Idiopathic Granulomatous Mastitis Research Articles

Abstract PO1-22-08: Ductal Lavage versus Oral Corticosteroids in Patients with Idiopathic Granulomatous Mastitis: A Multicenter, Open-label, Randomized, Controlled, Non-inferiority Study

Abstract Background: Idiopathic granulomatous mastitis (IGM) is an inflammatory breast disease characterized by the presence of mass, erythema and fistula. Various treatments have been proposed, including steroids, surgery, immunosuppressants, and observation alone. However, most of the reported studies are single-center, retrospective, single-arm with limited sample sizes, leaving the optimal treatment strategy unknown. In a previous single-arm study, we reported the efficacy and safety of ductal lavage as a novel treatment. This presentation presents the results of a multicenter, open-label, randomized controlled, non-inferiority trial that compares the efficacy and safety of ductal lavage with oral corticosteroids as the first-line treatment for IGM patients. Methods: Eligible IGM patients were randomized 1:1 to receive either ductal lavage or oral corticosteroids, stratified by M-score status. The M-score quantitatively evaluates IGM symptom severity as reported in our previous studies. Ductal lavage involved the intraductal infusion of lidocaine, triamcinolone acetonide, and ceftriaxone with saline, a total 5 times within 2 weeks. Oral corticosteroids were administered using prednisone or methylprednisolone at an initial dose of 20-40mg per day, decreased by 5mg every 2 weeks, and then maintained at 20mg per day for at least 1 month. The primary outcome was the rate of complete Clinical Response (cCR), which was defined as achieving M-score≤1 during any follow-up visit. Secondary outcomes included median time to first cCR, treatment failure, relapse, adverse events, and protocol compliance rate. If the lower limit of 95%CI of the absolute difference between ductal lavage and oral corticosteroids was greater than -15%, the non-inferiority was met. This trial was approved by the ethical committee of Sun Yat-sen Memorial Hospital and registered with ClinicalTrials.gov (NCT03724903). Results: Recruitment for this trial began in March 2019 and follow-up ended in May 2023 at 3 hospitals in China. In the intention-to-treat set (N=140), 69 patients were randomly assigned to the ductal lavage group and 71 patients to the oral corticosteroids group. The cCR rates after treatment were 85.51% (95% CI 77.20 ~ 93.81%) and 87.32% (95% CI 79.59 ~ 95.06%) in the ductal lavage and oral corticosteroids groups, respectively. The rate difference was -1.82% (95% CI -13.17 ~ 9.54%), not exceeding the non-inferiority margin (Non-inferiority P=0.011). In the per-protocol set (N=111), the cCR rate difference was -5.32%(ductal lavage: 92.86% vs. oral corticosteroids: 98.18%),with a 95%CI of -12.94% to 2.29%,also not exceeding the non-inferiority margin(Non-inferiority P=0.006).No significant differences were observed between groups in median time to first cCR (34.0 vs. 32.5 days, P= 0.878), treatment failure rate (14.49% vs. 11.27%, P=0.569), or relapse rate (10.14% vs. 4.23%, P=0.302).In the safety analysis set (N=129), the most frequently reported adverse events ( >15%) in the ductal lavage group were irregular menstruation (46.27%), while in the oral corticosteroids group, they were Cushingoid (79.03%), epigastric pain (17.74%), and arthralgia (16.13%). Conclusions: Ductal lavage demonstrates non-inferiority to oral corticosteroids in terms of efficacy as a first-line treatment for IGM patients. Furthermore, ductal lavage exhibits a significantly favorable adverse events profile. Primary endpoint in ITT and PP set *P value for non-inferiority comparison. Secondary endpoint in PP set §P value calculated by chi-square test. Adverse event in safety set No adverse event exceeding Grade3 have been recorded. Citation Format: Kai Chen, Xiaolin Chen, Shunrong Li, Liling Zhu, Jian Zhang, Tingting Hu, Hui Huang, Heng Huang, Lili Chen, Qiaozhen Xiao, Linhong Su. Ductal Lavage versus Oral Corticosteroids in Patients with Idiopathic Granulomatous Mastitis: A Multicenter, Open-label, Randomized, Controlled, Non-inferiority Study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-22-08.

