Diagnosis Of Granulomatous Mastitis Research Articles

Evaluation of the efficacy of intralesional triamcinolone injection therapy in patients with granulomatous mastitis: a comparative study with oral methylprednisolone

Aims: This study aims to compare the efficacy of oral steroid therapy with the combination of topical and intralesional steroid (TILS) therapy in patients with granulomatous mastitis (GM).
 Methods: This is a single-center retrospective longitudinal study. Women with a diagnosis of GM who applied to Medipol Universty Pendik Hospital General Surgery Clinic between January 2020 and April 2022 were included in the study. Participants received TILS or peroral steroid (POS) treatment in sequential order, and each patient received only one of the treatment options. Participants were evaluated by physical examination, USG, and radiography before and after treatment to assess lesion size, side, number of foci, skin characteristics, and the presence of pain. The clinical and radiological findings were compared betwen the groups at the end of the 6-month follow-up and the participants were followed up for the next 12 months to demonstrate the efficacy. 
 Results: A total of 52 women participated in the study, with 26 in the POS group and 26 in the TILS group. The mean age was 33.33+6.94 years and similar between the two groups (p=0.831). Three patients (11.53%) in the TILS group and 7 patients (26.92%) in the POS group were nonresponders to treatment (p=0.159). Given the nonresponders, GM lesions persisted in one patient (3.84%) in the TILS group and 3 patients (11.53%) in the POS group at the end of the study (p=0.610). At the end of the 12-month follow-up, five patients (19.2%) in the TILS group and 20 patients (76.9%) in the POS group who achieved a complete remission at the posttreatment 6 months experienced disease recurrence (p

Granulomatous Mastitis with Erythema Nodosum: A Case Report and Systematic Review

A healthy G5P3 34-year-old Hispanic patient with a new diagnosis of granulomatous mastitis of the right breast was referred to the dermatology clinic for painful skin lesions that had enlarged over the week prior and arthralgia in her knees and elbows. Examination revealed multiple tender, erythematous subcutaneous nodules scattered over the extensor surfaces of bilateral upper and lower extremities. Histology from the right forearm exhibited a mixed septal and lobular panniculitis with acute neutrophilic inflammation with granulomatous changes, consistent with erythema nodosum. The patient experienced significant improvement with prednisone taper, but flared on discontinuation; methotrexate was started with stabilization of her disease.
 Although once considered a rare association, GM associated with EN is increasingly recognized, and since 1987, a total of 28 reports have detailed 59 cases (including the present case). Here, we provide a comprehensive review of all 58 reported cases of this association, including ours. We found a preponderance of cases occurred in females of Turkish ancestry around the fourth decade of life in the peripartum period. Arthralgia is the most common additional symptom. The majority of cases responded to treatment with oral corticosteroids, but some required the addition of other immunosuppressants and/or definitive surgical excision.

Red flags for the differential diagnosis of granulomatous mastitis: a case report

BackgroundGranulomatous mastitis (GM) is a rare benign chronic inflammatory breast disease. GM presents as a heterogeneous illness with variable clinical presentations, and its diagnosis is usually made by exclusion. There are no guidelines for the treatment of GM. This manuscript describes the management of a patient with GM, initially unsuccessfully treated outside our clinic under a diagnosis of mastitis. The patient’s history, physical examination, and needle biopsy flagged the patient’s findings as nonmalignant; however, imaging studies indicated a tumor. Differential diagnosis became a critical element of her care. This case report represents a valuable resource to foster more assertive clinical practice in managing patients with GM. The case coordination and its course were led by a team from an outreach clinic that provides health care services to underserved communities in the state of Michigan.Case presentationA 41-year-old G1P1 Hispanic female immigrant from Central America presented with a rare breast disease, granulomatous mastitis. A similar presentation occurred 5 years before pregnancy when she had an episode of pain and swelling in the left breast, which resolved spontaneously. She sought our services after being diagnosed with mastitis that was unsuccessfully treated. Physical examination revealed a nodular mass in the outer quadrants of the left breast without regional lymphadenopathy. Needle biopsy showed fibrohistiocytic and florid inflammatory reactions, with no evidence of invasive carcinoma. However, this result was inconsistent with the degree of abnormality revealed by the mammogram (BI-RADS grade 5), ultrasound, and physical examination. Full incisional biopsy revealed cystic neutrophilic GM. The surgical procedure, antibiotics, and corticosteroids resulted in a successful combination to secure the stable control of the symptoms and progression of this rare benign breast disease to date.ConclusionsThis patient’s case highlights the importance of integrated communication among front-line primary care and other health care professionals to reduce the risk of invasive procedures and avoid institutional costs. GM is a rare disease. We raised the manifold red flags in which the multiple professional chains recruited to care for this patient were concerning for advanced breast cancer. The lack of experience and evidence-based medicine contributed to the contradictory interpretation of the findings on GM's diagnosis.

