Diagnosis Of Idiopathic Granulomatous Mastitis Research Articles

Clinical, histological features, and predictors of relapse in patients with idiopathic granulomatous mastitis.

Idiopathic granulomatous mastitis is a benign, inflammatory disease of breasts characterized by non-caseating granulomas. Our study aims to identify distinguishing clinical and histopathological features of relapsing disease compared to those in complete remission. We queried databases at our institution (1990-2021) to include females ≥18 years with biopsy-proven diagnosis of idiopathic granulomatous mastitis, excluding patients with breast cancer, lymphoproliferative disorders, solid organ malignancy, foreign body reaction in breast, plasma cell mastitis, and ductal ectasia. Remission was defined as a 3-month period without recurrence of symptoms or imaging findings. Relapse was defined as recurrence after 3 months of remission. Clinical and histopathological features were compared using 2-sample t tests and chi-squared tests. Of the 27 patients that met our inclusion criteria, the mean age at diagnosis was 35.8 years (± standard deviation 9.4 years) with a mean body mass index of 31.7 kg/m2 (± standard deviation 6.7 kg/m2). 11 (41%) were Hispanic, 25 (93%) had at least one previous full-term pregnancy prior to diagnosis and 8 (30%) were on oral contraceptives. Remission was seen in 18 patients (66%) and 9 (33%) had relapse. Six of these patients received steroids after antibiotics, while 5 patients received methotrexate. Three (33%) patients with relapse and 14 (77%) with remission, had abscess formation confirmed on histopathology (P = .04). Patients with remission had a higher number of abscesses on histopathology and history of oral contraceptive use was associated with more relapse. By identifying key clinical and histopathological findings in this population may guide prognosis and treatment of these patients.

Application of Elastography in the Diagnosis of Idiopathic Granulomatous Mastitis (IGM): A Systematic Review

Context: Idiopathic granulomatous mastitis (IGM) is a benign inflammatory condition of the breasts with an unknown etiology, which can mimic breast cancer on conventional ultrasound. Other imaging modalities, such as mammography and magnetic resonance imaging, cannot efficiently differentiate this condition from malignancies. Elastography is a novel imaging technique used to evaluate tissue elasticity. Objectives: This systematic review aimed to investigate the imaging features of IGM on elastography and also to determine whether this modality is useful for distinguishing IGM from other breast malignancies. Materials and Methods: A comprehensive literature search was conducted across several databases, including Medline, Embase, Cochrane Library, Scopus, and Web of Science, in October 2022. The Joanna Briggs Institute (JBI) critical appraisal tool was used for the quality assessment of the studies. Results: After screening 851 articles, seven studies investigating ultrasound elastography were found to meet the inclusion criteria. Regarding the quantitative findings, both the strain ratio and shear wave velocity were observed to be higher in malignant masses as compared to IGM. Additionally, qualitative scoring systems, such as the Tsukuba and Tozaki classifications, assigned higher scores to malignant lesions. Five of the included studies in this review proposed a specific cut-off point for differentiating IGM from malignancies, using either shear wave velocity, strain ratio, or elasticity scores. In four of the studies, these criteria exhibited sensitivity and specificity of approximately 90%. Conclusion: The current findings suggest that ultrasound elastography can serve as a valuable tool for distinguishing IGM from breast malignancies. By potentially reducing the number of unnecessary tissue biopsies, this modality may lead to a more efficient patient evaluation process.

Role of fine-needle aspiration cytology as an inexpensive tool for diagnosis of idiopathic granulomatous mastitis

Role of fine-needle aspiration cytology as an inexpensive tool for diagnosis of idiopathic granulomatous mastitis

