Varied Clinical Presentation of Granulomatous Mastitis- A Retrospective Cohort Study

Abstract

Introduction: Granulomatous Mastitis (GM) is a infrequent chronic inflammatory breast disease with unidentified aetiology. It has varied clinical presentations from a completely benign breast abscess to a presentation mimicking locally advanced malignant tumour. As there is no definitive radiological feature which clinches the diagnosis of GM and even the lack of specific cytological features, every case is diagnosed and managed differently. Aim: To present the varied clinical presentations of granulomatous mastitis. Materials and Methods: A retrospective study was conducted at JSS Teaching Hospital, Mysore, India. Histopathological database in Pathology Department was reviewed from January 2017 to December 2020 and all the cases diagnosed with GM were enlisted. Their case files, data in the hospital information system were reviewed and the patients were telephonically interviewed. The data was analysed for incidence rates of various clinical presentations, surgeries and expressed in percentages. Results: On reviewing the histopathological database, there were 22 cases of GM. All the patients were married females of age 22 to 57 years with duration of symptoms ranging from 4 days to 5 years. Most common complaint was breast lump 22 (100%) followed by pain 12 (54.54%). Based on the symptoms and signs, clinically 7 different diagnoses were made and granulomatous mastitis was suspected only in 6 (27.27%) cases. All the patients were primarily subjected for surgical treatment [lumpectomy 12 (57.14%), incision and drainage with wall biopsy 6 (28.57) and wide local excision 3 (14.28). Telephonic interview could be done for 12 (54.54) patients, of which, 9 (75) patients had remained asymptomatic and 3 (25) patients had multiple recurrences. Eventually 2 (9.09) patients were treated with anti tubercular treatment and became recurrence free. None of the patients were given steroids as primary treatment or during the episodes of recurrence. Conclusion: While managing breast lump cases, either painful or painless, the surgeons should keep the possibility of granulomatous mastitis, as it varies widely in clinical manifestation.

Bilateral plasma cell mastitis simulating breast cancer: a case report and literature review

“…2 The acute (Figure 3(b)) and chronic (Figure 3(a)) stages of PCM may be mistaken for different diseases: idiopathic granulomatous mastitis, sclerosing lymphocytic mastitis, lactational breast abscess, tuberculosis, periductal mastitis, inflammatory cancer of the breast, or diffuse ductal cancer of the breast. 3,12,13…”

“…2 The acute (Figure 3(b)) and chronic (Figure 3(a)) stages of PCM may be mistaken for different diseases: idiopathic granulomatous mastitis, sclerosing lymphocytic mastitis, lactational breast abscess, tuberculosis, periductal mastitis, inflammatory cancer of the breast, or diffuse ductal cancer of the breast. 3,12,13 No serum markers for PCM have been established. IgM, IgA, C 3 , and C 4 in patients with nonlactating mastitis were found to be increased in several independent clinical studies.…”

Granulomatous mastitis in accessory breast tissue: A rare presentation and surgical management

“…Although FNAC may aid in a quicker diagnosis, it is not as specific as CNB. As a result, in the literature, CNB is regarded as the gold standard preoperative diagnostic modality ( 1 , 5 , 13 ). The condition is distinguished by the formation of granulomas in conjunction with localized infiltration of multi-nucleated giant cells, lymphocytes, epithelioid histiocytes and plasma cells ( 1 ).…”