The Identification of Gene Expression Profiles Associated with Granulomatous Mastitis

Background: Granulomatous mastitis (GM) is a rare chronic inflammatory disease of the breast. The current therapeutic effects of the antibiotic therapy and surgical or immunomodulatory (steroid) treatment are normally poor due to the unclear etiology. Method: This study aimed to identify the differentially expressed mRNAs in GM tissues using RNA sequencing and further explored the functions of differentially expressed mRNAs resulting in GM. Moreover, we revealed the relationship between GM and breast cancer by shared highly expressed genes in GM tissues and breast cancer tissues. Results: A total of 12,115 mRNAs were analyzed in the whole expression profile, and 207 mRNAs (136 upregulated and 71 downregulated mRNAs) were differently expressed between the GM tissues and normal tissues. The enrichment analysis showed that the differentially expressed mRNAs were enriched in the biological processes and played a significant role in the immune system. Besides, the genes expressed significantly highly in breast cancer tissues are found to be enriched with GM genes, which may explain the similar clinical features between breast cancer and GM. We also found that the HSD11B1 gene which was differentially expressed in GM was used as drug target of prednisone, which is a common treatment for GM. Conclusion: This study is the first to use sequencing technology to elucidate the genetic mechanisms of GM. The finding of this study may have potential value in GM diagnosis and also provides potential drug targets for GM treatment.

Management of Granulomatous Mastitis Following Aesthetic Breast Surgery.

Granulomatous mastitis (GM) is not among the well-known diseases in the field of aesthetic breast surgery (ABS). The clinical presentation of GM resembles infectious diseases or malignancies, but the management of these diseases is quite different. In this study, we aimed to present the management of GM in patients who underwent ABS. In this study, patients with GM (n = 65) and patients who underwent ABS (n = 531) were evaluated. A total of six GM patients with a history of ABS were included in the study between January 1, 2010, and January 1, 2019. The data were collected retrospectively. The quantitative variables are shown as medians (minimum-maximum), and categorical variables are shown as numbers and percentages (%). Median duration of disease onset after the ABS was 16 (8-38) months. After the diagnosis of GM was obtained, all patients received steroid treatment. Median steroid treatment duration was 10 (8-20) weeks. Methotrexate was administered in two patients due to persistent breast mass and steroid side effect. Surgical excision was performed in three patients with wide excision. No patient needed further surgery such as mastectomy. Median follow-up period was 37.5 (18-70) months. This is the first study to declare GM in patients who underwent ABS. Atypical clinical presentation such as breast abscess, mass or fistula after ABS should alert the surgeon about GM. Unlike other mastitis, the primary treatment of this rare disease is steroid and immunosuppressive treatment. Insufficient knowledge about GM can lead to unnecessary surgeries or breast loss. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Idiopathic granulomatous mastitis\u2014our experience

BackgroundIdiopathic granulomatous mastitis (IGM) is a rare benign chronic inflammatory condition of the breast and is most commonly seen in women of childbearing age. The etiology is uncertain, and an autoimmune association has been suggested with the diagnosis usually made by exclusion. The clinical and radiological features often mimic that of breast cancer and hence confirmed early diagnosis is required to avoid misdiagnosis and unnecessary delay in the treatment.ResultsThe most common clinical presentation of granulomatous mastitis is unilateral palpable breast lump with or without associated pain. The typical ultrasound finding is an ill-defined, irregular heterogeneous, predominantly hypoechoic lesion with multiple tentacles. Histologic features show a well-defined non-necrotizing epitheloid granulomas along with Langhans type giant cells.ConclusionImaging features mimic that of breast cancer, and final diagnosis of granulomatous mastitis always requires specific pathologic findings while excluding other causes.

