Idiopathic granulomatous mastitis: Long-discussed but yet-to-be-known

Abstract

Idiopathic granulomatous mastitis (IGM) is a chronic benign inflammatory disease of the breast with unknown etiology. It is an important diagnostic and therapeutic challenge, as most patients were initially misdiagnosed by their primary care physicians, leading to diagnostic confusion and heightened anxiety. Although several triggers have been proposed for development of IGM, the etiologic association of neither of them has been documented. Three main hypotheses about the possible causes of IGM have been suggested, including autoimmune response, infectious disease, and hormonal disruption. Here, we discuss a hypothetical perspective of IGM to explain the possible role of autoinflammation in the pathogenesis of the disease. We also reviewed the previously published literature on pathogenesis of IGM.

Methotrexate‐based regimen as initial treatment of patients with idiopathic granulomatous mastitis

“…About the management of patients with IGM different therapeutic strategies have been proposed; however, the efficacy of none of them was evaluated in randomized placebo control trials . A recent systematic review regarding treatment for IGM showed that surgical managements with or without corticosteroids are associated with high complete resolution rate and relatively low recurrence rate .…”

“…There are a few reports of patients with IGM for whom MTX had been initiated at different stages or their treatment was changed to MTX because of a lack of response to corticosteroid treatment, recurrence or corticosteroid‐induced adverse reactions, while in others MTX in combination with corticosteroid was the initial treatment. Most of the reports on MTX in the management of IGM used it in combination with high doses of corticosteroid or after recurrence of symptoms during or after tapering of corticosteroids ; however, MTX monotherapy or in combination with low doses of corticosteroids were rarely reported …”

Idiopathic Granulomatous Mastitis-A Mystery Yet to be Unraveled: A Case Series and Review of Literature

“…Three leading hypotheses for possible etiologies are: autoimmune, infectious, and hormonal [9]. Of these, autoimmunity has been accepted as the most likely cause [9][10][11]. The hypothesis that IGM might be an autoimmune condition has emerged from the fact that there is a T-lymphocytic predominance in IGM evidenced by histochemical studies and also because several studies have shown an excellent response of IGM to steroids [8][9].…”

“…High prolactin levels have been reported to have an association with IGM. However, the cases of IGM with reported high prolactin levels have been those that were either drug-induced or recurrent disease [10]. No causal relationship has been established in past studies and thus the relation of IGM with hormonal status remains unclear.…”

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

“…[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.…”