Rare and Complicated Granulomatous Lobular Mastitis (2000-2023): A Bibliometrics Study and Visualization Analysis.

Since idiopathic granulomatous lobular mastitis, also known as idiopathic granulomatous mastitis or granulomatous lobulitis, was first described by Kessler and Wolloch in 1972, no consensus on the ideal and definitive treatment for this phenomenon has been reached thus far. Idiopathic granulomatous lobular mastitis mostly frequently observed in women of childbearing age within a few years of pregnancy with a higher incidence in patients of Hispanic, Native American, Middle Eastern, and African descent. This entity, per se, is a rare, benign, chronic inflammatory breast condition of unknown aetiology mimicking two common breast disorders. The first is breast inflammations or infection, such as cystic neutrophilic granulomatous mastitis; granulomatous mastitis due to Corynebacterium;other infections with granulomas, mycobacteria, fungi, cat scratch disease, and Brucella; granulomatosis with polyangiitis (Wegener's granulomatosis); sarcoidosis; and squamous metaplasia of lactiferous ducts. The second is breast carcinoma in some challenging cases. Of note, no consensus, per se, has been declared on its therapeutic management. The following vignette case described in this report involves idiopathic granulomatous lobular mastitis imitating breast carcinoma. It is important to note that, the aetiology of idiopathic granulomatous lobular mastitis is unknown, its diagnosis is difficult, and physicians should be vigilant and aware of this condition in order of abstaining from an overtreatment for malignancy or overlooking a true malignancy.

Granulomatous mastitis is an uncommon benign breast disease. Varied aetiologies such as tuberculosis, foreign body reactions, sarcoidosis, fungal and parasitic infections and autoimmunity have been suggested. Pre-operative definitive diagnosis is essential for proper treatment. In developing countries like India, fine needle aspiration is still widely used as a reliable technique for preoperative evaluation of palpable breast lumps. The objective of this study is to study the cytomorphological features of different forms of granulomatous mastitis and correlate with other clinical findings including histological features. A total of 33 cases of granulomatous mastitis were reviewed. The patients underwent fine needle aspiration. Cytomorphological features were studied in detail and correlated with histopathological features and other clinical findings. All the 33 patients showed varied cytomorphological features which included epithelioid cells/granuloma with lymphocytes/plasma cells/polymorphs with or without necrosis/caseous necrosis and with or without giant cells. Ziehl Nelson stain showed acid fast bacilli in 13 smears. Out of 17 cases, the eight cases showed positive acid fast bacilli culture. Fungal stain such as Grocott-Gommeri Methane amine did not show fungi. Based on cytomorphological features in aspiration smears, they were grouped into 4 Groups. A total of 27 breast lesions were diagnosed as tuberculous mastitis, the four lesions were diagnosed as idiopathic granulomatous lobular mastitis and two lesions were diagnosed as foreign body granulomatous mastitis. Grocott-Gommeri Methane amine did not showed fungi. Based on cytomorphological features in aspiration smears, they were grouped into 4 Groups. A total of 27 breast lesions were diagnosed as tuberculous mastitis, the four lesions were diagnosed as idiopathic granulomatous lobular mastitis and two lesions were diagnosed as foreign body granulomatous mastitis. Epithelioid granulomas with caseous necrosis with or without acid fast bacilli in cytology smears are diagnostic of tuberculosis. Cytology smears showing epithelioid granulomas with predominant polymorphs without necrosis and acid fast bacilli, a diagnosis of idiopathic granulomatous lobular mastitis must be considered. Histopathological examination is essential for definitive diagnosis in these cases.

BackgroundIdiopathic granulomatous lobular mastitis is a rare chronic inflammatory disease of the breast. Idiopathic granulomatous lobular mastitis is a benign entity of unknown etiology occurring mainly in women of reproductive age that can clinically and radiologically mimic breast carcinoma, making diagnosis both challenging and delayed.Case presentationA 38-year-old otherwise healthy Indonesian female patient presented with a painful and enlarging mass of the left breast with overlying erythema that was unresponsive to antibiotic therapy. Regional lymphadenopathy and mammography findings were concerning for inflammatory cancer of the breast. The patient eventually developed erythema nodosum and polyarthralgia, coupled with histopathology confirmation, leading to a diagnosis of idiopathic granulomatous lobular mastitis. Complete symptom resolution was achieved using immunosuppressive treatment with systemic steroids and localized intralesional steroids. The patient remained asymptomatic with no disease relapse at 3-year follow-up using a conservative approach to treating idiopathic granulomatous lobular mastitis, with high patient satisfaction.ConclusionIdiopathic granulomatous lobular mastitis is a rare and diagnostically challenging condition that clinically and radiologically mimics breast carcinoma. A high index of clinical suspicion is required for diagnosis. Histopathology is recommended over clinical imaging studies if idiopathic granulomatous lobular mastitis or breast cancer are suspected. Due to the rarity of this condition, this case report provides valuable insight into the diagnostic approach, differential diagnosis, associated radiological and histopathological findings, and treatment options, and also serves as a reference for successful treatment of idiopathic granulomatous lobular mastitis using conservative local and systemic immunosuppressive therapies with no clinical relapse for 3 years. Multidisciplinary approach is needed to prevent diagnostic delay and provide optimal therapeutic management and outcome.