Would hyperbaric oxygen therapy be a supportive treatment method for refractory idiopathic granulomatous mastitis?

BackgroundRefractory IGM causes patients to use antibiotics, steroid therapy, immunosuppressive agents for a very long time and even leads to surgical procedures resulting in the loss of breast tissue. Hyperbaric Oxygen Therapy (HBOT) is a frequently used method in the treatment of wounds that are difficult to heal. We thought that HBOT would be an alternative treatment method for refractory IGM patients. MethodsIt is a retrospective cohort study on refractory IGM patients conducted at three tertiary care treatment centers between January 2021 and July 2023. The patients were evaluated in two groups: those who only took steroid treatment and those who received HBOT and steroid treatment. The demographic and clinical characteristics of the patients, the types of treatment applied and their responses to treatment were evaluated. ResultsThere were no significant differences generally in the demographic and clinical features in both groups. The incidence of multicentric GM was found to be higher in the HBOT group (66.67%; p = 0.044). Although the recovery results were similar in both groups, the average daily steroid dose and duration of drug use were found to be higher in the group receiving only steroid treatment (16 mg vs. 4 mg and 270 days vs. 30 days) (p<0.001). ConclusionIn our study, we showed for the first time in the literature that HBOT is effective in the treatment of refractory IGM patients. Our study needs to be supported by prospective studies evaluating cost effectiveness and possible long term complications..

OA15 A case series of idiopathic granulomatous mastitis patients and their immunosuppressive management

Abstract Background/Aims Rheumatologists are experts in managing immunosuppression and are asked to supervise immunosuppression for non-rheumatic conditions. Thus, it is important to be aware of these conditions and the regimes required. Idiopathic granulomatosis mastitis (IGM) is a rare inflammatory breast condition which can have systemic manifestations including arthritis. Methods Our index case presented with peripheral ankle synovitis/tenosynovitis, struggling to weight bear, whilst being investigated for a breast mass. Breast US, mammogram and biopsy (acute and chronic inflammatory cells including multi-nucleated giant cells) were completed and there was little response to 3 courses of antibiotics. No mycobacteria were seen on microscopy, ZN stain negative, CXR normal, T spot negative and serum ACE normal. There was no rash and no conditions associated with a seronegative spondyloarthropathy. RF, anti-CCP and ANA were negative. A moderate course of prednisolone immediately resolved the peripheral arthritis, but high-dose steroids were required to reduce the breast mass. The mass recurred upon weaning prednisolone requiring the addition of azathioprine as a steroid-sparing agent. Results Our case series includes the immunosuppressive management of 3 other IGM patients: 1) 43-year-old referred after an 8 year history of alternating breast ‘abscesses’ and sinuses treated with courses of antibiotics to little avail. High dose prednisolone and methotrexate resolved the breast mass within a month. 2) 37-year-old referred with a 14 year history of breast masses and fistulae previously treated with surgery and antibiotics. Currently asymptomatic so commenced on methotrexate. 3) 39-year-old referred with a 3 year history of recurrent sterile breast abscesses previously managed with antibiotics, incision and drainage. Recent small masses had settled with NSAIDs. Conclusion IGM is a rare benign inflammatory breast disease of unknown aetiology, commonest in Middle Eastern populations, median age 30s. The most common presentation is a unilateral painful mass, which can ulcerate, fistulate and form abscesses. Management of IGM varies from expectant/topical steroids/NSAIDs to high dose steroids and DMARDs. A literature review shows that the usual starting dose of prednisolone is 40-60mg; the addition of methotrexate and azathioprine increases likelihood of successful treatment and allows for faster steroid tapering. Surgery for specific types of IGM can also be useful; for example, where there is duct granuloma, surgical excision can be curative. IGM can associate with arthritis, erythema nodosum, and episcleritis. One case series found that 14% of patients with IGM had concomitant arthritis. Key points: In our local experience we have had four patients with IGM, all previously treated with antibiotics or surgical methods but subsequently diagnosed with IGM and referred for immunosuppressive therapy. Being a rare condition, we feel it’s important for clinicians to be aware of IGM and its link with inflammatory arthritis. Disclosure S. Islam: None. P. Stonelake: None. H. John: None.

