Management Of Idiopathic Granulomatous Mastitis Research Articles

>Efficacy of disease-modifying antirheumatic drugs in the treatment of granulomatous mastitis: a systematic review.

Idiopathic granulomatous mastitis (IGM) is an inflammatory breast disorder of unknown etiology. This benign condition can mimic the clinical presentation of breast cancer and is characterized by symptoms such as breast pain, erythema, and swelling. Over the past few years, Disease-Modifying Antirheumatic Drugs (DMARDs) have been increasingly used to manage this condition. However, strong evidence to support their use is lacking. This systematic review aimed to summarize the evidence and evaluate the efficacy of DMARDs in the management of IGM. A systematic literature review, adhering to PRISMA guidelines, was conducted across electronic databases, including PubMed, EMBASE, SCOPUS, directory of open access journals (DOAJ) and Cochrane Library from their inception until May 2024. We included retrospective and prospective studies while excluding case reports and case series of less than 10 patients. Eighteen studies met our eligibility criteria. Fifteen studies were retrospective, while 2 were prospective. No randomized controlled trials were identified. Of these, 16 papers examined the effect of methotrexate on IGM, revealing significant disease improvement in most cases. Several of the studies indicated that patients treated with azathioprine and mycophenolate mofetil also achieved favorable responses. Given the rarity of IGM, only a limited number of studies have explored the use of DMARDs as a pharmacological treatment option. A significant barrier to advancing our understanding is the substantial heterogeneity in the quality and volume of data provided by these studies. Therefore, there is a need for well-designed, randomized, placebo-controlled trials to rigorously assess the efficacy of DMARDs in the treatment of IGM.

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

Efficacy of preoperative Shugan Sanjie decoction combined with mammotome-assisted minimally invasive surgery in the treatment of idiopathic granulomatous mastitis: A retrospective cohort study.

The management of idiopathic granulomatous mastitis (IGM) poses a significant challenge because of its ambiguous etiology. This study aimed to investigate the efficacy of traditional Chinese medicine (TCM) combined with mammotome-assisted minimally invasive surgery (MAMIS) for the treatment of IGM. This retrospective cohort study included patients with IGM who underwent treatment at our hospital between January 2017 and June 2022. Patients treated with Shugan Sanjie decoction alone and preoperative Shugan Sanjie decoction combined with MAMIS were included in Groups A and B, respectively. We focused on the demographics, clinical characteristics, and outcomes of the patients in the 2 groups. A total of 124 female patients with an average age of 33.9 ± 3.6 years were included in the study. The demographic and clinical characteristics of patients in Groups A (n = 55) and B (n = 69) were similar (P > .05). However, there were significant differences between the 2 groups in terms of treatment duration, 1-year complete remission (CR), and recurrence. Group B showed shorter treatment time (11.7 ± 5.1 vs 15.3 ± 6.4 months, P = .001), higher 1-year CR (72.5% vs 45.5%, P = .002), and lower recurrence (7.2% vs 21.8%, P = .019) in comparison to Group A. Shugan Sanjie decoction promoted the shrinkage of breast lesions in patients with IGM. Combined with MAMIS, this treatment regimen shortened the treatment duration, accelerated the recovery process, and reduced the recurrence rate.

Surgical management of idiopathic granulomatous mastitis; A single-center experience

Surgical management of idiopathic granulomatous mastitis; A single-center experience

Management of Idiopathic Granulomatous Mastitis: A Single Institution Experience.

