Postlactational tumoral granulomatous mastitis: A localized immune phenomenon

Brown, Kent; Tang, Peter H.

doi:10.1016/0002-9610(79)90397-0

Cited by 97 publications

(62 citation statements)

References 4 publications

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“…Due to morphological similarities to granulomatous thyroiditis, allergic and immunologically mediated causes have been suggested. 3 Concomitant erythema nodosum in several previously reported cases 2,5,6 support altered immune status as a potential etiology. The immune reaction may be in response to extravasated milk secretion, breast trauma, or infection.…”

Section: Discussionmentioning

confidence: 81%

Idiopathic granulomatous mastitis with erythema nodosum simulating breast abscess in pregnancy: A case report

et al. 2013

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Granulomatous mastitis is a rare benign inflammatory condition of the breast and is known to be associated with pregnancy. A 25-year-old Hispanic G2P1 at 17 weeks gestation presented to the emergency department with findings consistent of a breast abscess. The abscess failed to resolve with incision and drainage followed by multiple courses of antibiotic therapy. A biopsy was then obtained and yielded a diagnosis of granulomatous lobulitis. The patient was treated with steroids and her symptoms resolved. Granulomatous lobulitis may present with characteristics of various clinical entities including neoplasm or, as in this case, abscess. Clinicians should consider a diagnosis of granulomatous mastitis in cases of recalcitrant breast abscess. KeywordsComplications, high-risk pregnancy, immunology, maternal-fetal medicine, neoplasm Case reportA 25-year-old Hispanic G2P1 at 17 weeks gestation with an uncomplicated prenatal course, presented to the emergency department with fever, erythema nodosum, left breast erythema, tenderness, and swelling. Findings were consistent with a breast infection with a WBC of X10 9 /L and sedimentation rate of 89 mm/h. Urine and blood cultures were negative. She was treated with Nafcillin without improvement. A methicillin-resistant Staphylococcus aureus infection was suspected and antibiotics were changed to vancomycin and ceftazidime. Rheumatology consultation diagnosed the patient with erythema nodosum secondary to primary infection. There was no serologic evidence of lupus, vasculitis, or sarcoidosis. Breast ultrasound was consistent with an abscess. Surgery consulted and she underwent an incision and drainage of the left breast lesion. Postoperatively, the erythema nodosum and breast lesion resolved with prednisone 5 mg twice daily for one week followed by a two week taper.Despite patient compliance with the medication regiment, her left breast abscess continued to drain. She returned at 20 and 27 weeks gestation and had a second and third incision and drainage. During both repeat occurrences, breast cultures remained negative. She received multiple course of antibiotics. Biopsy showed acute and chronic inflammation with necrosis consistent with abscess.At 34 weeks, the patient presented with worsening breast symptoms. Her clinical course, labs, and pathology were reviewed (Figure 1). Upon review of the histologic specimens, a noncaseating granulomatous inflammation in the breast lobules composed of epithelioid cells and multinucleated giant cells was identified. The final diagnosis was determined to be granulomatous lobulitis.Treatment with Prednisone was initiated with a dose of 40 mg daily with a taper to 10 mg daily. The patient had an immediate response, the lesions resolved, and no new areas appeared. Her symptoms flared when Prednisone was decreased to 5 mg daily and she remained on Prednisone 10 mg daily for the remainder of her prenatal course. She had an uncomplicated delivery.Post-partum, she was stable on 5 mg of Prednisone daily. She was offered surgical resec...

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Section: Discussionmentioning

confidence: 81%

Idiopathic granulomatous mastitis with erythema nodosum simulating breast abscess in pregnancy: A case report

et al. 2013

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“…It has been reported post-lactational [7], post-partum [8], and with hyper-prolactinemia [9]. Most of the reported cases in the literature have been young parous women.…”

Section: Discussionmentioning

confidence: 99%

“…Some have speculated that granulomatous mastitis may represent a localized autoimmune or hypersensitivity response [1,7]. Others [4] found no evidence of immune dysfunction or vasculitis.…”

Section: Discussionmentioning

confidence: 99%

“…Kessler and Wolloch [1] were the first to describe it as a separate entity in 1972. Our review of the literature [1][2][3][4][7][8][9][10][11][12][13][14][15][16] revealed that since then, 77 cases of this form ofmastitis have been reported. Among these, there have been several detailed reports on the subject, especially those of Going et al [2] in 1982 (9 cases) and Fletcher et al [3] in 1987 (7 cases).…”

Section: Discussionmentioning

confidence: 99%

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Granulomatous Mastitis: A Case Report and Review of the Literature

Khoshim

Sadiq

1991

Ann Saudi Med

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“…These findings can be accompanied by peaud`orange like changes, nipple inversion, nipple retraction and sinus formation skin changes [6].…”

Section: Introductionmentioning

confidence: 99%

Non-surgical Management in Idiopathic Granulomatous Mastitis

Akbari¹,

Lotfolahzadeh²,

Nafissi³

et al. 2014

J Women's Health Care

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Introduction: Idiopathic Granulomatous Mastitis; Despite its low incidence, is in high interest due to masquerading as carcinoma of the breast. In confirmed IGM case series, it`s been reported that more than 50% of patients were initially misdiagnosed as affecting by carcinoma of the Breast. Herein we are introducing a non-surgical management of IGM with frequently aspiration of the masses accompanied by using bacteriostatics and close regular surveillance.

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Postlactational tumoral granulomatous mastitis: A localized immune phenomenon

Cited by 97 publications

References 4 publications

Idiopathic granulomatous mastitis with erythema nodosum simulating breast abscess in pregnancy: A case report

Idiopathic granulomatous mastitis with erythema nodosum simulating breast abscess in pregnancy: A case report

Granulomatous Mastitis: A Case Report and Review of the Literature

Non-surgical Management in Idiopathic Granulomatous Mastitis

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