Idiopathic granulomatous mastitis: Diagnostic and therapeutic challenges to general surgeon

Gudimani, Santosh C.; Rohit, Kumar; Mithun, V.V.; Gowda, Chaitra K.N.; Deepa, A

doi:10.3233/bd-140375

Cited by 6 publications

(3 citation statements)

References 14 publications

(23 reference statements)

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“…Histologically, IGM is characterized by the presence of chronic granulomatous lobulitis in the absence of an obvious etiology. Clinically, patients present with a hard breast lump that imitates carcinoma (Kessler and Wolloch, 1972;Yaghan, 2004;Bani-Hani et al, 2004) Breast abscesses, fistulas, and sinuses are occasional findings (Prasad et al, 2017;Gudimani et al, 2015). Ultra-sonographic and mammographic findings are nonspecific and are occasionally interpreted as malignant (Yaghan, 2004, Prasad et al, 2017Fazzio et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

A Proposal of a Clinically Based Classification for Idiopathic Granulomatous Mastitis

Yaghan

Hamouri

Ayoub

et al. 2019

Asian Pac J Cancer Prev

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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.

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Section: Introductionmentioning

confidence: 99%

A Proposal of a Clinically Based Classification for Idiopathic Granulomatous Mastitis

Yaghan

Hamouri

Ayoub

et al. 2019

Asian Pac J Cancer Prev

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“…Similarly, most of our cases had active extramammarian TB or a past/contact history of TB. IGM, first described by Kessler and Wollock (13), has often been reported as small case series (3,14,15). To date, various associated conditions such as smoking, oral contraceptive use, pregnancy, breastfeeding, Corynebacterium infection, and α1-antitrypsin deficiency have been described (1,9).…”

Section: Discussionmentioning

confidence: 99%

Granulomatous Mastitis: A Diagnostic and Therapeutic Challenge

Kılıç¹,

Sen²,

İçen³

2017

West Indian Med J

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Objective: Granulomatous mastitis (GM), including idiopathic granulomatous mastitis (IGM) and tuberculous mastitis (TBM), is a rare and benign disease of the breast. Our aim is to highlight the nonspecific clinical presentations, diagnostic difficulties and therapeutic approaches of GM.Methods: Sixty-eight women with GM (52 with IGM and 16 withTBM) were included in the study. All clinical characteristics, diagnostic methods, and therapeutic approaches were evaluated in detail. Results:The patients with IGM had earlier onset in comparison to the patients with TBM. Suspicion of malignancy clinically was more frequent in patients with TBM than in those with IGM. While anti-TB therapy was quite effective in TBM patients, surgical excision had the lowest recurrence rate in patients with IGM. Conclusion:GM usually poses a diagnostic and therapeutic challenge for the physicians. TB is still an important cause of GM, and should be always kept in mind in the differential diagnosis. Due to the diagnostic and therapeutic challenges, a multidisciplinary approach is needed to avoid mistakes and to obtain well outcomes.

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“…Discussion IGM is a rare benign inflammatory breast disease, usually seen in females of reproductive age, with around 200 cases being reported in the literature so far (2,4). Beyond clinical examination and imaging, establishing a diagnosis can be challenging for a surgeon and requires a high index of suspicion with exclusion of infective and autoimmune breast diseases, as most patients are initially misdiagnosed by their primary care physicians, leading to diagnostic confusion and heightened anxiety (1,5). Core biopsy is diagnostic only in around 70% of these patients (1).…”

Section: Case Presentationmentioning

confidence: 99%

Is idiopathic granulomatous mastitis a surgical disease? The jury is still out

Moris¹,

Damaskos²,

Davakis³

et al. 2017

Ann. Transl. Med.

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Idiopathic granulomatous mastitis (IGM), is a rare entity of chronic inflammatory disorder of the breast of unknown etiology. Very few cases have been described so far, almost exclusively in women. Here we describe a case of IGM in a 53-year-old man presented with a right breast mass, progressively enlarging during the last 6 months. Due to the findings of clinical examination and CT-scan, the suspicion for a potentially malignant lesion was given and the decision for surgical resection was made. Microscopic analysis of the specimen showed non-caseating granulomas around mammary lobules, findings compatible with IGM.The patient is recurrence-free at 18-month follow-up. IGM is a rare benign inflammatory breast disease, usually seen in females of reproductive age. Establishing a diagnosis can be challenging for a surgeon and requires a high index of suspicion as most patients are initially misdiagnosed by their primary care physicians.Steroids and immunosuppressive drugs are considered as fundamental treatment modalities but they are correlated with increased rates of disease response and recurrence. On the contrary, surgical resection demonstrated significantly superior results compared to steroid-alone treatment in terms of recurrence and post-treatment recovery.

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Idiopathic granulomatous mastitis: Diagnostic and therapeutic challenges to general surgeon

Cited by 6 publications

References 14 publications

A Proposal of a Clinically Based Classification for Idiopathic Granulomatous Mastitis

A Proposal of a Clinically Based Classification for Idiopathic Granulomatous Mastitis

Granulomatous Mastitis: A Diagnostic and Therapeutic Challenge

Is idiopathic granulomatous mastitis a surgical disease? The jury is still out

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