Abstract
Even though idiopathic granulomatous mastitis (IGM) is a benign breast lesion of the mammary grand, it poses a problem of diagnosis as it is a rare entity. Because it resembles breast abscess or inflammatory carcinoma, patients undergo surgical excision leading to breast scarring and disfigurement. In this work, we carried a prospective study of cases of IGM managed over the past 7 years from 2009 to 2015. Among 4200 patients who were treated for breast swelling, 40 cases of IGM were diagnosed. We present the clinical data of our IGM patients and results of treatment with corticosteroids and methotrexate. The mean age of presentation was 33 years, and the median duration of steroid and methotrexate treatment was 3 and 6–9 months, respectively. The diagnosis of IGM was confirmed by core needle biopsy in all the patients. With this combination therapy, all the patients showed complete resolution of IGM and the recurrence was observed in only 2 patients. Our study demonstrates that a combination of corticosteroids (prednisolone) and methotrexate is an ideal choice of treatment for IGM rather than the surgical excision. The combination of low doses of corticosteroids with methotrexate could significantly prevent the side effects of high doses of corticosteroids.
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References
Kessler E, Wolloch Y (1972) Granulomatous mastitis: a lesion clinically simulating carcinoma. Am J Clin Pathol 58:642–646
Veyssiere C, Vives M, Smadja A (1967) Difficultes diagnostiques de la tuberculose mammaire. Le probleme de la mastite granulomateuse, Lille Chir 22:104–109
DeHertogh DA, Rossof AH, Harris AA, Economou SG (1980) Prednisone management of granulomatous mastitis. N Engl J Med 303:799–800
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 123:447–452
Sakurai K, Fujisaki S, Enomoto K, Amano S, Sugitani M (2011) Evaluation of follow up strategies for corticosteroid therapy of idiopathic granulomatous mastitis. Surg Today 41:333–337
Akbulut S, Arikanoglu Z, Senol A, Sogutcu N, Basbug M, Yeniaras E, Yaagmur Y (2011) Is methotrexate an acceptable treatment in the management of idiopathic granulomatous mastitis? Arch Gynecol Obstet 284:1189–1195
Yau FM, Macadam SA, Kuusk U, Nimmo M, Van Laeken N (2010) The surgical management of granulomatous mastitis. Ann Plast Surg 64:9–16
Brown KL, Tang PH (1979) Postlactational tumoral granulomatous mastitis: a localised immune phenomenon. Am J Surg 138:326–329
Carmalt HL, Ramsey Stewart G (1981) Granulomatous mastitis. Med J Aust 1:356–359
Alper A, Hizir A, Mehmet A, Hulya A (2006) Granulomatous lobular mastitis: a complex diagnostic and therapeutic problem. World J Surg 30:1403–1409
Bani Hani KE, Yaghan RJ, Matalka II, Shatnawi NJ (2004) Idiopathic granulomatous mastitis: time to avoid unnecessary mastectomies. Breast J 10:318–322
Sakurai T, Oura S, Tanino H, Yoshimasu T, Kokawa Y, Kinoshita T, Okamura Y (2002) A case of granulomatous mastitis mimicking breast carcinoma. Breast Cancer 9:265–268
Al Khaffaf B, Knox F, Bundred NJ (2008) Idioipathic granulomatous mastitis - a 25 year experience. J Am Coll Surg 206:269–273
Boufettal H, Hermas S, Noun M, Samouh N (2009) Mastite granulomateuse idiopathique bilaterale. Imagerie Femme 19:262–264
Asoglu O, Ozmen V, Karlik H (2005) Feasibility of surgical management in patients with granulomatus mastitis. Breast J 11:108–114
Azlina AF, Ariza Z, Anni T, Hisham AN (2003) Chronic granulomatous mastitis: diagnostic and therapeutic considerations. World J Surg 27:515–518
Pourbagher A, Tokmak N, Pourbagher MA, Kuc Z (2005) Idiopathic granulomatous mastitis: a report of three cases. Eur J Radios Extra 56:1–5
Shyamla CB, Prasad KRK, Rao G (1992) Chronic granulomatous mastitis: review of 26 case with special reference to chronic lobular mastitis. Indian J Pathol Micobiol 35:38–43
Salem A, Bennaceur R, Driss M, Mehiri S, Mrad K, Rajhi H, Hamza R, Ben Romdhane K, Mnif N (2008) Imagerie des mastites granulomateuses idiopathic. Imagerie Femme 18:46–54
Akcan A, Akyildiz H, Deneme MA, Akgun H, Aritas Y (2006) Granulomatous lobular mastitis : a complex diagnostic and theraupetic problem. World J Surg 30:1403–1409
Katz U, Molad Y, Ablin J et al (2007) Chronic idiopathic granulomatous mastitis. Ann N Y Acad Sci 1108:603–608
Imoto S, Kitaya T, Kodama T, Hasebe T, Mukai K (1997) Idiopathic granulomatous mastitis – case report and review of the literature. Jpn J Clinical Oncol 27:274–277
Baslaim MM, Khayat HA, Amoudi SA (2007) Idiopathic granulomatous mastitis: a heterogeneous disease with variable clinical presentation. World J Surg 31:1677–1681
Lai EC, Chan WC, Ma Tang AP, Poon CS, Leong HT (2005) The role of coservative treatment in idiopathic granulomatous mastitis. Breast J 11:454–456
Hugon Rodin J, Plu-Bureau G, Hugol D, Gompel A (2012) Management of granulomatous mastitis: a series of 14 patients. Gyecol Endocrinol 28:921–924
Hovanssian Larsen LJ, Peyvandi B, Klipfel N, Grant E, Iyengar G (2009) Granulomatous lobular mastitis: imaging, diagnosis and treatment. AJR Am J Roentgenol 193:574–581
Goldberg J, Baute L, Storey L, Park P (2000) Granulomatous mastitis in pregnancy. Obstet Gynecol 96:813–815
Kim J, Tymms KE, Buckingham JM (2003) Methotrexate in the management of granulomatous mastitis. ANZ J Surg 73:247–249
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The study was approved by the Institutional Scientific and Ethics Board of Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute (ISEB Code: C-3/32/2015). Routine consent was obtained from all individuals participating in the study.
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Oak, J., Nadkarni, M., Shetty, A. et al. Methotrexate in the Treatment of Idiopathic Granulomatous Mastitis. Indian J Surg 83 (Suppl 2), 454–460 (2021). https://doi.org/10.1007/s12262-021-02754-w
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DOI: https://doi.org/10.1007/s12262-021-02754-w