Recurrent granulomatous mastitis mimicking inflammatory breast cancer

Abstract

Granulomatous mastitis (GM) is an uncommon benign breast lesion. Diagnosis is a matter of exclusion from other inflammatory, infectious and granulomatous aetiologies. Here, we presented an atypical GM case, which had clinical and radiologic features overlapping with inflammatory breast cancer (IBC). The disease had multiple recurrences. The patient is a 40-year-old Caucasian woman with a sudden onset of left breast swelling accompanied by diffuse skin redness, especially of the subareolar region and malodorous yellow nipple discharge from the left nipple. The disease progressed on antibiotic treatment and recurred after local resection. A similar lesion developed even after bilateral mastectomy. GM may show clinical/radiologic features suggestive of IBC. Multiple recurrences can be occasionally encountered. GM after recurrence could be much more alarming clinically. Pathology confirmation is the key for accurate diagnosis and a multidisciplinary approach is important to rule out IBC.

Management of idiopathic granulomatous mastitis with observation

“…Many previous studies have shown that recurrences after surgical excision are frequent, even after bilateral mastectomy. [8][9][10][11]14,17,18,[21][22][23][24] Additionally, breast cancer has never been reported as a co-existent finding in patients with granulomatous mastitis.…”

“…8,9,[10][11][12][13] Recurrence or residual disease, however, may still occur after mastectomy. 10,11,14 Currently, surgical management has become less prominent in its management and non-surgical M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 5 recommendations have become more common including medications (i.e., steroids, methotrexate, azathioprine, tuberculosis medications) or close observation. 8,9,15,16 One study found that patients underwent spontaneous resolution in 14.5 months.…”

An Unusual Case of Bilateral Granulomatous Mastitis

“…Antibiotics, steroids, and surgery are the options from the least to the most aggressive [13]. Antibiotics are widely used but the most effective noninvasive treatments are corticosteroids.…”

Idiopathic granulomatous mastitis: dilemmas in diagnosis and treatment

“…The disease, was first described by Kessler and Wollock in 1972 (5). Although it is a benign condition, it is important from different points of view: 1-it poses a diagnostic and treatment dilemma (2, 3), also, it clinically and mammographically mimics breast cancer, especially inflammatory type (4).…”