There are multiple management modalities for idiopathic granulomatous mastitis, but the treatment of choice is still under debate. This study aims to evaluate the diagnosis and outcomes of different management modalities in patients with idiopathic granulomatous mastitis and to identify the risk factors associated with recurrence. This is a single-group cohort study that included those patients who had idiopathic granulomatous mastitis. Ultrasonography was conducted for all of the cases using LOGIQ E9 with an ML6-15 transducer (5-15 MHz). A core needle biopsy was conducted to take samples from the cases for histopathological examination. The patients were put on steroid therapy. Whenever the cases did not respond to the steroid therapy, treatment with a combination of low-dose steroids and methotrexate was started. In the lack of response to conservative treatments, surgical interventions were started. Sixty-three cases with a confirmed histopathological diagnosis of granulomatous mastitis were included. The mean age of patients was 35.7 years. The history of more than one childbirth was positive in a large portion of the cases (82.5%). The lesion side was unilateral in 58.7% of the cases. A large proportion of the lesions were classified as BIRADS category 2. The best treatment outcome was yielded by a combination of low-dose steroids and incision and drainage. The factors of age, lesion area (cm2), skin thickening, and white blood cell count enhanced the chance of recurrence. Incision and drainage in combination with a low dose of steroids can give an acceptable outcome with a low rate of recurrence.

A review of Imaging Findings of Idiopathic Granulomatous Mastitis

Background: Imaging has an established role in the diagnosis and management of idiopathic granulomatous mastitis (IGM). The main purpose of this article is to explain an imaging-based diagnostic approach for IGM and describe the imaging findings of the disease. Methods: The present article is a narrative review of the literature regarding the imaging of IGM. Results: Ultrasound and mammography are the two commonly used modalities for evaluating IGM patients. Focal asymmetry and irregular high-density mass are the most common mammographic findings. Irregular hypoechoic mass with tubular extensions is a frequent ultrasound finding. Magnetic resonance imaging (MRI) can be used as a complementary modality, but it does not usually change the disease management.. The most important differential diagnosis of IGM includes breast cancer, infectious mastitis, and tuberculous mastitis. There is currently no agreed-upon schedule for the imaging follow-up of IGM patients. Conclusion: The commonly used imaging modalities for the evaluation of IGM include ultrasound with or without mammography. There is currently no consensus on the imaging follow-up of these patients.

Role of Corticosteroids along with Other Therapies for Treatment of Idiopathic Granulomatous Mastitis: A Narrative Review

Background: The use of oral corticosteroids to treat idiopathic granulomatous mastitis (IGM) has been a point of controversy for a long time. In addition, a wide diversity of combinations with other therapies have been reported so far. This study aims to review the usage of oral corticosteroids and their combinations in the published literature. Methods: PubMed and Scopus were searched using the key word “granulomatous mastitis.” Citations were filtered in two stages, considering the titles/abstracts and full texts. Papers reporting the treatment of IGM with corticosteroids with/without other treatments were included. Results: Fifty-eight citations were included in this study, 31 of which had at least a group of patients treated only with systemic corticosteroids. Combination therapy of systemic steroids with immunosuppressants, surgical interventions, and antibiotics were used in 6, 12, and 13 studies, respectively. Conclusion: Considering the inconsistency of studies in reporting the severity of the disease, administered treatments, outcome of treatment, side effects, and follow-up, our study failed to provide solid evidence for using corticosteroids as the first step in the management of idiopathic granulomatous mastitis. There is still a need for further studies emphasizing the homogenization of such reports. In this regard, preparing a questionnaire to help homogenize future reports on IGM is highly recommended.

Effectiveness of homoeopathy for the treatment and management of idiopathic granulomatous mastitis in women: A case series

Introduction: Idiopathic Granulomatous Mastitis (IGM) is a rare, debilitating, chronic inflammatory disease of the breast, occurring in women of the child-bearing age, which can clinically, and radiologically mimic abscess, tubercular infection or breast cancer. Homoeopathy can treat the disease by addressing its multifactorial origin, given its holistic approach. The paper presents a case series of 11 patients of IGM treated with classical homoeopathy in place of conventional methods. Case Summary: After exclusion of differential diagnosis of inflammatory breast lesions by radiology, and biopsy, the patients were given individualised homoeopathic treatment. Common symptoms were pain, single or multiple lumps, abscesses, sinuses, ulcers and discharge in various patients. Descriptive statistics, clinical observation and patient’s feedback were used for analysis. 11patients were followed up for a median period of 24 months. All 11 patients experienced subsidence of the lumps with no recurrence and general improvement in health, without any conventional medication or surgical intervention. The initial experience of resolution of IGM with homoeopathic treatment is encouraging. For an evidence-based evaluation of the results, larger numbers of case studies are required. The key to positive outcome of the case series was meticulous follow up of each patient and intervention with acute homoeopathic remedies, as indicated.