GRANULOMATOUS MASTITIS IS NOT ALWAYS TUBERCULAR: ROLE OF FINE NEEDLE ASPIRATION CYTOLOGY IN EVALUATION OF GRANULOMATOUS MASTITIS

INTRODUCTION AND OBJECTIVES:
 Granulomatous mastitis is rare chronic inflammatory benign breast lesion, which clinically and radiologically resembles carcinoma breast thus creating a diagnostic dilemma. The term granulomatous mastitis includes two broad categories namely specific granulomatous mastitis for which aetiological factors can be defined such as infectious causes like Mycobacterium tuberculosis, blastomycosis, cryptococcosis, histoplasmosis, actinomycosis and filarial infection. Other factors include association with autoimmunue diseases such as Wegner’s granulomatosis and giant cell arteritis and there are other rare causes such as include duct ectasia, foreign body reaction and fat necrosis which also leads to granulomatous lesions of breast.
 Cytological features of granulomatous mastitis(GM) have not been widely discussed and described in literature, so through this study we have made an attempt to thoroughly discuss cytological spectrum of granulomatous mastitis.
 MATERIALS AND METHODS:
 A retrospective study was performed over a period of four years from 2016 to 2019. A total of 465 cases of breast lump reported to cytopathology section out of which 24 cases of GM diagnosed on FNAC were included in our study. Results of Erythrocyte sedimentation rate (ESR) and Mantoux test along with TB-PCR were recorded. FNAC slides were retrieved pertaining to study period.
 Granulomatous lesions of breast were further categorized broadly into IGM/ NGM, granulomatous mastitis without caseous necrosis and tubercular mastitis where diagnosis were made definite on basis of demonstration of AFB or positive TB-PCR .
 RESULTS:
 Patient age ranged from 23 years to 55 years with the mean age of 36.6 years with maximum of patients falling in second decade followed by third decade. Granulomatous lesions were broadly categorized into Idiopathic/ Non specific granulomatous mastitis(11 cases,45.8%), GM with caseous necrosis(8 cases, 33.3%) and tubercular mastitis(5 cases, 20.9%). Histopathology was available in 7 cases(29.2%). TB-PCR was sent in all cases of granulomatous mastitis diagnosed on cytology and was positive in 10 cases(41.7%).
 CONCLUSION:
 Idiopathic granulomatous mastitis and tubercular mastitis are rare inflammatory diseases of breast which mimic malignancy clinically and radiologically. FNAC plays important role in diagnosis of granulomatous diseases of breast and also their differentiation from malignant tumors. Tubercular mastitis needs to be differentiated from IGM since treatment options are different in both the cases. Cytopathology plays an important role in differentiationg both the diseases supplemented by radiological and microbiological investigations.
 The present study thus highlights the importance of FNAC as an infalliable tool in diagnosis of granulomatous mastitis and its differentiation from neoplastic lesions of breast thus avoiding time consuming histopathological work up of cases.

Granulomatous Mastitis: Incidence and Experience in a Mexican Institute

The significance of this work is that chronic granulomatous disease can mimic two common breast diseases; breast cancer and breast abscess; so it is mandatory that the diagnosis is made in order to avoid mistaken carcinoma diagnosis. On the other hand, the current treatment of this particular disease still remains controversial. Objectives: The aim of this study is to expose and describe the chronicity and the impact in a patient’s quality of life with Granulomatous Mastitis diagnosis. We describe the evolution of the disease and the treatment of the disease in a Mexican Institution. Material and methods: In a descriptive retrospective study we identified 9 patients with idiopathic granulomatous mastitis (IMG), all of them were diagnosed with histopathological findings. Results: In a period of time between January 2005 and December 2017, we included a total of 9 female patients. All of them have had histopathological findings consistent with granulomatous mastitis. The age range was 25 - 83 years old (mean 50.8 yrs). In 4 patients (44.4%) had the right side affected, three patients (33.3%) had the left side affected and 2 patients (22.2%) had a bilateral presentation. In 3 patients (33.3%) we observed more than one affected quadrant and 4 patients (44.4%) had a diffuse presentation on image. The most common symptom was breast pain in 9 patients (100%) and the most common sign was the presence of a nodule, 8 patients (88.8%). We observed erythema in 7 cases (77.7%) followed by abscess, edema and pus secretion in 6 patients (66.6%). The most frequent treatment was the use of a combination of NAIDs and antibiotic in 8 patients (88.8%). Six patients were incised with scalp and drained. Six patients underwent mastectomy.

