A Proposal of a Clinically Based Classification for Idiopathic Granulomatous Mastitis

Abstract

Objectives:There is no consensus regarding the surgical or immunosuppressive treatment of idiopathic granulomatous mastitis (IGM). This study aimed to introduce a clinical classification system for IGM that might facilitate its treatment and predict recurrence.Methods:We analyzed the management of 68 patients with IGM at (Princess Basma Teaching Hospital and King Abdulla University Hospital (1994-2016) to find out if distinct patterns of presentation exist according to the following parameters: presence of a painful or painless breast mass, local inflammation, abscess formation, communication to the skin, and extra-mammary manifestation.Results:We identified four distinct patterns of IGM: A: (13.23 %) A hard, painless breast mass. B: (52.94 %) A hard, painful breast mass with gross inflammation. C: (26.47 %) A breast abscess-like presentation. D: (7. 35 %) A subacute presentation with ulceration, sinus, or fistula formation. Erythema nodosum might complicate any of these patterns. Wide local excision in pattern A was curative with zero recurrence rate. The recurrence rates in patterns B and C were 22.20 % and 50.00 %. Patterns B, C, and D were treated by a combination of surgery and prednisolone. In keeping with this, recent literature is in favor of a wider use of immunosuppression especially in the presence of pus and extra-mammary findings.Conclusion:IGM could be classified into 4 distinct patterns according to the presenting signs and symptoms. These patterns correlated with treatment, recurrence rate, and the gross operative findings. This is the first step toward a classification for IGM. Multicenter and Meta-analysis studies are essential for a comprehensive prognostic classification. Treatment of IGM in any institution should be the responsibility of a multidisciplinary team.

Comparison of the Outcome of Low Dose and High-Dose Corticosteroid in the Treatment of Idiopathic Granulomatous Mastitis

“…The management strategy for IGM is controversial. Use of corticosteroids alone or in combination with methotrexate or azathioprine and antibiotics especially azithromycin, abscess drainage, and wide local excision of the lesions have been reported for the treatment of IGM (Akcan et al, 2014;Atak et al, 2015;Salehi et al, 2017;Sheybani et al, 2015;Yaghan et al, 2019;Yukawa et al, 2015). Considering the efficacy of the corticosteroids in the previous studies which are mostly retrospective, there is a need for clinical trials to confirm these findings.…”

Mastitis to mastectomy: a rare, unresponsive postpartum eruption

“…Pattern D presents as a hard breast mass communicating to the outside through ulceration, fistulae, and/or sinuses that may mimic an ulcerating breast carcinoma or tuberculous mastitis. These patterns correlated with treatment, recurrence rate, and the gross operative findings …”

“…Ultimately, IGM is a histologic diagnosis that is supported by radiologic imaging . The histologic characteristics as identified by Kessler and Wolloch are the main diagnostic requirement for IGM: noncaseating granulomatous inflammation centered on breast lobules, with the presence of epithelioid histiocytes, lymphocytes, plasma cells, polymorphonuclear leukocytes, and multinucleated Langhans‐type giant cells . Other forms of granulomatous dermatitis such as palisaded neutrophilic granulomatous dermatitis (PNGD) and interstitial granulomatous dermatitis (IGD) may demonstrate similar histologic features but are commonly associated with underlying autoimmune disease.…”

“…These patterns correlated with treatment, recurrence rate, and the gross operative findings. 4 There are no formal diagnostic criteria for IGM, and it is considered to be a diagnosis of exclusion. It presents a diagnostic challenge as there is significant clinical overlap with other disease processes often resulting in delayed diagnosis and prolonged courses of antibiotic therapy.…”

Ultrasound classification-guided minimally invasive rotary cutting in granulomatous lobular mastitis

“…As described in the literature, ultra-sonographic findings of granulomatous lobular mastitis are nonspecific and are occasionally interpreted as malignant [3,4]. Yaghan [2] first proposed a classification system for IGM that provides therapeutic clues and helps to predict recurrence.…”