Granulomatous Mastitis during Chronic Antidepressant Therapy: Is It Possible a Conservative Therapeutic Approach?

Abstract

Granulomatous mastitis is a rare benign inflammatory disease of the breast with multiple etiologies such as tuberculosis, sarcoidosis, foreign body reaction, and mycotic and parasitic infections. In contrast, idiopathic granulomatous mastitis (IGM) is characterized by the presence of chronic granulomatous lobulitis in the absence of an obvious etiology. Clinically and radiologically it may mimic breast carcinoma and so awareness of surgeons, pathologists, and radiologists is essential to avoid unnecessary mastectomies. Cases of IGM are reported during antidepressant therapy in patients also showing high levels of prolactinemia. In these cases, we believe that surgical excision must be avoided being replaced with a conservative management of the pathological condition based on a corticosteroid treatment.

Granulomatous Mastitis: A Ten-Year Experience at a University Hospital

“…High levels of prolactinemia in the cases of IGM on antidepressant therapy, suggests a possible side effect of selective inhibitors of serotonin reuptake (SSRI). Also, a functional crosstalk between serotonin and dopamine receptors is noteworthy [22][23][24]. Bellavia et al [22] reported that the cases of IGM related to the chronic use of antidepressant therapy should be treated with non-surgical therapeutic approaches, where possible, a conservative approach based on administration of an antiinflammatory therapy is favoured.…”

Bilateral granulomatous mastitis after local nandrolone injection

“…An immune-related pathophysiology due to oozing of secretions from milk ducts into lobules during pregnancy and lactation has been widely considered [1][2][3]. Reports of association of the disease with autoimmune disorders such as erythema nodosum, sarcoidosis, Wegener's granulomatosis, giant cell arteritis, or polyartheritis nodosa strengthens the theory [1,3,6]. The disease has also been seen after local trauma and consumption of anti-depressant drugs, perhaps due to hyperprolactinemia, as well as other granulomatous disorders as granulomatous thyroiditis, prostatitis and orchitis [2,6].…”

“…Methotrexate and azathioprine have proved helpful in some of these cases [1,4]. Steroids or methotrexate may eliminate the need for surgery [6]. A large review has demonstrated complete resolution of the lesions in 6 to 12 months with one or several of the above treatment plans [1].…”

“…Almost all affected women reported in different series have had a history of pregnancy and lactation, recent in many cases. The etiology is unknown; association of the disease with pregnancy, breastfeeding and oral contraceptives (OCP) has been mentioned [1,[3][4][5][6]. Imoto et al focus on an association of the disease with hormonal changes.…”

“…Many other factors have been postulated as causative, but never proven: local irritants, various infectious agents (viral, mycotic and parasitic), other hormonal disorders (increased serum prolactin), diabetes, smoking, alpha-1 antitrypsin deficiency [1,3,6]. An immune-related pathophysiology due to oozing of secretions from milk ducts into lobules during pregnancy and lactation has been widely considered [1][2][3].…”