Ultrasound-guided microwave ablation for the treatment of idiopathic granulomatous mastitis: comparison with surgical excision

BackgroundIdiopathic granulomatous mastitis (IGM) results in notable clinical symptoms and breast deformity. This study aimed to evaluate the clinical feasibility of microwave ablation (MWA) for the treatment of IGM through comparison with surgical excision.MethodsFrom June 2016 to December 2020, a total of 234 consecutive patients admitted to the hospital were retrospectively included in this study. IGM was pathologically confirmed via breast biopsy in all included patients. These patients were divided into the MWA group (n = 91) and surgical group (n = 143) based on the type of treatment. Patients in both groups received oral prednisone prior to intervention. The clinical remission rate, recurrence rate, operative pain, complications, and BREAST Q score were compared between the two groups.ResultsThere were 340 lesions in the MWA group, and 201 lesions in the surgical group were ultimately included. Significant differences in the complete remission rate (96.7% vs. 86.7%, p = 0.020), recurrence rate (3.3% vs. 13.3%, p = 0.020), operation time (48.7±14.6 min vs. 68.1±36.4 min, p < 0.001), postoperative pain (p < 0.001) and postoperative BREAST Q score (p < 0.001) were observed between the MWA and surgical groups.ConclusionsMicrowave ablation is feasible for the treatment of IGM, due to its high curative rate and low recurrence rate. Because of the minimal invasiveness of MWA and sufficient preservation of the gland and contour of the breast, patients are more satisfied with the appearance of the breast. Therefore, for patients with complex conditions requiring surgery, MWA is a good alternative treatment.

Surgery speeds recovery in Idiopathic Granulomatous Mastitis

Surgery speeds recovery in Idiopathic Granulomatous Mastitis

Correlación clínico-patológica para el diagnóstico de mastitis crónica tratada con cirugía

ObjectivesChronic mastitis (CM) frequently relapse without an identified etiology, although they have been treated with a spectrum of treatments that includes different antibiotics, anti-inflammatories and surgery, more or less aggressive depending on their extension. The objective is to investigate if clinicopathological correlation is useful in the diagnosis of CM. Material and methodsA descriptive, observational and retrospective study of a series of 100 patients (n = 100) diagnosed during ten years with CM is presented. Anamnesis, clinical debut, physical examination, imaging techniques, type of surgery, number of recurrences, histological inflammatory pattern data, complementary tests including microbiological study and serology, number of biopsies, number of consultation visits and time until final diagnosis are evaluated. Finally, the average of cases diagnosed by clinicopathological correlation is determined. ResultsResults of surgical interventions, clinical and histopathological findings, microbiology and serology are included in tables. Clinicopathological correlation achieved etiopathogenic diagnosis in 99% of the cases including chronic suppurative galactophoritis (91%); vasculitis (3%), two of them compatible with granulomatosis with polyangiitis; idiopathic granulomatous mastitis (2%) and non-diabetic lymphocytic lobulillitis (3%). Thirty-eight percent of the cases presented recurrences. The mean time to definitive diagnosis was 20.02 (standard deviation = 49.87) weeks. The average number of visits to outpatient clinics was 15.35 (standard deviation = 14.97). ConclusionsClinicopathological correlation improves the diagnosis of CM, specially relapsed and without an identified etiology, although it may take a long time.

