Etiologic revelation and outcome of the surgical management of idiopathic granulomatous mastitis; An Egyptian centre experience

Granulomatous mastitis (GM) is a rare benign inflammatory breast disease that affects mostly women of childbearing age with a history of breastfeeding. The etiopathogenesis is still unknown; however, inflammation as the result of a reaction to trauma, metabolic or hormonal processes, autoimmunity, and an infection with Corynebacterium kroppenstedtii have all been implicated. Clinical findings are pain, mass, hyperemia, and inflammation. Because the clinical presentation can mimic infectious mastitis or inflammatory carcinoma, the disease course is often protracted. The diagnosis is made by histopathology. Biopsies show a granulomatous formation in combination with a localized infiltration of multi-nucleated giant cells, epithelioid histiocytes, and plasma cells. Ultrasound, mammography, and magnetic resonance imaging are not specific; however, ultrasound and mammography should be done to exclude other pathologies. Due to the lack of data including randomized controlled studies, the management of GM is controversial. In Western industrialized countries, most authors use a therapy regimen starting with antibiotics and corticosteroids, followed by continuous steroid therapy and surgery in patients with persisting symptoms. More data are needed to define the best therapy. The role of immunotherapy has not yet been ascertained. The implementation of a registry to collect more information on this rare disease is highly recommended.

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“…GM is per definition a sterile inflammatory disease; therefore, antibiotic therapy usually fails [30,31] (table 1). …”

Section: Treatmentmentioning

confidence: 99%

Granulomatous Mastitis: A Therapeutic and Diagnostic Challenge

et al. 2018

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“…As the infection is presumed based on physical exam findings, antibiotic therapy is usually initiated without microbiological proof. GM is by definition a sterile inflammatory disease; therefore, antibiotic therapy usually fails [ 8 , 9 ]. This would explain the lack of success with the initial pharmacotherapy.…”

Section: Discussion/commentarymentioning

confidence: 99%

Red flags for the differential diagnosis of granulomatous mastitis: a case report

Chalmers¹,

McClellan²,

Silva³

et al. 2020

J Med Case Reports

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Background Granulomatous mastitis (GM) is a rare benign chronic inflammatory breast disease. GM presents as a heterogeneous illness with variable clinical presentations, and its diagnosis is usually made by exclusion. There are no guidelines for the treatment of GM. This manuscript describes the management of a patient with GM, initially unsuccessfully treated outside our clinic under a diagnosis of mastitis. The patient’s history, physical examination, and needle biopsy flagged the patient’s findings as nonmalignant; however, imaging studies indicated a tumor. Differential diagnosis became a critical element of her care. This case report represents a valuable resource to foster more assertive clinical practice in managing patients with GM. The case coordination and its course were led by a team from an outreach clinic that provides health care services to underserved communities in the state of Michigan. Case presentation A 41-year-old G1P1 Hispanic female immigrant from Central America presented with a rare breast disease, granulomatous mastitis. A similar presentation occurred 5 years before pregnancy when she had an episode of pain and swelling in the left breast, which resolved spontaneously. She sought our services after being diagnosed with mastitis that was unsuccessfully treated. Physical examination revealed a nodular mass in the outer quadrants of the left breast without regional lymphadenopathy. Needle biopsy showed fibrohistiocytic and florid inflammatory reactions, with no evidence of invasive carcinoma. However, this result was inconsistent with the degree of abnormality revealed by the mammogram (BI-RADS grade 5), ultrasound, and physical examination. Full incisional biopsy revealed cystic neutrophilic GM. The surgical procedure, antibiotics, and corticosteroids resulted in a successful combination to secure the stable control of the symptoms and progression of this rare benign breast disease to date. Conclusions This patient’s case highlights the importance of integrated communication among front-line primary care and other health care professionals to reduce the risk of invasive procedures and avoid institutional costs. GM is a rare disease. We raised the manifold red flags in which the multiple professional chains recruited to care for this patient were concerning for advanced breast cancer. The lack of experience and evidence-based medicine contributed to the contradictory interpretation of the findings on GM's diagnosis.

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“…[139], IdGM involved fewer than 2% of benign breast conditions. The prevalence is apparently higher among Turkish, Middle-Eastern, North African, and South-East Asian patients than in European patients [136,137,[140][141][142][143][144]. Recently, in an extensive review by Martinez-Ramoz and coll., 70 studies reporting idiopathic granulomatous mastitis were identified, involving 3060 patients with a median age of 36 years old.…”

Section: Granulomatous Mastitis Associated With Other Autoimmune Disementioning

confidence: 99%

“…These elements, which suggest the key role of autoimmunity in the pathophysiology of IdGM, are sustained by the therapeutic strategies used. Indeed, although wide surgical excision still remains a therapeutic option [142,148,159], patients with recurrent IdGM have a good clinical response after steroid and immunosuppressive treatment [148,160]. A large retrospective series of 206 Iranian women of childbearing age (22-40 years old) highlights the positive effect of immunosuppressive treatment [138].…”

Section: Granulomatous Mastitis Associated With Other Autoimmune Disementioning

confidence: 99%

Mastitis in Autoimmune Diseases: Review of the Literature, Diagnostic Pathway, and Pathophysiological Key Players

Goulabchand

Hafidi

Perre

et al. 2020

JCM

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Mastitis frequently affects women of childbearing age. Of all the pathological breast conditions requiring specific management, autoimmune mastitis is in the third position after infection and breast cancer. The aim of this literature review was to make a comprehensive description of autoimmune diseases targeting the mammary gland. Four main histological patterns of autoimmune mastitis are described: (i) lymphocytic infiltrates; (ii) ductal ectasia; (iii) granulomatous mastitis; and (iv) vasculitis. Our literature search found that all types of autoimmune disease may target the mammary gland: organ-specific diseases (diabetes, thyroiditis); connective tissue diseases (such as systemic erythematosus lupus or Sjögren’s syndrome); vasculitides (granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, giant cell arteritis, polyarteritis nodosa, Behçet’s disease); granulomatous diseases (sarcoidosis, Crohn’s disease); and IgG4-related disease. Cases of breast-specific autoimmune diseases have also been reported, including idiopathic granulomatous mastitis. These breast-limited inflammatory diseases are sometimes the first symptom of a systemic autoimmune disease. Although autoimmune mastitis is rare, it is probably underdiagnosed or misdiagnosed. Early diagnosis may allow us to detect systemic diseases at an earlier stage, which could help to initiate a prompt, appropriate therapeutic strategy. In case of suspected autoimmune mastitis, we hereby propose a diagnostic pathway and discuss the potential pathophysiological pathways leading to autoimmune breast damage.

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Etiologic revelation and outcome of the surgical management of idiopathic granulomatous mastitis; An Egyptian centre experience

Cited by 22 publications

References 25 publications

Granulomatous Mastitis: A Therapeutic and Diagnostic Challenge

Granulomatous Mastitis: A Therapeutic and Diagnostic Challenge

Red flags for the differential diagnosis of granulomatous mastitis: a case report

Mastitis in Autoimmune Diseases: Review of the Literature, Diagnostic Pathway, and Pathophysiological Key Players

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