Are all Granulomatous Mastitis Cases Tuberculous?: A Study on the Role of Cytology in Evaluation of Granulomatous Mastitis.

Granulomatous mastitis is a rare inflammatory condition of the breast clinically mimicking breast carcinoma and pyogenic abscess, thereby creating a diagnostic dilemma. Tuberculous mastitis is a rare clinical entity accounting for approximately 3% of all mammary lesions. All cases of granulomatous mastitis diagnosed cytologically over a period of 3 years were evaluated to ascertain the cases with tuberculous etiology. Fine needle aspiration cytology of the breast lump was performed and all the cytological parameters were evaluated. Wherever histopathology was available, the diagnosis was confirmed on Hematoxylin & Eosin stained sections and the Ziehl Neelsen (ZN) stain was applied. A total of 10 cases of granulomatous mastitis were diagnosed on cytology during the 3-year period. On cytological smears, four cases showed presence of ill-formed granulomas and one case had scattered epithelioid histiocytes; however, the rest of the cases had well-formed granulomas. Finally, four out of ten cases were labeled as tuberculous mastitis based on the ZN stain/Tuberculosis-Polymerase chain reaction (TB-PCR) and the other six cases were granulomatous mastitis. Cytology plays a significant role in the diagnosis of granulomatous mastitis. This study re-emphasizes the role of the cytopathologist in the accurate and early diagnosis of these lesions so that unnecessary surgery can be avoided, and also highlights the fact that all granulomatous mastitis cases are not tuberculous.

A Rare Case of Granulomatosis with Polyangiitis Presenting as a Breast Mass: A Differential Diagnosis of Granulomatous Mastitis

A Rare Case of Granulomatosis with Polyangiitis Presenting as a Breast Mass: A Differential Diagnosis of Granulomatous Mastitis

Cytological Features of Granulomatous Mastitis-A study of ten cases

Introduction: Granulomatous mastitis is a rare benign disease, the exact cause of which is still unknown. It usually presents as a mass which may simulate carcinoma. Many patients are put on long term antibiotics because of breast abscess suspicion, but are not cured. This disease usually affects women of child-bearing age with a history of oral contraceptive use. Most cases have been reported in third decade. In previous studies most of cases of idiopathic granulomatous mastitis were within six years of pregnancy. There are two types of granulomatous mastitis, specific and idiopathic. Aim: To study cytological features of granulomatous mastitis, the age group involved and how to differentiate it from malignancy to prevent unnecessary mastectomies. Method: FNAC was performed with 22G needle. Slides prepared were stained with leishman stain. Special stains like Zeihl Nelson stain and Periodic Acid Schiffs were done to rule out mycobacterium and fungal etiology. Result: Cytological features of noncaseating granuloma along with plenty of polymorphs in the background is suggestive of granulomatous mastitis. History of lactation and oral contraceptives along with special tests further aids in its diagnosis. Conclusion: In this study of ten cases we describe the importance of cytology in diagnosis of granulomatous mastitis which helps us to prevent unnecessary mastectomies. GM is essentially a diagnosis of exclusion that is by excluding other causes of chronic inflammation. Infective causes such as tuberculosis should always be ruled out before stating treatment with steroid. Keywords: Breast, Mastitis, Granuloma, Polymorphs

Granulomatous mastitis: Presentations, diagnosis, treatment and outcome in 206 patients from the north of Iran

ObjectivesThe aim of this study is to review the clinical presentations, diagnostic methods, treatment options and outcome of patients with Granulomatous Mastitis (GM). Material and methodsIn a retrospective study, we indentified 206 women who met the required histological criteria of (GM). ResultsThirty eight (18%) of these women had taken antibiotics before their diagnosis of GM. The most common symptoms in remaining 168 symptomatic women were breast mass. The most common ultrasonographic and mammographic finding was large irregular hypo echoic masses and an irregular mass, respectively. As a diagnostic tool, fine needle aspiration (FNA) was performed in 33 (19.5%) and core needle biopsy with or without ultrasound was done in 92 (55%) of patients while successful rate was 13 (39%) and 87 (94.5%), respectively. The remaining 43 (25.5%) of women underwent surgical excisions. Only 6 (3%) patients improved with antibiotics and 200 (97%) of women who did not respond to antibiotics, were treated with steroid and among them 144 (72%) improved. Treatment with combination of methotrexate and steroid was done in 56 (28%) patients and was effective in 40 (71%) of them. Sixteen (8%) patients were treated with a combination of steroid and bromocriptine which was effective in 5 (31%) patients. A wide surgical excision was performed in 11 (5.5%) patients who were nonresponsive to steroid and methotrexate and bromocriptine therapy. ConclusionOur findings indicate that clinical and imaging findings of (GM) have overlapped with malignancy. The best diagnostic method is core needle biopsy. Corticosteroids are in the first line of treatment with a good therapeutic response.