Efficacy of Oral Prednisolone in the Management of Idiopathic Granulomatous Mastitis

Background: Idiopathic granulomatous mastitis (IGM) is a benign inflammatory lesion of the mammary gland. Globally it possesses a major diagnostic and therapeutic problem. To date, there is no universally agreed treatment for this condition. Many treatment modalities have been attempted from conservative therapy to mastectomy but none of them has shown satisfactory results. Recent studies have shown promising results of corticosteroids on idiopathic granulomatous mastitis, so steroid therapy can be an effective treatment for idiopathic granulomatous mastitis. The goal of the study is to provide a therapeutic strategy in the future for idiopathic granulomatous mastitis. Methods: Our study included all patients with idiopathic granulomatous mastitis confirmed histologically by core needle/incisional biopsy at the general surgery unit of Chittagong Medical College Hospital and the private hospitals in the Chittagong Metropolitan City for a period of one year from October 2016 to September 2017. A total of seventy patients were included in the study provided they fulfilled predetermined criteria. All of them were included in this study by purposive sampling.  After diagnosis oral prednisolone (1mg/kg/day) was given and the cases were observed by personal interview and through telephone interview. The patients were on follow-up for 06 months. Age, size of the breast lump, breast pain, nipple discharge, and skin changes were recorded in all cases. Results were analyzed using mean, percentage, and proportion as appropriate. Results: The mean age was 26.35±13.5 years ranging from 19 to 40 years. Out of 70 patients, Core cut biopsy was done in 55 patients (78.58%), and incisional biopsy with abscess drainage was performed in 15 patients (21.42%). 59 patients (84.28%) had complete recovery after a single cycle of steroid treatment, remaining 11 patients (15.72%) had recurrence, among them 6 patients were cured after 2nd cycle of steroids but unfortunately, 5 patients did not respond. Though complications were found in 50 patients, all of them made good progress in the short term. Conclusion: We recommend steroid therapy as the first-line treatment in our study. However, prospective, randomized clinical trials are needed to determine the treatment algorithm. Mediscope 2024;11(1): 22-26

Is poor oral health a risk factor for idiopathic granulomatous mastitis?

Idiopathic granulomatous mastitis (IGM) is a rare inflammatory breast disease that can be clinically and radiologically mistaken for carcinoma. Although its etiology remains uncertain, potential associations with pregnancy, lactation, hormonal imbalances, autoimmunity, smoking, and various microorganisms have been suggested. This study aimed to evaluate the relationship between IGM and oral health. We included 42 female patients diagnosed with IGM based on histopathological evaluations conducted between September 2018 and October 2023. The reference group consisted of 47 female patients with clinically, radiologically, and laboratory-proven non-specific mastitis and 36 healthy female individuals. The oral health of all participants was evaluated by an experienced dentist using the "Decayed, Missing and Filled Teeth" (DMFT) index and the "Simplified Oral Hygiene Index" (OHI-S). The ages of IGM patients included in this study ranged from 29 to 51 years, with a mean age of 34.88 ± 4.87 years. The most common clinical findings were pain (n = 38), palpable breast mass, erythema, induration, and dermal sinus. Comparison of the OHI-S and DMFT index values among participants revealed that those diagnosed with IGM had significantly higher values than those in the reference group (P < 0.05). Our findings suggest a potential involvement of poor oral health in the etiology of IGM. Future studies should consider oral health as a factor in IGM etiology and explore the oral microbiota in samples obtained from the affected tissue.

Ultrasound-guided vacuum-assisted excision for idiopathic granulomatous mastitis at the abscess stage.

