et al. Idiopathic granulomatous mastitis: a 10-year study from a multicentre clinical database. Pathology. 2018;50:742–7.

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank the pathology and radiology departments for their contributions to the diagnosis of the patients included in the study.

Funding

The authors declare that this study has received no financial support.

Author information

Authors and Affiliations

  1. Department of General Surgery, Ministry of Health Konya City Hospital, Hamidiye Faculty of Medicine, Saglik Bilimleri University, 42040, Konya, Turkey

    Hande Koksal

Authors
  1. Hande Koksal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hande Koksal.

Ethics declarations

Conflict of interest

No conflict of interest was declared by the author.

Ethics committee approval

Ethics committee approval was received for this study from the ethics committee of Selcuk University (No: 2020/265).

Informed consent

Written informed consent was not obtained due to the retrospective nature of the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Koksal, H. What are the new findings with regard to the mysterious disease idiopathic granulomatous mastitis?. Surg Today 51, 1158–1168 (2021). https://doi.org/10.1007/s00595-020-02204-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-020-02204-2

Keywords

Search

Navigation