Idiopathic Granulomatous Mastitis, Is It a Surgical Disease? Case Series and Literature Review

Idiopathic Granulomatous Mastitis (IGM) is an uncommon benign chronic inflammatory breast disease. It can mimic two frequent breast disorders, breast cancer and breast abscess. Although it is associated with certain risk factors, neither clinical presentation nor radiological findings are diagnostic. Histopathological evaluation plays a crucial role in the diagnosis of IGM and its treatment is controversial. We present two patients with IGM treated at King Fahad Specialist Hospital-Dammam, Saudi Arabia, over a period of 4 years. Both patients had different clinical presentations, and treatment courses. However, they both achieved remission of the disease eventually. We recommend that surgical management should be considered last in the treatment options, to avoid wound related chronic complications and poor cosmetic outcomes. The clinical presentation, diagnosis and management of IGM are discussed in this paper.

Out Come of Wide Local Excision with and without Corticosteroid Therapy in Management of Idiopathic Granulomatous Mastitis

Introduction: Idiopathic granulomatous mastitis is a rare benign breast disease. Initial reports from hospitals in Egypt from Departments of Pathology at Cancer Institutes of Cairo, Tanta and Mansoura Universities; indicate that the disease is not as rare as that in the developed countries. It often mimics breast carcinoma both clinically and radiologically. Histological examination is the gold standard for diagnosis. Management of Idiopathic granulomatous mastitis is still debatable. In our study, we aimed to evaluate the addition of corticosteroid therapy to surgical excision in management of idiopathic granulomatous mastitis. Patients and Methods: This is a comparative study was conducted at Ain-Shams University Hospital’s breast clinic on patients with idiopathic granulomatous mastitis from to August 2015 till September 2018. Thirty patients were divided into 2 groups. Group (A) includes patients who underwent surgical management only. Group (B) includes patients who received corticosteroid therapy according to the severity of the cases then surgical Excision was done for the residual lesion. Follow up of all cases up to 1-2 years was done to document the recurrence rate and compare the cosmetic outcome of both groups. Informed consent was obtained from all patients included in the study. Results: The mean age of the affected women was 38.80 and 33.13 in group (A) and group (B), respectively and it wasn’t statistically different (p value = 0.099). The most common presenting symptom was a palpable mass in the breast (66.7% and 93.3%) in group (A) and group (B) respectively. Recurrence rate was higher in group (A) (40%) with no recurrence documented in group (B) however 2 cases were omitted from the study due to steroid noncompliance and complications. Cosmetic outcome was excellent in 76.9% of group (B) and good in 53.3% of group (A). Conclusion: Systemic steroid therapy with surgical resection is the recommended as first-line treatment strategy for IGM as it shows less recurrence rate and surgical scarring. Increased awareness of IGM will increase their understanding and improve their management.

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.

Efficacy of surgical treatment in the management of idiopathic granulomatous mastitis: an institutional experience in Sri Lanka

The journal is the official publication of the College of Surgeons of Sri Lanka. Its mission is to reach the highest standard of scientific surgical practice by dissemination of high quality scientific information and to foster and promote the growth of scientific surgery in Sri Lanka and in the region. The Sri Lanka Journal of Surgery publishes peer-reviewed leading articles, review articles, scientific articles, perspectives and case reports in the field of surgery and broadly related surgical sciences The journal adheres to the publication ethics as portrayed by the Committee on Publication Ethics (COPE) and is a member of this organisation. It is listed as an ICMJE journal which follow its recommendations (ICMJE recommendations) on Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals.