Idiopathic granulomatous mastitis (IGM) is a rare inflammatory disease of the breast with clinical features that are often confused withthose of breast cancer leading to delayed diagnosis and treatment.This retrospective study aimed to evaluate the therapeutic effectiveness and cosmetic results of drainage surgery using ultrasound-guided vacuum-assisted excision (VAE) for the treatment of IGM at the abscess stage. The time of recovery, cases of further surgical intervention, and cosmetic results were retrospectively collected and analyzed from patients who underwent drainage with VAE or conventional drainage between October 2017 and August 2021. A total of 65 patients diagnosed with IGM at the abscess stage who underwent drainage surgery with VAE or conventional drainage surgery were enrolled. Overall, 38 (58.5%) underwent conventional drainage surgery and 27 (41.5%) underwent drainage with VAE. We found that patients who underwent VAE recovered much faster than those who underwent traditional drainage surgery (30.1 vs. 48.0days). Nine (33.3%) patients in the VAE group required further surgical intervention after drainage, whereas 33 (86.8%) patients in the control group underwent another surgery to resect residual lesions. Additionally, patients in the VAE group were more satisfied with the breast appearance, mainly due to less influence of the scars and better symmetry of their breasts. Compared with conventional drainage surgery, drainage surgery using VAE for IGM patients at the abscess stage improved therapeutic and cosmetic outcomes. Furthermore, postoperative management of IGM is crucial.

Immune pathogenesis of idiopathic granulomatous mastitis: from etiology toward therapeutic approaches.

Idiopathic granulomatous mastitis (IGM) is a noncancerous, chronic inflammatory disorder of breast with unknown causes, posing significant challenges to the quality of life due to its high refractoriness and local aggressiveness. The typical symptoms of this disease involve skin redness, a firm and tender breast mass and mastalgia; others may include swelling, fistula, abscess (often without fever), nipple retraction, and peau d'orange appearance. IGM often mimics breast abscesses or malignancies, particularly inflammatory breast cancer, and is characterized by absent standardized treatment options, inconsistent patient response and unknown mechanism. Definite diagnosis of this disease relies on core needle biopsy and histopathological examination. The prevailing etiological theory suggests that IGM is an autoimmune disease, as some patients respond well to steroid treatment. Additionally, the presence of concurrent erythema nodosum or other autoimmune conditions supports the autoimmune nature of the disease. Based on current knowledge, this review aims to elucidate the autoimmune-favored features of IGM and explore its potential etiologies. Furthermore, we discuss the immune-mediated pathogenesis of IGM using existing research and propose immunotherapeutic strategies for managing this condition.

Refractory and Recurrent Idiopathic Granulomatous Mastitis Treatment: Adaptive, Randomized Clinical Trial.

Idiopathic Granulomatous Mastitis (IGM) is mostly described as an autoimmune disease with high prevalence among Middle Eastern childbearing-age women. The current study aimed to evaluate the best treatment of choice in patients with resistant or recurrent IGM. Patients with established recurrent or resistant IGM who were referred to the breast cancer research center from 2017 to 2020 were randomly assigned to either one of the following treatment groups: A (Best supportive care), B (corticosteroids: prednisolone), and C (methotrexate and low dose corticosteroids). This adaptive clinical trial evaluated radiological and clinical responses, as well as the possible side effects, on a regular basis in each group, with patients followed up for a minimum of 2 years. A total of 318 participants, with a mean age of 33.52 ± 6.77 years, were divided into groups A (10 patients), B (78 patients), and C (230 patients). In group A, no therapeutic response was observed; group B exhibited a mixed response, with 14.1% experiencing complete or partial responses, 7.7% maintaining stability, and 78.2% experiencing disease progression. Accordingly, groups A and B were terminated due to inadequate response. In group C, 94.3% achieved complete response, 3% partial remission, and 2.7% no response. Among the entire patient cohort, 11.6% tested positive for anti-nuclear antibodies (ANA), 3.5% for angiotensin-converting enzyme (ACE), and 12.3% for erythema nodosum (EN). Notably, hypothyroidism was a prevalent condition among the patients, affecting 7.2% of the cohort. Furthermore, the incidence of common side effects was consistent across all groups. The most effective treatment option for patients with recurrent or resistant idiopathic granulomatous mastitis is a combination therapy involving steroids and disease-modifying antirheumatic drugs such as methotrexate.