Granulomatous mastitis: changing clinical and imaging features with image-guided biopsy correlation.

To review clinical presentation, revisit patient demographics and imaging findings in granulomatous mastitis and determine the optimal biopsy method for diagnosis. A retrospective study was performed to review the clinical presentation, imaging findings and biopsy methods in patients with granulomatous mastitis. Twenty-seven patients with pathology-proven granulomatous mastitis were included. The average age at presentation was 38.0years (range, 21-73years). Seven patients were between 48 and 73years old. Twenty-four patients presented with symptoms and three patients were asymptomatic. Nineteen patients were imaged with mammography demonstrating mammographically occult lesions as the predominant finding. Twenty-six patients were imaged with ultrasound and the most common finding was a mass lesion. Pathological diagnosis was made by image-guided biopsy in 44% of patients. The imaging features of granulomatous mastitis on mammography are infrequently described. Our study demonstrates that granulomatous mastitis can occur in postmenopausal or asymptomatic patients, although previously reported exclusively in young women with palpable findings. Presentation on mammography as calcifications requiring mammographically guided vacuum-assisted biopsy has not been previously described. The diagnosis of granulomatous mastitis can easily be made by image-guided biopsy and surgical excision should be reserved for definitive treatment. • Characterizes radiographic appearance of granulomatous mastitis in postmenopausal or asymptomatic patients. • Granulomatous mastitis can present exclusively as calcifications on mammography. • The diagnosis of granulomatous mastitis is made by image-guided biopsy techniques.

Idiopathic Granulomatous Mastitis: Diagnostic strategy and therapeutic implications in Omani patients.

Idiopathic granulomatous mastitis (IGM) is a rare benign disorder of the breast whose aetiology is controversial, and is often misdiagnosed clinically and radiologically as mammary malignancy; as a result, it may be incorrectly treated. Although no standard treatment is available for this chronic disease, surgery with or without corticosteroids has been tried with controversial results. This study discusses the clinical presentation, diagnosis, management, recurrence, and follow-up data of IGM with a review of relevant literature. From 2009-2012, the Breast Unit at Sultan Qaboos University Hospital, Oman, conducted a clinical study on 20 patients with breast lumps. Their clinical and radiological examinations were indeterminate, and a diagnosis of granulomatous mastitis was established only by histopathology. The majority of the patients were cases of unknown aetiology, who presented with a unilateral breast mass. A few patients had a mass with an abscess, along with axillary lymphadenopathy. A total of 4 patients were suspected of malignancy using radiology. In all patients, sterilised pus was sent for culture and sensitivity. Microscopy showed the characteristic pattern of granulomatous inflammation. All patients were treated with antibiotics for 6 weeks, and the mean follow-up period was 15 months (11-33 months). All patients had complete remission with no further recurrence. This single largest study of cases of IGM in Oman highlights the pitfalls in diagnosing this non-neoplastic disease of unknown aetiology and uncertain pathogenesis. It emphasises IGM's excellent response to antibiotics, which is crucial, as IGM is a disease which is notoriously difficult and controversial to treat.

Granulomatous Mastitis Complicated by Arthralgia and Erythema Nodosum Successfully Treated with Prednisolone and Methotrexate

A 23-year-old woman was admitted with complaints of swelling and pain in the left breast, fever, polyarthralgia and erythema nodosum. A fine-needle biopsy of the mass in the left breast revealed non-caseous granulomatous lobulitis. A diagnosis of granulomatous mastitis was thus made. The administration of prednisolone 40 mg/day resulted in the resolution of the patient's symptoms, and the breast mass thereafter decreased in size. The mass relapsed during the subsequent prednisolone taper. Additional therapy with methotrexate resulted in complete remission. Granulomatous mastitis should therefore be included in the differential diagnosis of polyarthralgia.