Idiopathic granulomatous mastitis, also known as idiopathic granulomatous lobular mastitis, is a benign breast lesion that represents both a diagnostic and therapeutic dilemma. We report two cases of granulomatous mastitis recently evaluated and managed at our institution. To better understand this rare disease, we analyzed treatment outcomes in reported cases of granulomatous mastitis. One hundred sixteen cases were subsequently analyzed. Primary management strategies included observation (n = 9), steroids (n = 29), partial mastectomy (n = 75), and mastectomy (n = 3). Success rates with each treatment were observation, 56 per cent; steroids, 42 per cent; partial mastectomy, 79 per cent; and mastectomy, 100 per cent. Based on this analysis, we propose a clinically useful algorithm for both workup and management of these challenging cases.

Idiopathic granulomatous lobular mastitis (IGLM), also known as idiopathic granulomatous mastitis, is a rare chronic inflammatory lesion of the breast that can clinically and radiographically mimic breast carcinoma. The aim of this study was to describe the radiological imaging and clinical features of IGLM in order to better differentiate this disorder from breast cancer. We performed a retrospective analysis of the clinical and radiographic features of 11 women with a total of 12 IGLM lesions. The ages of these women ranged between 29 and 42 years, with a mean age of 34.8 years. Ten patients were examined by both mammography and sonography and one by sonography alone. The sites that were the most frequently involved were the peripheral (6/12), diffuse, (3/12), and subareolar (3/12) regions of the breast. The patient mammograms showed irregular ill-defined masses (7/11), diffuse increased densities (3/11), and one oval obscured mass. In addition, patient sonograms showed irregular tubular lesions (7/12) or lobulated masses with minimal parenchymal distortion (2/12), parenchymal distortion without definite mass lesions (2/12), and one oval mass. Subcutaneous fat obliteration (12/12) and skin thickening (11/12) were also observed in these patients. Contrary to previous reports, skin changes and subareolar involvement were not rare occurrences in IGLM. In conclusion, the sonographic features of IGLM show irregular or tubular hypoechoic masses with minimal parenchymal distortion. Both clinical information and the description of radiographic features of IGLM may aid in the differentiation between IGLM and breast cancer, however histological confirmation is still required for the proper diagnosis and treatment of the disorder.

In this study we aimed to define clinical, radiologic and pathological specialties of patients who applied to General Surgery Department of Atatürk University Medical Faculty with granulomatous mastitis and show medical and surgical treatment results. With the help of this study we will be able to make our own clinical algorithm for diagnosis and treatment. We searched retrospectively addresses, phone numbers and clinical files of 93 patients whom diagnosed granulomatous mastitis between a decade of January 2001 - December 2010. We noted demographic specialties, ages, gender, medical family history, main complaints, physical findings, radiological and laboratory findings, medical treatments, postoperative complications and surgical procedures if they were operated; morbidity, recurrence and success ratios, complications after treatment for patients discussed above. In this study we evaluated 93 patients, 91 females and 2 males, with granulomatous mastitis retrospectively who applied to General Surgery Department of Atatürk University Medical Faculty between January 2001 and December 2010. Mean age was 34.4 years. The diagnosis was confirmed by histopathologic examination of the lesions. Seventy three patients had idiopathic granulomatous lobular mastitis and 20 patients had specific granulomatous mastitis IGM (18 tuberculosis mastitis, 1 alveolar echinococcosis and 1 silk reaction). All the patients had surgical debridement or antibiotic, and anti-inflammatory treatment with results bad clinical response before applied our clinic. Empiric antibiotic therapy and drainage of the breast lesions are not enough for complete remission of idiopathic granulomatous mastitis. The lesion must be excised completely. In selected patients, corticosteroid therapy can be useful. In the patients with tuberculous mastitis, abscess drainage and antituberculous therapy can be useful, but wide excision must be chosen for the patients with recurrent disease.