Rheumatologic manifestations of female patients with idiopathic granulomatous mastitis

BackgroundIdiopathic granulomatous mastitis (IGM) is an infrequent inflammatory breast disease that typically presents with unilateral and sometimes bilateral breast masses, leading to pain, erythema, and nipple discharge. IGM may be accompanied by extramammary symptoms, including episcleritis and arthralgia suggesting and underlying autoimmune process. Aim of the workTo evaluate the frequency of characteristics manifestations including rheumatologic in females with IGM referred to Imam Ali Hospital (Karaj, Iran). Patients and methodsThis study was performed on 178 females referred to the breast surgery department of Imam Ali Hospital and diagnosed with IGM based on core needle biopsy and histopathological examination. The various manifestations including rheumatic presented for those patients were recorded. ResultsThe mean age of the patients was 35.17 ± 5.88 years and body mass index was 26.38 ± 2.45. 91 % of the patients were nulliparous and only 3 used oral contraceptive pills. The breast-feeding duration of parous patients was 28.91 ± 14.97 months. Associated minor thalassemia was present in 2.25 %, bronchial asthma, diabetes, psoriasis and hypothyroidism were present in 2 patients each. 7 (3.92 %) of cases had history of previous breast surgery. Twenty-five (14 %) patients with IGM had associated manifestations including arthralgia (10.11 %), arthritis (2.25 %) and erythema nodosum (2.81 %). Only one patient had peripheral and another optic neuritis. 158 (88.76 %) patients had no notable past medical history. IGM was bilateral in 21 (11.8 %) patients. ConclusionsThe coexistence of erythema nodosum and arthritis with IGM is not uncommon. They are mostly unilaterally present in nulliparous Iranian females. Optic and peripheral neuropathies are rarely associated.

Idiopathic Granulomatous Mastitis.

Idiopathic granulomatous mastitis (IGM) is a rare, benign inflammatory disorder of the breast that is often underrecognized. The exact etiology and pathophysiology are unknown, but milk stasis is felt to play a role. Classically, this condition is noninfectious, but many cases are noted to be associated with Corynebacterium species. Most patients affected are parous women with a mean age of 35, and many have breastfed within five years of diagnosis. Patients typically present with a painful mass and symptoms of inflammation, and these features can sometimes mimic breast cancer. Biopsy is needed to make a definitive diagnosis, and noncaseating granulomas are found on core biopsy. Many patients have a waxing and waning course over a period of six months to two years. Goal of treatment is to avoid surgery given poor wound healing, high risk of recurrence, and poor cosmetic outcomes. Medical treatment is preferred and includes observation, antibiotics, steroids, and immune modulators such as methotrexate. In more recent years, topical and intralesional steroids have become the treatment of choice, with similar outcomes to oral steroids.

A single center experience with a rare clinical entity of idiopathic granulomatous mastitis: Case series and review of the literature

Introduction and importanceIdiopathic granulomatous mastitis (IGM), also called autoimmune mastitis or granulomatous lobular mastitis is a benign, rare disease of the breast lobules. It is characterized by chronic non-caseating granulomatous sterile inflammation of the breast lobules. It is a disease of middle-aged women. Case series presentationHerein we report six cases of IGM the General Surgery Department at Palestinian Medical Complex (PMC) with a good response to treatment and significant improvement. The patients were followed-up for an average of 4-month period. DiscussionPathophysiology is uncertain. It has a wide differential diagnosis and malignancy should be ruled out. Its diagnosis is highly challenging and is only made by biopsy. Treatment options include medical and surgical therapy. Patients are usually started with a low dose prednisolone, other options include immunosuppressive agents, antibiotics, NSAIDs, colchicine and minimally invasive surgery. IGM has a high recurrence rate up to 40 % and long term follow up is advised. ConclusionIGM is a rare breast pathology that evolves in an unpredictable manner over time. Clinical and radiological aspects vary and pose a diagnostic challenge, particularly in breast cancer. The pathological examination is still the most important component of certain diagnoses. The clinically correlated treatment is still debatable.