Granulomatous mastitis: is it an autoimmune disease? Diagnostic and therapeutic dilemmas

Granulomatous mastitis (GM) is a rare benign inflammatory breast disease. The clinical presentation of granulomatous mastitis usually mimics malignancy or infection. The aim of this study was to review the clinical and diagnostic features of GM and discuss the medical and surgical treatment of our series of eight GM patients. Between 2008 and 2010, eight patients were diagnosed with GM and underwent surgery. Patients were evaluated clinically and radiologically. The diagnosis of GM was confirmed in all cases by core needle or excisional biopsies. Serological tests were performed for rheumatoid factor (RF), antinuclear antibody (ANA), and anti-double-stranded DNA (anti-dsDNA). The mean patient age was 37 years. Common presenting symptoms were a hard mass, pain, inflamed hyperemic skin, and sinus formation. Serological tests for RF were positive in 6 patients, and ANA and anti-dsDNA antibodies were detected in 2 patients. All patients underwent antibiotic therapy before surgery, and were treated with wide surgical excision with negative margins. Methylprednisolone (16 mg/day for 3 months) therapy was used in 3 patients (all RF and 2 ANA/anti-dsDNA positive) following a wide excisional biopsy after a postoperative recurrence mimicking skin lesions was seen. These patients responded well to steroid therapy. The diagnosis of GM should be made carefully to avoid a misdiagnosis. Steroid therapy should be considered based on the idea that this is an autoimmune disease.

Granulomatous mastitis: Presentation, treatment and outcome in 43 patients

Background Granulomatous mastitis is a rare benign breast condition commonly affecting women of child-bearing age. It is characterised histopathologically by the presence granuloma and microabscess formation. It is frequently mistaken for inflammatory breast carcinoma both clinically and mammographically. The aim of this study was to retrospectively review the clinical presentation, radiological investigation, histopathological features, treatment and outcome of granulomatous mastitis of women presenting to Ripas Hospital between October 1997 and June 2009. Results Forty-three patients with a mean age of 34 years presented with a diagnosis of granulomatous mastitis. All patients presented with a palpable breast lump; 24 (56%) patients also experienced pain in the lump and 3 (7%) patients also had associated nipple discharge on presentation. The role of radiological imaging is found to be limited in differentiating GM from other inflammatory and malignant conditions of the breast. Forty (93%) patients underwent a surgical procedure as the main treatment; in the form of excision or incision and drainage of the breast lesions. Mean follow-up was 15 (range 1–80) months with recurrence in 10 (23%) patients. Conclusion Granulomatous mastitis presents clinically with a palpable breast lump. The diagnosis is often only made histopathologically after surgical excision or core biopsy. Complete surgical excision or incision and drainage of the lesion are the main treatment modalities. Treatment with corticosteroids and immunosuppression remains controversial and there is tendency for this condition to recur after treatment.

Granulomatous mastitis diagnosed by core-needle biopsy and successfully treated with corticosteroid therapy: A case report

A 46-year-old woman presented to our hospital with a rapidly growing lump in her right breast. Fine-needle aspiration (FNA) cytology and core needle biopsy of the mass revealed many epithelioid cells admixed with multinucleated Langhans-type giant cells, neutrophils, lymphocytes, and stromal cells, leading to a diagnosis of granulomatous mastitis. Mammography and ultrasonography provided little information for differentiating between granulomatous mastitis and carcinoma. This patient was successfully treated with low dose and short period of corticosteroid therapy.

Characteristic mammographic and sonographic findings in the diagnosis of granulomatous mastitis

Objective: Granulomatous mastitis (GM) is a rare inflammatory breast disease of unknown etiology that can clinically mimic infectious mastitis or carcinoma. We report the mammographic (MM) and sonographic (US) findings of GM that can aid in the differential diagnosis.

Fine Needle Aspiration Cytology in the Diagnosis of Tuberculous Mastitis

To study the relationship between granulomas in the breast and tuberculous mastitis. Retrospective analysis of 22 breast aspirates that showed epithelioid cell granulomas. The aspirates were reviewed and the cytomorphologic findings summarized. Aspiration cytology revealed epithelioid cell granulomas along with giant cells, necrosis and inflammatory cell infiltrate. Overall acid-fast bacillus (AFB) positivity was 22.7%. AFB positivity was greater in the presence of necrosis when epithelioid cells were absent. In a country like India, the diagnosis of granulomatous mastitis must be made with caution, even in the absence of AFB. Only after a sufficient trial of antituberculosis treatment has been given and the patient fails to respond should an alternative diagnosis be suggested.