A 36-Year-Old Woman With a Unilateral Breast Mass

Idiopathic granulomatous mastitis (IGM) is an uncommon chronic inflammatory lesion of the breast with an uncertain optimal treatment regimen, the physical examination, and radiologic features of which may be confused with breast carcinoma. In this study, we aimed to describe the clinicopathologic characteristics of 33 patients who admitted to our breast policlinic and took the diagnosis of granulomatous (idiopathic and non-idiopathic) mastitis, and report the place of corticosteroids and the timing of surgery in the treatment of patients with IGM. The clinical features of 33 patients who presented to our breast policlinic with the complaint of breast mass and reached the final diagnosis of GM between March 2005 and October 2009 were reported. The most common symptoms were mass (n: 27) and pain (n: 11). Ultrasonography (USG) and biopsy were performed in all of the patients. Mammography (MMG) was performed in 9, and magnetic resonance imaging (MRI) in 10 patients. The diagnosis of idiopathic lobular granulomatous mastitis (ILGM) was made in 25 patients and tuberculous mastitis (non-idiopathic GM) in the remaining 8 patients. Twenty-four patients received steroid treatment except one who was pregnant. After giving birth, she also received steroids. One of the patients who developed recurrence after 11 months repeated the steroid therapy. Eight patients with tuberculous mastitis were placed on a regimen of antituberculosis therapy for 6 months. In the diagnosis of IGM, physical examination, USG, MMG, and even MRI alone may sometimes not be enough. They should be discussed altogether and the treatment should begin after definitive histopathologic result. Fine needle aspiration biopsy for cytology will result in a high level of diagnostic accuracy, however, core biopsy will reinforce the exact result. Corticosteroid therapy has been shown to be efficacious for IGM, but in the existence of complications such as abscess formation, fistulae, and persistent wound infection, surgical treatment has been the first method of choice.

Idiopathic granulomatous lobular mastitis (IGLM) is an uncommon and rare chronic inflammatory breast disease. The exact etiology is not known. Although various etiologies have been implicated, autoimmunity is favored and widely accepted. In countries with a high prevalence of tuberculosis, the diagnosis of IGLM is often challenging. Clinical presentation is quite variable. Ultrasonography and mammography findings lack specificity. Fine-needle aspiration (FNA) cytology features of idiopathic granulomatous mastitis (IGM) have been described in few reports, but they are still debatable. We report the case of a 36-year-old female with a hard lump in the left breast. Aspiration cytology smears showed many well-formed epithelioid granulomas and few scattered epithelioid cells. The background showed numerous polymorphonuclear leukocytes with few reactive lymphoid cells and foreign-body giant cells. There was no necrosis. Acid-fast bacilli (AFB) and fungal stains did not show AFB and fungal hyphae. A diagnosis of IGM was suspected on aspiration cytology. Histopathology examination confirmed the diagnosis. To conclude, though tuberculosis is highly prevalent in India, if breast FNA smears show epithelioid granulomas with numerous polymorphonuclear leukocytes with no necrosis or AFB, IGLM must be suspected.

Imaging manifestations of idiopathic granulomatous lobular mastitis on cone-beam breast computed tomography

Idiopathic granulomatous lobular mastitis (IGLM) is a rare, chronic inflammatory breast disease without a known etiology. Even though the current literature proposes several treatment strategies, there is no universal consensus for long-term management. A 43-year-old White woman (gravida 5, para 4) presented with a 2-week history of right lower outer quadrant breast tenderness, heaviness, warmth, and redness. Mammography and ultrasound were concerning for inflammatory breast cancer. Biopsies returned as granulomatous mastitis without malignancy. After 8 months of unsuccessful therapy with prednisone and methotrexate, surgeons excised the breast tissue. Cultures and special stains were negative for other organisms. At the 7-month follow-up, no evidence of recurrence was seen. As there remains no consensus behind the etiology or management of IGLM, our case demonstrates a reasonable and successful stepwise treatment beginning with medical therapy before proceeding to surgical cure. Because of possible malignancy risk with chronic IGLM, patients should not delay surgical excision if their condition remains refractory to medical therapy alone.

Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory disease of the breast of unknown etiology. The typical clinical presentation is a unilateral palpable breast mass with pain and overlying skin erythema. IGM remains a diagnosis of exclusion, and it is necessary to exclude all infectious and noninfectious causes of granulomatous disease. Definitive diagnosis of IGM relies on histological examination, demonstrating granulomatous inflammation without caseous necrosis. Common medical treatment entails the use of corticosteroids and other immunosuppressive agents in patients with IGM. We present a rare case of bilateral IGM in a patient found to have latent tuberculosis (TB), and we discuss the challenges of treating IGM in a tuberculin skin test positive patient. The patient is a 44-year-old female veteran with a history of a positive tuberculin skin test who initially presented with a unilateral painful breast mass. She continued to present with recurrent painful breast masses that progressed to bilateral disease. Mammography and breast MRI were suspicious for malignancy and required biopsy. Histopathology revealed noncaseating granulomas. All stains and cultures were negative for mycobacterium. After 3 years, the disease subsided and she did not present with any further recurrences. She was subsequently treated with isoniazid to reduce the risk of TB reactivation. The diagnosis of IGM is challenging and should be considered in the differential diagnosis of persistent or recurrent breast masses. Patients with IGM found to have latent TB are of particular concern, and tuberculous mastitis must be carefully excluded. IGM is generally a self-limiting disease, and treatment options include observation, symptomatic palliation, steroids, and in complicated recurrent cases or cases involving an abscess, surgery may be considered as a last resort. Treatment of IGM in patients with latent TB should be primarily symptomatic, and steroids should not be used. J Med Cases. 2014;5(8):430-434 doi: http://dx.doi.org/10.14740/jmc1835w

Introduction and Importance: Granulomatous mastitis is a rare inflammatory disorder of the breast, which can be either idiopathic or due to secondary etiology. This disease affects women of reproductive age. The exact pathophysiology underlying idiopathic granulomatous mastitis (IGM) remains unclear, but it is believed to be mediated by immunological processes. Establishing a diagnosis of this condition could be challenging due to the long list of differential diagnoses that it creates. Case Presentation: We report a 24-year-old Syrian female presented to the clinic complaining of a 2-week history of fatigue, fever and chills, swelling, and localized pain in her left breast. Physical examination revealed erythema nodosum, episcleritis, and arthralgia in the wrists, ankles, and elbows. An excisional biopsy was done and a microscopic examination of the lesion confirmed granulomatous perilobular mastitis. Symptoms had resolved after the surgical excision and follow-up evaluation showed no signs of recurrence. Clinical Discussion: IGM typically presents as an enlarging breast mass that can be mistaken for breast cancer or an abscess. The diagnostic approach should consider the presence of extramammary symptoms such as fever, arthralgia, and fatigue. Treatment options include corticosteroids, surgical excision, or steroid-sparing agents, but relapse rates vary. Conclusions: Episcleritis should be considered as a potential extramammary manifestation in cases of IGM. We highlight the importance of recognizing and investigating the potential systemic involvement in patients with IGM. Accurate interpretation of pathological and radiological findings by a multidisciplinary breast team can facilitate the diagnosis and reduce unnecessary interventions.

Objective To explore the risk factors of idiopathic granulomatous mastitis (IGM). Methods Totally 58 patients with IGM (IGM group) and 91 patients with benign breast disease (control group) in the Department of Breast Surgery, Wuhan Red Cross Hospital from January to December 2018 were enrolled for a retrospective study. The Pearson χ2 test or Wilcoxon rank sum test was used to analyze the general data of the two groups. The variables with P<0.050 were processed by the binary logistic regression analysis to screen out the risk factors associated with IGM. Results Univariate analysis showed that the following factors presented a significant difference between IGM group and control group: autoimmune diseases, chest impact, use of contraceptive drugs, number of full-term pregnancies, full-term pregnancy during the past five years, alternate breastfeeding and increased prolactin level (χ2= 4.180, 8.649, 4.650, -2.782, 19.607, 5.419, 10.740, all P<0.050). Multivariate analysis showed that autoimmune diseases, increased prolactin level, chest impact, full-term pregnancy during the past 5 years, use of contraceptive drugs and non-alternate breastfeeding were independent risk factors for IGM (OR=6.793, 4.553, 4.248, 3.657, 3.101, 2.492; 95%CI: 1.759-26.240, 1.519-13.648, 1.007-18.093, 1.652-8.095, 1.286-7.476, 1.146-5.419; P=0.005, 0.007, 0.047, 0.001, 0.012, 0.021). Conclusion For the patients with the above-mentioned IGM-related risk factors, the doctors should be aware of the high risk of IGM and provide certain prevention and intervention if necessary. Key words: Mammary glands, human; Granulomatous mastitis; Risk factors

Granulomatous lobular mastitis is a rare chronic inflammatory disease of the breast. The differential diagnosis with malign breast disease is often not easy. In most cases a surgical biopsy is needed for correct diagnosis. Idiopathic granulomatous mastitis is an exclusion diagnosis, based on the demonstration of a characteristic histological pattern, combined with the exclusion of other possible causes of granulomatous breast lesions. There is still no generally accepted optimal treatment. If surgery forms part of the treatment, a conservative approach seems to be adequate in most cases. Another option is a long-term steroid treatment. It is mandatory to exclude infectious causes of granulomatous mastitis before corticoid therapy is started.