Granulomatous mastitis, erythema nodosum, and polyarthritis: a case report

BackgroundGranulomatous mastitis is a rare inflammatory disease of the breast, typically seen in woman of child-bearing age. No definitive etiology has been described. In rare instances, this condition has been reported to be associated with extramammary manifestations such as erythema nodosum and arthritis. We describe this rare condition in an adolescent female.Case presentationA 16-year-old, Hispanic female presented with right-sided painful breast swelling, polyarthritis, and erythema nodosum on bilateral shins and lower thighs. Physical examination was negative for lymphadenopathy and pulmonary, gastrointestinal, and cardiovascular findings. Ophthalmologic examination for uveitis and serologic tests for autoimmune diseases were negative. Diagnosis of idiopathic granulomatous mastitis was made by exclusion of other etiologies and conditions. Confirmation was made by histopathologic examination demonstrating noncaseating granuloma within breast lobules with neutrophils and microabscess formation. After wide local excision and a short course of trimethoprim–sulfamethoxazole, our patient was placed on naproxen and prednisone, the latter being tapered off over 3 months, with steady and complete resolution of all symptoms.ConclusionThis is the first reported case of idiopathic granulomatous mastitis in a pediatric patient who also had extramammary manifestations, including erythema nodosum and polyarthritis. In this case-based review, we summarize the phenotype, risk factors, prognosis, and treatment options of this rare condition, chiefly to make the readers cognizant of such a diagnostic possibility in similar clinical presentation in the future.

Is it possible to avoid the late diagnosis of idiopathic granulomatous mastitis?

Introduction: Idiopathic granulomatous mastitis (MGI) is a rare chronic inflammatory disease of unknown etiology. Its diagnosis is one of exclusion, it requires a histological sample that confirms the presence of granulomas, and specific cultures that rule out other causes of granulomatous disease. The initial mismanagement of these patients due to the lack of sampling for histological study and cultures, leads to a delay in diagnosis. There is no established treatment for this pathology, with surgical treatment and medical treatment with corticosteroids being the most used, either individually or in combination. Objectives: To determine the incidence of MGI in those patients who consulted for inflammatory lesions of the breast and its incidence in those who finally underwent surgical treatment. Identify clinical characteristics that allow an initial diagnostic suspicion, and establish guidelines for surgical management that allow an early diagnosis. Material and Methods: A retrospective, cross-sectional and descriptive work was carried out. The medical records of all patients undergoing surgical treatment of the breast for inflammatory lesions in the period from February 2018 to February 2020 were evaluated at the Gynecology and Obstetrics Service of the Sanatorio Güemes of Buenos Aires. Its clinicopathological characteristics, type of surgery performed and whether it required subsequent corticosteroid treatment were analyzed. Results: In the period of time analyzed, 410 patients consulted for an inflammatory breast process, where only 10 of them (2.44%) had a diagnosis of MGI. If we consider those with surgical indication, the incidence of MGI amounts to 32.25% (31 patients). Ten patients had at least 2 previous consultations with a presumptive diagnosis of acute mastitis treated with different antibiotic regimens prior to the definitive diagnosis. Half of the patients required 2 surgical interventions prior to diagnosis. The average time interval elapsed between the first consultation and the definitive diagnosis was 4 months. Conclusion: Patients with inflammatory breast disease with surgical indication, the differential diagnosis between abscessed acute mastitis and MGI should be considered, especially in the subpopulation of patients between 30-40 years of age, multiparous, and with multiple previous consultations for breast inflammatory processes refractory to antibiotic treatments. The surgical approach must include biopsy and specific cultures.

Mastitis granulomatosa idiopática. Caso clínico y revisión literaria

The clinical case of a patient with a histological diagnosis of idiopathic granulomatous mastitis is described, a rare disease in which immunosuppressants are used as the described treatment and can be confused with other entities treated in the specialty. The case is described and a literature review is carried out.

Preoperative Fibrinogen and Hematological Indexes in the Differential Diagnosis of Idiopathic Granulomatous Mastitis and Breast Cancer.

