Idiopathic granulomatous mastitis: imaging update and review

Abstract

ObjectivesThe purpose of this study was to review the imaging features of idiopathic granulomatous mastitis (IGM) with clinical and pathology correlation.MethodsWith institutional review board (IRB) approval, a retrospective search of the surgical pathology database from January 2000 to July 2015 was performed. Clinical, imaging and histology findings were reviewed. Cases of granulomatous mastitis without a known source, diagnosed with percutaneous or surgical biopsy, were included in our analysis.ResultsSeventeen cases of IGM were identified with imaging available for review. The majority of patients presented with a palpable abnormality, whereas a minority were asymptomatic with an abnormal screening mammogram. At imaging, IGM most often demonstrated a focal asymmetry at mammography, a hypoechoic mass with irregular or angular margins at ultrasound, and robust enhancement with mixed progressive and plateau kinetics at magnetic resonance imaging (MRI). Axillary lymph nodes were reactive in appearance at ultrasound. Molecular breast imaging performed in one case showed mild focal asymmetric radiotracer uptake.ConclusionIGM is a rapidly progressive rare inflammatory condition of the breast resulting in non-necrotizing granuloma formation. Imaging features mimic breast carcinoma and diagnosis can be difficult. Radiologists’ awareness of this condition is essential to prevent delayed or unnecessary treatment.Teaching points• Idiopathic granulomatous mastitis is rapidly progressive inflammatory condition.• Imaging features may mimic breast carcinoma or infection.• Ultrasound shows irregular hypoechoic masses with increased vascularity and sinus tracts.• MRI shows irregular, enhancing masses or non-mass enhancement with microabscesses.• MRI is useful for assessment of breast involvement and response to treatment.

Granulomatous Mastitis: A Therapeutic and Diagnostic Challenge

“…Ultrasound, mammography, and magnetic resonance imaging (MRI) are considered as non-specific in GM [28]. …”

Breast Involvement in Anti-Neutrophil Cytoplasmic Antibodies Positive Granulomatosis With Polyangiitis in a 64-Year-Old Female Patient

“…7 The idiopathic granulomatous mastitis affects females of childbearing age, typically few years postpartum, with history of breastfeeding and presents as painful lump, often with inflammation of the overlying skin, suspected of autoimmune or bacterial etiology (Corynebacterium). 8 The characteristics of patient's history and clinical presentation in entities cited above are clearly distinct from the description of our case. Nevertheless, it is impossible to exclude any of the above diagnoses without histopathological examination of biopsy specimen.…”

Idiopathic granulomatous mastitis: diagnosis and follow-up with magnetic resonance imaging

“…The MRI can include a parenchymal asymmetry or distortion with different contrast enhancement patterns (diffuse, heterogeneous and ring-shaped enhancement). In our case, the MRI showed a regional enhancement, and because there were other signs in the skin and lymph nodes, an inflammatory process was suggested 1,4,10 . Although radiology findings have a limited value, our report showed that they can be used to monitor the clinical response in a conservative treatment 13 .…”

“…There are some controversies about the best treatment to it. We present the case of IGM with complete response in the magnetic resonance imaging (MRI) follow-up [1][2][3][4] .…”