Re-evaluating if observation continues to be the best management of idiopathic granulomatous mastitis

Davis, John R.; Cocco, Daniela; Matz, Samantha; Hsu, Chiu Hsieh; Brown, Morgan J.; Lee, Jennifer; Bouton, Marcia E.; Caruso, Daniel M.; Komenaka, Ian K.

doi:10.1016/j.surg.2019.06.030

Cited by 52 publications

(48 citation statements)

References 18 publications

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“…In a study of 34 GLM cases, patients who had wide excision had a higher recurrence rate (25%) compared with the steroid and drainage group (7.1%) and developed extensive scarring 114. In a recent study involving 120 women with IGM, where six patients underwent excision and the remaining 114 patients were observed and managed with drainage after biopsy-confirmed GLM, IGM was found to be self-limiting and resolved spontaneously in an average of 5 months 115. CNGM not infrequently presents as an abscess or a draining sinus (online supplementary table 1).…”

Section: Managementmentioning

confidence: 99%

Cystic neutrophilic granulomatous mastitis: an update

Turashvili

2020

J Clin Pathol

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Cystic neutrophilic granulomatous mastitis (CNGM) is a rare subtype of granulomatous mastitis with a highly distinct histological pattern often associated with Corynebacterium species. CNGM is characterised by suppurative lipogranulomas that are composed of central lipid vacuoles rimmed by neutrophils and an outer cuff of epithelioid histiocytes. Some of the lipid vacuoles may contain sparse, rod-shaped, gram-positive bacilli that can be easily missed or dismissed. The surrounding mixed inflammatory infiltrate contains Langhans-type giant cells, lymphocytes and neutrophils. CNGM occurs in reproductive age women with a history of pregnancy and typically presents as a palpable mass that can be painful. CNGM has many mimickers, most significantly breast carcinoma. In many cases, CNGM has significant pathological and clinical overlap with other forms of granulomatous mastitis. Given the association with Corynebacterium species, early diagnosis of CNGM is essential in offering patients the most appropriate treatment. Prolonged antibiotic therapy specifically directed to corynebacteria is required, sometimes even beyond resolution of clinical symptoms. This comprehensive review of the existing literature on CNGM describes clinical–pathological features, microbiological findings, challenges associated with the microscopic differential diagnosis, clinical implications of this diagnosis and emerging treatment options. Morphological criteria and suggested comments to convey the degree of diagnostic certainty are also proposed for standard pathology reporting.

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Section: Managementmentioning

confidence: 99%

Cystic neutrophilic granulomatous mastitis: an update

Turashvili

2020

J Clin Pathol

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“…[ 12 , 13 ] Some researchers reported that close observation was the best management for IGM. [ 7 , 14 ] However, observation alone can lead to a prolonged disease process and increased risk of disease exacerbation leading to ultimate skin rupture. The increased psychological pressure on patients is an issue that needs to be avoided when choosing this “wait and watch” approach.…”

Section: Discussionmentioning

confidence: 99%

“…[ 3 ] The primary treatments include corticosteroids, surgical intervention, and methotrexate. [ 4 – 7 ] Treatment with oral corticosteroids generally requires at least 2 to 3 months and can result in substantial side effects. Methotrexate is also a drug with many adverse reactions, especially when used for long periods, and is not generally used to treat IGM.…”

Section: Introductionmentioning

confidence: 99%

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Postoperative Yanghe decoction regimen improves outcomes for idiopathic granulomatous mastitis

Zhang¹,

Hu³

2020

Medicine

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The etiology of idiopathic granulomatous mastitis (IGM), a rare inflammatory breast disease, is not understood. There is no consensus regarding the treatment of IGM. The purpose of this study was to determine the efficacy of surgery combined with traditional Chinese medicine for the treatment of IGM. We retrospectively analyzed 53 patients of IGM who were treated with surgical excision at our hospital. Group A (n = 25) included patients treated with only surgery, and Group B included patients treated with surgery combined with postoperative Yanghe decoction. The clinical data were compared between the 2 groups, including demographics, clinical characteristics, and outcomes. All patients were female with a mean age of 34.6 ± 5.9 years. There were no significant differences between the groups regarding preoperative demographics or clinical characteristics. The follow-up time was comparable between the groups (13.2 ± 10.0 vs 12.0 ± 10.2 months). Patients in Group B had shorter complete remission (CR) times than patients in Group A (76.1 ± 15.2 vs 84.0 ± 12.2 days; P < .05). The CR rate was higher in Group B than in Group A (96.4% vs 76.0%; P < .05), and the recurrence rate was lower in Group B than in Group A (0% vs 16.0%; P < .05). The postoperative Yanghe decoction regimen was associated with more rapid recovery after IGM surgery. Surgical management combined with postoperative oral Yanghe decoction treatment yielded a higher CR rate and lower recurrence rate than surgery alone. The effect of traditional Chinese medicine in IGM treatment requires further study.

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“…However, considering their potential side-effects, these surgical or immunosuppressive treatments should be proposed only after a period of observation: indeed, David and coll. reported recently that 112/120 IdGM resolved spontaneously after a mean period of 5.1 months [164].…”

Section: Granulomatous Mastitis Associated With Other Autoimmune Disementioning

confidence: 93%

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

Goulabchand

Hafidi

Perre

et al. 2020

JCM

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Mastitis frequently affects women of childbearing age. Of all the pathological breast conditions requiring specific management, autoimmune mastitis is in the third position after infection and breast cancer. The aim of this literature review was to make a comprehensive description of autoimmune diseases targeting the mammary gland. Four main histological patterns of autoimmune mastitis are described: (i) lymphocytic infiltrates; (ii) ductal ectasia; (iii) granulomatous mastitis; and (iv) vasculitis. Our literature search found that all types of autoimmune disease may target the mammary gland: organ-specific diseases (diabetes, thyroiditis); connective tissue diseases (such as systemic erythematosus lupus or Sjögren’s syndrome); vasculitides (granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, giant cell arteritis, polyarteritis nodosa, Behçet’s disease); granulomatous diseases (sarcoidosis, Crohn’s disease); and IgG4-related disease. Cases of breast-specific autoimmune diseases have also been reported, including idiopathic granulomatous mastitis. These breast-limited inflammatory diseases are sometimes the first symptom of a systemic autoimmune disease. Although autoimmune mastitis is rare, it is probably underdiagnosed or misdiagnosed. Early diagnosis may allow us to detect systemic diseases at an earlier stage, which could help to initiate a prompt, appropriate therapeutic strategy. In case of suspected autoimmune mastitis, we hereby propose a diagnostic pathway and discuss the potential pathophysiological pathways leading to autoimmune breast damage.

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Re-evaluating if observation continues to be the best management of idiopathic granulomatous mastitis

Cited by 52 publications

References 18 publications

Cystic neutrophilic granulomatous mastitis: an update

Cystic neutrophilic granulomatous mastitis: an update

Postoperative Yanghe decoction regimen improves outcomes for idiopathic granulomatous mastitis

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

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