Chronic granulomatous mastitis: A therapeutic dilemma revisited

Abstract

Background: Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory disease. Because of obscure etiology and diagnosis, its management remains a challenge. Rareness and varied presentation of IGM makes it difficult to standardize treatment protocol. The aim of this study was to analyze the clinical presentations, imaging findings, clinical course, and management of patients who were treated for IGM. Patients and Methods: In this study, a retrospective review of 15 patients with IGM between January 2012 and December 2014 was performed based on clinical, radiological, and pathological findings; follow-up information and recurrence were obtained from records. Results: The median age of presentation was 30 years (age range: 24–42). All patients were married and parous with a history of breast feeding. Breast mass with or without skin changes was a symptom in all patients. While parenchymal heterogeneity, abscess, and mass were the findings of ultrasound, increased asymmetric density was the main finding of mammography. Wide local excision was performed in 7 (46.7%) patients and incisional biopsy with abscess drainage in 4 (26.7%) patients. Medical treatment was given to 4 (26.7%) patients. Median follow-up was 24 (range: 10–34) months. Eleven patients (73%) were recurrence free. Conclusions: Granulomatous mastitis often presents as a breast lump with or without skin changes. The diagnosis is done with pathological examination of the surgical specimen or biopsy. The main treatment should be guided according to the clinical presentation either surgical or medical or both.