Background and Aim: Studies on hematological parameters in the differential diagnosis of idiopathic granulomatous mastitis (IGM) and breast cancer (BC) are limited. This study investigated whether preoperative fibrinogen and hematological indexes can be used in the differential diagnosis of patients with IGM and early-onset BC. Methods: Fifty patients with BC, 55 patients with IGM, and 50 healthy volunteer women were included in the study. Results: There was a statistically significant difference between the IGM and the BC with respect to fibrinogen, fibrinogen/albumin (Fib/Alb) ratio, C-reactive protein (CRP), white blood cells (WBC), neutrophils, neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), and monocyte values. When fibrinogen (p < 0.001), the Fib/Alb ratio (p < 0.001), CRP (p < 0.001), WBC (p < 0.001), neutrophil (p < 0.001), NLR (p < 0.001), monocyte (p = 0.008), and 2-hour sedimentation rate (p < 0.001) were compared between the groups, the highest levels were found in the IGM group. There was a negative relationship between CRP and albumin, and a positive relationship was observed between CRP and WBC, NLR, PLR, and 2-h sedimentation rate. CRP had the highest sensitivity (95%), whereas the Fib/Alb ratio (86%) had the highest specificity. Patients with recurrent IGM had increased fibrinogen, Fib/Alb, CRP, neutrophils, NLR, and 2-h erythrocyte sedimentation rate (ESR) and decreased lymphocyte levels compared to non-recurrent patients. Conclusions: Preoperative CRP, albumin, fibrinogen, Fib/Alb, WBC, neutrophil, NLR, monocyte, and 2-h ESR have considerable potential to be early and sensitive biomarkers of IGM caused by inflammation compared to BC. These parameters also have a significant effect on the recurrence of the disease, suggesting their potential as a practical guide for the differential diagnosis of BC from IGM.

CHRONIC BREAST INFECTIONS: CHALLENGING CONDITION TO DIAGNOSE AND TREAT; AN OVERVIEW OF 70 CASES

Objective: To share our experience of clinical features and management strategies for treatment of chronic breast infections.&#x0D; Study Design: Case series.&#x0D; Place and Duration of Study: Combined Military Hospital Rawalpindi, from Feb 2016 to Feb 2018.&#x0D; Methodology: We prospectively enrolled patients with diagnosis of chronic breast infections over a period of two years. All patients with infections (less than one month old) were excluded from the study. We studied the demographic characteristics like age, clinical presentation, histopathological features, treatment given and response to the treatment.&#x0D; Results: A total of 70 patients were enrolled in the study. Patients age was between 21-75 years with mean age of 42 ± 5 years. Most common clinical presentation was lump and in duration with abscess in 23 (33%) cases, mass with discharging sinuses in 16 (23%) cases, while 7 (10%) cases had recurrent abscess. Diagnosis was made on core biopsy in 21 cases and in remaining cases with incision and drainage. Histopathology confirmed diagnosis of Idiopathic Granulomatous mastitis in 30 (43%) cases, acute on chronic mastitis in 27 (38%) and chronic granulomatous mastitis in 13 (18%) cases. Out of all cases 29 (41%) showed response to antibacterial treatment while 27 (38%) cases responded to anti tuberculous treatment. Spontaneous resolution occurred in 11 (16%) cases while 3 (4%) cases responded to antifungal treatment.&#x0D; Conclusion: Chronic breast infections are a challenging condition to diagnose and treat for breast surgeons and can present with diverse range of clinical features.

Management of idiopathic granulomatous mastitis in lactation: case report and review of the literature

BackgroundIdiopathic Granulomatous Mastitis (IGM) is a benign chronic inflammatory breast condition that mimics two common breast disorders: breast carcinoma and breast abscess. It can form breast masses, fistulae, and fluid collections, resulting in breast disfigurement with retraction and nipple areolar complex (NAC) inversion. IGM most often presents in women of childbearing age within a few years of pregnancy, and can significantly impact lactation. Despite the prevalence of this disease, no current literature describes an approach to managing IGM during breastfeeding.Case presentationA 28-year-old G3P2 patient of Native American origin presented to her obstetrician at 7 months pregnant with worsening left breast swelling and redness. She underwent a mammogram, ultrasound and core needle biopsy that confirmed the diagnosis of Idiopathic Granulomatous Mastitis. During the postpartum period, she underwent intralesional triamcinolone injections of her left breast. Due to the contraindication of breastfeeding after local steroid injection, the patient stopped breastfeeding from the affected breast and continued breastfeeding unilaterally.ConclusionsIdiopathic Granulomatous Mastitis is a challenging chronic inflammatory breast disease that affects women primarily in the reproductive years, with a higher incidence in patients of Hispanic, Native American, Middle Eastern, and African descent. Treatment of IGM during pregnancy and lactation has thus far not been addressed. We review the literature on the treatment of IGM in the non-lactating population, and propose considerations for treating breastfeeding women affected by this disease. Traditional treatment has included systemic immunosuppression and surgery, but newer literature demonstrates that intralesional injection of steroid can provide significant symptomatic relief to patients. A diagnosis of IGM does not preclude breastfeeding, though patients may experience challenges with milk production and latch on the affected breast. Individualized care should be provided, with considerations given to the following: side effects of systemic steroids, the need to wean a breast being treated with intralesional steroids, and augmentation of milk production on the unaffected breast to promote continued breastfeeding.