Challenges in management of idiopathic granulomatous mastitis during the pandemic of COVID‐19

Challenges in management of idiopathic granulomatous mastitis during the pandemic of COVID‐19

Management of idiopathic granulomatous mastitis: dilema in diagnosis and management

Background: Idiopathic granulomatous mastitis is a rare disease of the breast. Clinically and radiologically it may mimic breast carcinoma. To date, there is no agreed gold standard treatment for IGM. The clinical management often starts with tests to eliminate microbial infection and when microbial infection can be ruled out, long-term oral steroid treatment or surgery is administered.
 Objective: To see the response of different treatment options of idiopathic granulomatous mastitis.
 Methods: This is a retrospective study involved 50 patients who were diagnosed with IGM and were treated in our institution between January 2009 to December 2016.
 Results: The mean age of patients was 34.3 years. Breast lump was the most common presentation. The right breast was affected in 30 cases & left breast 20 cases. 4 patients were pregnant at the time of presentation. Lactation within 6 months of presentation was documented in 4patients.45 patients used contraceptives pills. A clinical suspicion of malignancy was present in 17 cases. Mammography was performed in 20 patients and showed focal asymmetrical dense lesions in 9, well-circumscribed opacity in 8, speculated lesion in 1, and was normal in 2. Fine-needle aspiration was performed in 40 patients. Wide local excision was the mainstay of treatment. One patient underwent mastectomy due to recurrence and the final histology confirmed idiopathic granulomatous mastitis with no evidence of malignancy. 12 patients developed recurrence after a mean follow-up of 31.2 months.
 Conclusion: IGM is not so rare disease in our country. Clinical, radiologic, and even cytological findings are sometimes confused with malignancy. Adequate Surgical treatment as well as adjuvant therapeutic treatment are necessary. Knowledge, awareness and co-operation among surgeons and pathologist should also be strengthen to avoid unnecessary misdiagnosis and treatment.
 Journal of Surgical Sciences (2017) Vol. 21 (2): 89-93

Clinical Characteristics and Medical Management of Idiopathic Granulomatous Mastitis

This case series reports the clinical presentation and course of treatment for 32 women with biopsy-proven idiopathic granulomatous mastitis.

Anti-Tuberculosis Treatment for Idiopathic Granulomatous Mastitis Mimicking Breast Cancer: A Retrospective Review of 36 Cases

Purpose: This study aimed to share our experience with anti-tuberculosis (TB) therapy for the management of Idiopathic Granulomatous Mastitis (IGM). Methods: A retrospective study was performed on 36 IGM cases treated with anti-TB therapy from Jan 2009 to Dec 2012 in our department. Clinical data, including on presentation, histopathology, and management, were analyzed by reviewing medical records. Results: The diagnosis of IGM was based on histopathological evaluation. All patients had been excluded from tuberculosis mastitis by lab examinations. Fifteen relapsed IGM patients were switched to anti-TB treatment after surgery or when prednisolone failed. Another 21 patients accepted anti-TB drugs as their primary treatment. Among the 36 patients, 2 patients stopped treatment because of the side effects of the anti-TB drugs. In a 29.6-month follow-up of 34 patients who completed 6-12 months of therapy, a satisfactory result was obtained for 33 patients. Conclusions: Our study demonstrates that treatment with anti-TB drugs is a safe and effective therapy for IGM patients, presenting a high cure rate for both initial and relapsed cases.

