Clinical Study of Granulomatous Mastitis- A Rare Entity

Abstract

Introduction: Granulomatous Mastitis (GM), a rare and benign disorder, has two forms- Idiopathic Granulomatous Mastitis (IGM) and Specific Granulomatous Mastitis (SGM). IGM is caused without any particular discernable and attributable cause while SGM is caused secondary to tuberculosis, other infectious causes like syphilis, fungal, parasitic infections, corynebacterial; Wegener’s granulomatosis, sarcoidosis, reaction to a foreign body, vasculitis etc. Aim: To identify clinical presentations and to formulate a treatment protocol for patients with granulomatous mastitis. Materials and Methods: This study was a prospective descriptive observational study conducted at Government Wenlock Hospital and Kasturba Medical College Hospital, Attavar, Mangalore, Karnataka, India, from October 2015 to March 2018 on 32 patients admitted to the Department of General Surgery in the study centre, who had a histopathological diagnosis of granulomatous mastitis. All the relevant data of the patients: demographic data and clinical findings, any medical co-morbidities was collected by telephonic interview and case sheets, operative notes were studied thoroughly and the patients were followed up for regression of their signs and symptoms at one month, two months and six months of their hospital visits. Results of microbial cultures or stains, imaging (mammography, ultrasound if done) and biopsy results were collected. All the collected data was analysed by Chi-square test and Fisher’s exact test and the p-values <0.05 was considered significant. Results: Total of 32 female patients (13 patients were in the age group of 31-40 years) were analysed in the present study. A total of 27 (84.4%) had last child birth <5 years back. The patients who presented with a left laterality lesion were 25 (78%) with statistically significant difference. A total of 18 (56%) of the patients had a lesion in the upper outer while 11 (34%) in lower outer quadrant of breast. A total of 29 (90.6 %) of patients, the disease was extending upto the areola region. All the patients had a firm lump and out of these, 25 (78.1%) of the patient presented with a painful lump. Inflammatory skin changes were seen in 20 (62%) of the patients. Retraction of nipple was presented in 26 (81%) of the patients. A total of 19 (59.4%) patients underwent an excision biopsy of the lump and 22 (69%) patients were initiated with Antitubercular Therapy (ATT). Conclusion: Granulomatous mastitis is a highly unpredictable disease with frequent flares and periods of inactivity which may falsely be considered as successful treatment. Due to rare nature of this disease, randomisation of all treatment modalities are available.