A Case Series of Idiopathic Granulomatous Mastitis: Surgical Intervention is not the Only Option

Idiopathic Granulomatous Mastitis (IGM) is a benign inflammatory disease of the breast that is difficult to treat, as there is no definitive protocol for management and it has a higher recurrence rate. The present case series presents five patients who exhibited clinical symptoms such as breast swelling, pain and nipple discharge, and were diagnosed with IGM. They were treated with a multimodality approach (surgical and/or conservative management) based on their symptoms. All patients were successfully treated for IGM using the multimodality approach. While a recurrence was observed in one out of five patients, it was further successfully treated with additional conservative management. The proposed multimodality treatment is effective in treating IGM. It eliminates the risk associated with surgical intervention among patients clinically diagnosed with IGM. It also eliminates the risk of corticosteroid side-effects among patients whose initial clinical diagnosis and postoperative histopathological examination is negative for IGM.

Treatment of Granulomatous Mastitis With Steroids: Should the Decision to End the Treatment be Made Radiologically?

Idiopathic granulomatous mastitis (IGM) is a benign inflammatory breast disease of unknown etiology that affects women in their reproductive period. The most commonly preferred option as first-line treatment is steroids, but the lack of a standard treatment protocol and high recurrence rate after treatment constitutes a recurring challenge during its management. The aim of this study was to investigate whether the decision to end the treatment should be made radiologically or clinically. This retrospective cohort study included IGM patients who had complete clinical recovery with steroids and were followed for a minimum of 30 months. Patient demographics, disease severity and findings, treatment regimens and duration, and magnetic resonance imaging (MRI) findings at clinical recovery were assessed for their relation to recurrence. Eighty-nine patients who were clinically completely healed after steroid treatment for IGM were included in the study. At the time of clinical healing, 51 (57.3%) patients had a complete radiological response and 38 (42.7%) had a partial radiological response (PRR) on MRI. Overall, recurrence developed in 22 (24.7%) patients after a median 38.6-month follow-up. Patients who experienced recurrence were significantly older and had PRR when their treatment was stopped upon clinical healing. During the process of clinical healing, the imaging findings revealed that the remaining disease seems to be a significant predictor for recurrence in IGM patients. In patients with PRR, extending the treatment with either prolonged steroid therapy or by surgical excision of the occult residual disease may prevent recurrences in IGM patients.

İdiopatik Granülomatöz Mastitin Ameliyatsız ve Steroidsiz Tedavisi: Tek Beden Herkese Olmaz

Aim: Idiopathic granulomatous mastitis (IGM) is a rare inflammatory breast disease mimicking malignancy&#x0D; with no consensus on the optimal treatment. We aimed to present a single-center algorithm for&#x0D; IGM treatment without surgery and steroids.&#x0D; Material and Methods: This study was conducted at Bülent Ecevit University Hospital, Zonguldak,&#x0D; Turkey, between 2010 and 2020. A prospective database was reviewed to identify patients with biopsyproven&#x0D; IGM who were managed through observation and ultrasound-guided interventions over a 10-&#x0D; year period.&#x0D; Results: Seventy-eight female patients with a confirmed diagnosis of IGM via reevaluation were&#x0D; determined. Of these, 34.61% required ultrasound-guided abscess aspiration and 10.25% required&#x0D; incisional abscess drainage without surgical resection. Complete clinical resolution was achieved within&#x0D; 6 months in 58.97% cases. The overall recurrence rate was 12.82%, and surgical drainage was required&#x0D; in one patient. Univariate logistic regression analysis revealed no statistically significant association&#x0D; between recurrence and the demographic or pathologic factors evaluated. Twenty-two (28.2%) patients&#x0D; with a histopathologic diagnosis of cystic İGM who received antibiotics (doxycycline) achieved complete&#x0D; resolution within 2 weeks and experienced no recurrence.&#x0D; Conclusion: IGM is a self-limiting disease that resolves spontaneously independent of medical&#x0D; intervention and without resection in up to 18 months. After diagnosis, surgery with or without steroids as&#x0D; the first line of therapy should be replaced with close observation and ultrasound-guided interventions&#x0D; according to patients’ preferences.

