Management of Granulomatous Mastitis: A Series of 13 Patients Who Were Evaluated for Treatment Without Corticosteroids

Abstract

Granulomatous mastitis (GM) is a rare chronic inflammatory breast condition with unknown etiology. There is still no generally accepted optimal treatment for GM. Corticosteroid treatment and/or wide excision is most commonly reported in the literature. Incision and drainage or limited excision alone has little benefit because of a strong tendency of recurrence. Corticosteroids also have a high failure rate and possible side effects. In the current series, we treated GM patients without corticosteroids, except for one patient. We also devised multidirectional deep drainage for advanced and complicated abscesses, which are characteristic of GM. This retrospective study included 13 women who met the required histologic criteria of GM. The mean age of the patients was 41 years. All of the patients were premenopausal. Six patients had breast-fed in the last 5 years. Five patients were under medication with antidepressants. A total of 11 patients developed abscesses during the clinical course, and the abscesses penetrated the retromammary space in 4 patients. We treated 2 of these 4 patients with multidirectional deep drainage and obtained complete remission in 5 and 6.5 months, respectively. These times were much shorter than those in the other 2 patients. The time to resolution in 11 patients was 4 to 28 months. This overall outcome was comparable with that of corticosteroid treatment reported in the literature. Because the natural history of GM is thought to be self-limiting, close observation and minimally required drainage of abscesses without corticosteroid administration remain the treatment modality of choice.

Idiopathic Granulomatous Mastitis: Overcoming this Important Clinical Challenge

“…IGM was first described by Kessler and Wolloch in 1972. 1,3,10 It is also named as idiopathic granulomatous lobular mastitis and granulomatous lobulitis. IGM is a benign, chronic, inflammatory breast disorder that clinically and radiologically mimics breast cancer.…”

“…[6][7][8][9] The treatment of IGM involves 1 or a combination of several treatment options including treatment-free close follow-up, drainage, excision, antibiotics, steroids, and various immunosuppressive treatment. 1,3,10 The lack of a standard treatment algorithm, high recurrence rate despite appropriate treatment, and mimicking breast cancer in radiologic studies are the most critical points regarding the diagnosis and treatment of IGM. 4,11 The primary aim of this retrospective study was to determine possible risk factors for recurrence development in patients with IGM.…”

Comparison of the Outcome of Low Dose and High-Dose Corticosteroid in the Treatment of Idiopathic Granulomatous Mastitis

“…The management strategy for IGM is controversial. Use of corticosteroids alone or in combination with methotrexate or azathioprine and antibiotics especially azithromycin, abscess drainage, and wide local excision of the lesions have been reported for the treatment of IGM (Akcan et al, 2014;Atak et al, 2015;Salehi et al, 2017;Sheybani et al, 2015;Yaghan et al, 2019;Yukawa et al, 2015). Considering the efficacy of the corticosteroids in the previous studies which are mostly retrospective, there is a need for clinical trials to confirm these findings.…”

“…Idiopathic granulomatous mastitis (IGM) is a rare, benign and chronic inflammatory breast condition (Akcan et al, 2014;Salehi et al, 2017;Yukawa et al, 2015). Its etiology is unknown, but association with immunologic and connective tissue diseases, mycobacterium and fungus infections or any hypersensitivity reactions of the breast lobules are considered as possible cause (Akcan et al, 2014;Korkut et al, 2015;Salehi et al, 2017).…”

Випадок Лікування Гранулематозного Маститу

“…У всіх пацієнток були вагітності і пологи з грудним вигодовуванням щонайменше однієї дитини. Після останньої вагітності симптоми виникали в середньому на 34-му місяці (діапазон -10-Практична онкологія / Practical Oncology Лікарю, що практикує / Practicing Physician 62 місяці) і на 26-му місяці (діапазон -4-46 місяців) після припинення грудного вигодовування [12][13][14][15]. Середній час між початком симптомів і встановленням діагнозу захворювання за допомогою біопсії -5 місяців (діапазон -3-6 місяців).…”