Does ARFI elastography complement B-mode ultrasonography in the radiological diagnosis of idiopathic granulomatous mastitis and invasive ductal carcinoma?

Idiopathic granulomatous mastitis (IGM) is a chronic, unpleasant autoimmune inflammatory condition and is clinically and radiologically often confused with breast malignancy. To investigate the contributions of qualitative and quantitative aspects of acoustic radiation force impulse (ARFI) elastography to the differential diagnosis between IGM and invasive ductal carcinoma (IDC) in the breast. Ninety-four women with IDC and 39 with IGM were included in the study. Shear wave velocity (SWV) was calculated for all lesions using quantitative elastography. Next, each lesion's correspondence on qualitative elastographic images to those on the B-mode images was evaluated: pattern 1, no findings on elastography images; pattern 2, lesions that were bright inside; pattern 3, lesions that contained both bright and dark areas; and pattern 4, lesions that were dark inside. Pattern 4 was subdivided into 4a (dark area same size as lesion) and 4b (dark area larger than lesion size). Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were calculated. The mean SWV based on ARFI elastography was 3.78 ± 1.26 m/s for IGM and 5.34 ± 1.43 m/s for IDC lesions (P < 0.05). Based on qualitative ARFI elastography, IDC lesions were mostly classified as pattern 4b, while IGM lesions were mostly classified as pattern 1 or 2 (P = 0.01). Evaluation of both the qualitative and quantitative aspects of ARFI elastography yielded a sensitivity of 89% and specificity of 84%. ARFI elastography may facilitate the differential diagnosis between IGM and IDC.

Effectiveness of Methotrexate in Idiopathic Granulomatous Mastitis Treatment

Idiopathic granulomatous mastitis is a rare inflammatory disease of the breast, for which there is a lack of consensus on the treatment protocol; it requires long-term follow-up and is associated with a high rate of relapse after surgical treatment. In this study, we report on the largest single-center cohort of idiopathic granulomatous mastitis treated with steroids+methotrexate. We retrospectively examined the data of 33 patients histopathologically diagnosed with idiopathic granulomatous mastitis who were evaluated by our Rheumatology or General Surgery Clinics between 2013 and 2016. Of the 33 female patients (age: 38.64 ± 6.9 years), 24 were admitted with an initial diagnosis of idiopathic granulomatous mastitis, whereas 9 were admitted after surgical treatment. Remission was achieved in 87.9% of patients with steroid+methotrexate treatment, and there were no relapses during the 24-months follow-up period. Steroid+methotrexate treatment is an effective and reliable method for ensuring long-term remission in patients with idiopathic granulomatous mastitis diagnosis.