Clinical presentation and management of idiopathic granulomatous mastitis in a Middle Eastern country-a case series

Introduction: Idiopathic Granulomatous Mastitis (IGM) is a rare and benign inflammatory condition of the breast. IGM cases have been poorly documented in the Middle East, highlighting the need for improved awareness. Aim and Methods: A retrospective review of medical records was conducted, at a specialist centre on the clinical presentation, radiological findings, histopathological features, treatment and outcomes of IGM patients. Results: We identified twenty-two patients with a mean age of 36.6 years (range: 25-51) at presentation to breast clinic. 21/22 (96%) patients presented with a breast lump. 17/22 (77%) patients had breast pain, 4/22 (18%) patients had nipple discharge and 7/22 (32%) had palpable lymph nodes. GM was diagnosed histopathologically in 50% of fine needle aspirates, and 94% of core biopsies of breast. Conservative treatment was the sole treatment in 27%, while surgical management was undertaken in 5% of the patients. Conclusion: IGM appears to be a prevalent concern amongst Middle Eastern countries. There appears to be a diminishing role of surgery in its management and the role of immunosuppressants is emerging.

Idiopathic Granulomatous Mastitis: Manifestations at Multimodality Imaging and Pitfalls.

Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory breast entity characterized by lobulocentric granulomas. IGM has a persistent or recurrent disease course and affects parous premenopausal women with a history of lactation. It has also been associated with hyperprolactinemia. The most common clinical sign is a palpable tender mass. However, the nonspecific manifestations and varied demographic features of this condition, as well as the other similar-appearing and superimposed breast entities, pose substantial diagnostic challenges. Entities with similar manifestations include inflammatory breast cancer (IBC), infective mastitis, foreign body injection granulomas, mammary duct ectasia, diabetic fibrous mastopathy, and systemic granulomatous processes. The strategy for imaging IGM depends on patient age, clinical manifestations, and risk factors. Targeted ultrasonography, mammography, and less commonly, magnetic resonance imaging have proven to be useful for imaging evaluation. Core-needle biopsy, with or without fine-needle aspiration for cytopathologic examination, and culture analysis are usually required to exclude IBC and other benign inflammatory breast processes. Patients with IGM have an excellent prognosis when they are appropriately treated with oral steroids or second-line immunosuppressive and prolactin-lowering medications. However, surgical excision may be an option for patients in whom medication therapy is unsuccessful. Imaging surveillance can be offered to patients with incidentally encountered IGM or mild symptoms. Clinical suspicion for this rare disease and the breast imager's prompt diagnosis can lead to an improved patient outcome. The purpose of this article is to review the imaging manifestations of IGM in a multimodality case-based format and to describe relevant clinical and imaging-based differential diagnoses. The associated pitfalls, epidemiologic and histopathologic factors, clinical manifestations, natural course, and management of IGM also are discussed. ©RSNA, 2018.

Steroids administered after vacuum-assisted biopsy in the management of idiopathic granulomatous mastitis

AimsThe aetiology and treatment options for idiopathic granulomatous mastitis (IGM) are controversial. The aim was to study the clinical and diagnostic features and discuss medical and surgical treatment for IGM...

Etiologic revelation and outcome of the surgical management of idiopathic granulomatous mastitis; An Egyptian centre experience.

Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory condition that is confused with cancer. It usually affects women in child bearing age. The exact aetiology and pathogenesis are still unknown, and the optimal therapeutic modality has not yet been established. Treatment most frequently includes Antibiotics, corticosteroids and immunosuppressant, surgical excision, and even mastectomy. We studied a thirty cases diagnosed with IGM in our locality to find out the leading risk factors and the outcome of our surgical approach which involves excision of the lesion in continuity with duct system. Patients demographic data, history related to lactation and outcome were recorded. All patients were parous women with history of previous breast feeding for all kids. Twenty-six patients (86.66%) had a history of early incomplete nursing care to the affected breast. After our surgical approach, Twenty eight (93.3%) patients showed fast recovery with no detectable recurrences in the median follow up period (18 months) with acceptable cosmoses. History of breast feeding together with early failure of complete nursing from a single breast is the most important risk factors for development of IGM in young aged women. Surgery plays an important role in treating IGM, however, it should be directed towards excision of the present mass (s) together with the pathological and colonized duct system.