Idiopathic granulomatous mastitis: A systematic review of 3060 patients

Abstract

Idiopathic granulomatous mastitis is a rare benign breast disease. A systematic review was designed. Clinical and therapeutic characteristics were analyzed. Human Development Index (HDI) was used to define two groups of study: group A (very high and high HDI) and group B (medium and low HDI). Corticosteroid therapy was done in 69% group A and 78% group B. Surgery was done in 63% in group A and 83% in group B. Antibiotics were used in 68% group A and 88% group B. There is no consensus about optimal treatment for granulomatous mastitis.

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

“…A prospective study suggests that treatment with rifampicine for 6-9 months led to a complete remission of IdGM in 30 patients after a 15-month follow-up [147]. It should be noted that most of the published case series of IdGM concern patients from countries where tuberculosis has a high prevalence rate [148]. Corynebacterium kroppenstedtii has also been involved in the pathophysiology of IdGM and in its recurrence [145].…”

“…Finally, Martinez-Ramoz and coll. reported that "autoimmune diseases" or "rheumatic conditions" were reported in 34% of patients included in their extensive review [148].…”

“…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].…”

Idiopathic Granulomatous Mastitis: The Importance of Summarizing the Heterogenous Evidence of the Current Literature

“…Numerous therapeutic options are available, including observation, antibiotics, surgery, or drug therapy (steroids and immunosuppressants). 7 Generally, observation can be reasonably adopted in mild cases; antibiotics have very limited efficacy. The effectiveness of steroids has long been reported, and their topical formulations have demonstrated potential as a first-line option as they balance good efficacy with limited side effects.…”

Idiopathic Granulomatous Mastitis: Etiopathogenetic Considerations on a Rare Benign Inflammatory Breast Disease

“…The etiology of IGM remains controversial and several contributing factors, such as use of contraceptive pill, high level of prolactin [2], smoking and alpha-1 antitrypsin deficiency [3], have been emerged in the last decades. Overall, an autoimmune reaction related to presence of milk proteins in the interstitial breast tissues, as consequence of microtrauma secondary to infection, trauma or chemical irritation, seems to be the most accredited hypothesis for explaining the genesis of IGM [4].…”