An Integrative Approach for Idiopathic Granulomatous Mastitis

The World Health Organization established a strategy on traditional medicine activities to facilitate integration of traditional medicine into the national health care system. Traditional and complementary medicine is now addressed by a legislation in Turkey. The aim of this study is to explore an integrative approach from for idiopathic granulomatous mastitis. This is a retrospective study. Study was carried out on idiopathic granulomatous mastitis patients who were followed in the Breast Clinic at Istanbul Medipol University Hospital for between May 2015 and September 2018. Hirudotherapy and medical cupping therapy were applied as traditional and complementary medicine integratively in accordance with the related Regulation. Radiological imaging, microbiological and histological testing, side effects, and relapses were analyzed. Radiological response was evaluated at the end of the treatment. Follow-up consisted of clinical breast exam and imaging. Thirty patients with a mean age of 34.6 years were analyzed. The average duration of symptoms was 4.6 months. Common symptoms were breast mass (100%), tenderness to palpation (73.3%), erythema (56.6%), fistula formation and deformity (43.4%), and axillary lymph nodes (43.4%). After confirmation of diagnosis of idiopathic granulomatous mastitis, patients were treated with hirudotherapy combined with medical cupping therapy. Symptoms had completely resolved within 110.3 ± 24.70 days (range 90–180) after starting treatment, and complete radiological response was confirmed 3 months after the end of the therapy by breast ultrasound or magnetic resonance imaging (MRI). All patients were successfully treated, and no evidence of relapse was experienced within the follow-up period of 22.87 ± 12.47 months. Hirudotherapy and medical cupping therapy were observed as efficient methods. Further investigations are required to validate the results in larger numbers of patients with longer follow-up. ( ClinicalTrials.gov Identifier: NCT04096300).

Idiopathic granulomatous mastitis: a diagnostic challenge

Introduction: Idiopathic granulomatous mastitis is an uncommon and benign inflammatory breast disease that usually occurs in young women of childbearing age. Most common presentation is a slowly growing breast mass that is hard in consistency and can greatly mimic breast cancer. Mammographic and ultra-sonographic findings are non- specific and usually mimic malignant masses leading to higher BIRADS grading in reports. The only way to reach a definitive diagnosis is by histopathological diagnosis. Material & Methods: In the present study eight patients were presented to The Integrated Breast Care Centre (IBCC) department of AIIMS Rishikesh with breast lump or nipple discharge during January 2019 to June 2019. All the patients underwent mammography and ultrasonography followed by FNAC or Biopsy of the lesion as findings were mimicking malignant etiology. Results: On HPE all the patients showed features of granulomatous inflammation and diagnosis of idiopathic granulomatous mastitis was made. TB was excluded by CBNATT (Cartridge Based Nucleic Acid Amplification Test) examination of the aspiration cytology samples. To our knowledge, such a report is the first of its kind to address this topic in this region. Conclusion: In a young child-bearing age group female presenting with breast mass a differential of idiopathic granulomatous mastitis should also be considered. The clinicians as well as radiologists should be aware of this entity so that appropriate management may be done.

Clinical and Radiological Differences Between Fistular and Non-Fistular Idiopathic Granulomatous Mastitis

Background: Idiopathic granulomatous mastitis (IGM) is a rare and benign chronic inflammatory breast disease. The disease is usually associated with recurrent attacks and may result in the formation of fistulas. Fistula or ulceration on the skin of the breast makes it difficult to medication treatment and may necessitate extensive skin excision in patients undergoing surgery. Objectives: This study aimed to compare the clinical and radiological findings between fistular and non-fistular idiopathic granulomatous mastitis. Patients and Methods: The clinical and radiologic findings of 52 women with a histopathology diagnosis of idiopathic granulomatous mastitis were retrospectively evaluated. All the patients were assessed using ultrasonography and magnetic resonance imaging. Of the 52 patients, 20 underwent mammography. The findings in patients with fistular and non-fistular idiopathic granulomatous mastitis were compared. Results: Erythema, ulceration, and nipple changes were more common in patients with fistular idiopathic granulomatous mastitis. While the most common finding in ultrasounography in fistular IGM patients were collection areas with complicated cysts consistent with abscess, the finding in non-fistular IGM patients were multiple irregularly shaped hypoechoic masses. In magnetic resonance imaging, the most common finding in fistular IGM patients was non-mass lesions with regional clustering ring enhancement, whereas the most frequent finding in non-fistular IGM patients was non-mass lesions with regional heterogeneous enhancement. There were statistically significant differences between findings of both groups. Conclusion: There are differences in the clinical and radiologic findings of fistular and non-fistular idiopathic granulomatous mastitis. Ultrasonography and magnetic resonance imaging could be useful in identifying patients with a high risk of developing fistulas.

Use of Imaging for the Diagnosis of Idiopathic Granulomatous Mastitis: A Clinician's Perspective.