The Role of Corynebacterium in The Etiology of Granulomatous Mastitis

Introduction: Granulomatous mastitis (GM) is a rare, benign, chronic inflammatory illness of the breast. It is characterized by necrotizing granulomatous lobulitis of the breast that clinically mimics breast cancer. The aim of this study was to examine the existence of Corynebacterium strains thought to be covered in the etiology of idiopathic granulomatous mastitis. Material and Methods: In this study, we retrospectively analyzed the results of 201 breast tru-cut biopsies carry out for diagnostic purposes in the Department of General Surgery. The tissue samples of 41 patients with histopathologically diagnosed GM were examined by Gram staining. The existence of Corynebacterium kinds was investigated microscopically by adding appropriate medium. Results: The mean age of 41 female patients with GM was 35. 7 years and the age range was 20-58 years. At the end of the study, Corynebacterium amycolatum was defined as the causative microorganism as a consequence of microbiologic examination of the tissue sample of one patient (2.4%). Conclusion: We consider that Corynebacterium is not the etiologic agent of GM. Additionally studies with large case series are needed to explain the etiology.

Varied etiology in patients presenting with non-puerperal mastitis: an observational study

Abstract Introduction: The etiology of nonpuerperal mastitis is more diverse varying from infections to autoimmune disorders. Most of them are misdiagnosed as pyogenic mastitis and are treated with routine antibiotics. In this study the various causes of nonpuerperal mastitis which required surgical intervention were evaluated. It was observed that some of the pre-malignant and malignant conditions were also presented as nonpuerperal mastitis. Materials and methods: All non-lactating women who presented with symptoms and signs of mastitis and did not respond to single course of antibiotics (active against staphylococcus) treated in tertiary care Hospital and in private practice of primary author between June 2021 to December 2022 and in those in whom the ultrasound of breast was also suggestive of inflammatory breast disease were included in the study and rest were excluded from study. The final etiological diagnosis of these patients is given by the histopathological examination of tissue taken from the wall of abscess cavity or of breast mass. Results: Total 21 patients were included in the study of which 7 patients had nonspecific infection, 3 patients were diagnosed to have tuberculous mastitis, 3 patients with idiopathic granulomatous mastitis, 2 patients with periductal mastitis, 1 patient with fat necrosis, 3 patients with atypical ductal hyperplasia and 2 patients were diagnosed to have invasive duct cell carcinoma. Conclusion: The etiology of nonpuerperal mastitis is diverse. Not only the benign conditions but premalignant conditions like ADH, DCIS and even invasive carcinoma can present with clinical symptoms and signs of inflammatory breast disease.

Imiquimod as a new treatment in refractory idiopathic granulomatous mastitis: report of two cases.

Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory lesion of the breast that mimics breast cancer or infection. Immunological pathogenesis is strongly suggested for the disease. The treatment remains controversial, comprising a spectrum from observation or NSAIDs to immunosuppressive agents and surgery. Intractable cases are not uncommon and represent a major treatment challenge. Therefore in this study, we examine the effect of a topical immunomodulator agent, imiquimod, on refractory IGM. Patient 1 had IGM for 9months and had not responded to the existing treatments. She responded to a 7-week course of imiquimod. In patient 2, the disease had begun 4months sooner and had been resistant to all treatments; it responded to imiquimod after 4weeks. Ulcers appeared on the skin of both patients but resolved safely. Both patients were very satisfied with the results. Imiquimod can be an appropriate local treatment with limited adverse effects in refractory IGM. We propose similar studies to assess the efficacy of imiquimod in IGM further, paying attention to the possibility of developing skin wounds.