Idiopathic granulomatous mastitis (IGM) is an inflammatory breast disease with unknown etiology and nonspecific symptoms. Differentiation of breast cancer from granulomatous disease is a diagnostic and clinical challenge. Imaging features and decision of the surgeon, based on these findings, may be important steps during diagnosis and follow-up period. Articles in association with imaging of IGM were evaluated using a PubMed search in August, 2017. Hypo-echoic or heterogeneous mass/es with or without tubular extensions were the most common ultrasonographic findings. Focal asymmetric density with or without skin thickening and parenchymal distortion were detected in most of the patients during mammography. Magnetic resonance imaging most commonly revealed focal or diffuse asymmetrical signal intensity changes without significant mass effect. Although a specified and standardised criteria list for each type of the imaging modality has been lacking, the most commonly detected imaging findings, especially in cases of multiple lesions in accordance with the decision of the surgeon and/or clinician, can be used for the diagnosis and follow-up of IGM with acceptable safety margins. However, in the presence of any suspicious findings during imaging or clinical examination, histopathological analysis should be performed.

Multi-variated analysis of differential diagnosis in ultrasonography of idiopathic granulomatous mastitis and invasive ductal carcinoma

Objective: To evaluate the differential diagnosis of idiopathic granulomatous mastitis (IGM) and invasive ductal carcinoma. Methods: The ultrasonographic data of 37 IGM patients and 50 cases of IDC were analyzed retrospectively. The shape, growth direction, margin, internal echo, posterior echo, calcification, Adler blood flow classification, PSV(peak sestolic velocity), RI (resistance index)and elasticity scores were analyzed by χ(2) test and independent sample t test. The optimal cutoff values of age, PSV and RI were calculated by receiver operating characteristic (ROC) curve. Logistic regression analysis was used to calculate the odds ratio (OR) of ultrasonic variates in the diagnosis of both diseases. Results: There were no significant differences in the shape, margin, internal echo and blood flow grading between the two groups. The age, lesion growth direction, posterior echo, calcification, PSV, RI and elasticity were statistically different. The cut-of value of Age, PSV and RI were 38.5 years old, 13.20 cm/s, and 0.655. Logistic regression multi-variated analysis revealed that elastic score (OR=9.806) had the best value of the differential diagnosis, as well as calcification (OR=6.937), posterior echo decay (OR=4.613), RI (OR=3.257), lesion growth orientation (OR=3.198), and PSV (OR=1.202). Lesion shape, margin, internal echo, and Adler blood flow classification did not help in differential diagnosis. Conclusion: Ultrasound multi-parameter analysis has high value in IGM and IDC differential diagnosis.

Differential diagnosis of idiopathic granulomatous mastitis and breast cancer using acoustic radiation force impulse imaging.

Differentiation of idiopathic granulomatous mastitis (IGM) from carcinoma with routine imaging methods, such as ultrasonography (US) and mammography, is difficult. Therefore, we evaluated the value of a newly developed noninvasive technique called acoustic radiation force impulse imaging in differentiating IGM versus malignant lesions in the breast. Four hundred and eighty-six patients, who were referred to us with a presumptive diagnosis of a mass, underwent Virtual Touch tissue imaging (VTI; Siemens) and Virtual Touch tissue quantification (VTQ; Siemens) after conventional gray-scale US. US-guided percutaneous needle biopsy was then performed on 276 lesions with clinically and radiologically suspicious features. Malignant lesions (n=122) and IGM (n=48) were included in the final study group. There was a statistically significant difference in shear wave velocity marginal and internal values between the IGM and malignant lesions. The median marginal velocity for IGM and malignant lesions was 3.19m/s (minimum-maximum 2.49-5.82) and 5.05m/s (minimum-maximum 2.09-8.46), respectively (p<0.001). The median internal velocity for IGM and malignant lesions was 2.76m/s (minimum-maximum 1.14-4.12) and 4.79m/s (minimum-maximum 2.12-8.02), respectively (p<0.001). The combination of VTI and VTQ as a complement to conventional US provides viscoelastic properties of tissues, and thus has the potential to increase the specificity of US.

The Role of Interleukin-33 as an Inflammatory Marker in Differential Diagnosis of Idiopathic Granulomatous Mastitis and Breast Cancer

ABSTRACTIntroduction: Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory breast disease that can clinically and radiographically mimic breast carcinoma and bacterial mastitis. The aim of this study is to investigate the importance of levels of the inflammation markers, interleukin-33 (IL-33), soluble ST2 receptor of IL-33 (sST2), procalcitonin (PCT), and CRP on differential diagnosis of IGM and breast cancer (BC). Methods: 25 patients with IGM and 32 patients with primary BC who applied to General Surgery Clinic, and 30 healthy volunteer women with similar demographic condition were enrolled in the study. While the IL-33, sST2, and PCT levels were measured with ELISA method, other biochemical parameters were studied with autoanalyzer. Results: IL-33, sST2 levels were significantly higher in both BC and IGM groups than in control (p < 0.001). More importantly, the IL-33 levels of IGM group were found to be significantly higher when compared to the group with BC (p < 0.001). Accordingly the sST2 levels of the patients with IGM were significantly lower than the patients with BC (p < 0.001). There was no statistical significance between PCT levels BC and IGM groups (p > 0.05). Conclusion: The results of our study suggest that measurement of IL-33 and its receptor sST2 levels, alongside radiological studies can help distinguishing IGM from BC. Findings of our study need to be supported with additional studies.

Granulomatous mastitis: A retrospective review of 49 patients

Amac: Idiopatik granulomatoz mastit, nadir gorulen, benign, kronik inflamatuar bir hastalik olup meme kanserini taklit eder. Bu calismada idiopatik mastitli 49 hastanin tedavisini ve klinigini sunmayi amacladik. Yontemler: Hastane otomasyon sisteminde 2007-2012 yillari arasinda histolojik olarak granulomatoz tanisi konulmus hastalar incelendi. Hastalara ait klinik bulgular, demografik veriler ve tedavi yontemleri kaydedildi. Bulgular: Ortalama yas 37.71±7.1 idi. Tedavi gruplar arasinda etiyolojik ve demografik acidan istatistiksel fark yoktu. Nuks oranlari grup 1, grup 2 ve grup 3’te sirasiyla %8,3, %14,8 %20 olup, gruplar arasinda istatistiksel anlamli farklilik yoktu. Sonuc: Steroid ve cerrahi tedavinin idiopatik granulomatoz mastitli hastalarda uygulanabilecegini, steroid tedavisinin ilk basamak tedavi olmasi gerektigi kanaatindeyiz. Bununla birlikte tedavi algoritmasi belirlenebilmesi icin prospektif, randomize klinik calismalara ihtiyac vardir

Treatment for and clinical characteristics of granulomatous mastitis.

To describe the clinical and paraclinical characteristics of idiopathic granulomatous mastitis, the management of our patients, and review the literature on this topic. Patients referred to our clinic with a presumptive diagnosis of infectious mastitis were only included in the study if they had histopathologic confirmation of granulomatous mastitis. A systemic or infectious etiology was excluded by the testing of tissues and fluids by staining, culture, and polymerase chain reaction methods. Those patients with no reported etiology were categorized as idiopathic granulomatous mastitis and treated with antiinflammatory drugs. All were monitored for signs of recurrence. All 22 patients with a final diagnosis of idiopathic granulomatous mastitis were women with a mean age (± standard deviation) of 32.8 ± 6.2 years. Initial treatment with a prednisone regimen was given in 15 (68.2%) patients, prednisone plus methotrexate (MTX) in six (27.3%), and MTX alone in one (4.5%). Among the total of 22 patients with idiopathic granulomatous mastitis, 12 (54.5%) received MTX either as an initial treatment or as an alternative regimen. Of the 22 patients, three (13.6%) had disease recurrence and four (18.2%) experienced adverse drug reactions. Sixteen (72.7%) patients discontinued the initial treatment regimen with acceptable control of disease activity and without recurrence or adverse drug reactions during the follow-up period. Idiopathic granulomatous mastitis is a distinct benign breast condition of unknown etiology but several triggers are suspected, including inflammatory, infectious, and hormonal factors. Corticosteroids and MTX, with or without surgery, are the treatment of choice in these patients.