Mimic Breast Cancer Research Articles

Diabetic Mastopathy – A Case Report

Introduction: Diabetic mastopathy is a rare benign condition that can occur in patients with long standing Type I or II diabetes mellitus male or female of any age. Diabetic mastopathy is a fibroinflammatory condition that resembles carcinoma of breast. Here, we report a case of Type II Diabetic female patient with suspicious breast lump in right breast Case presentation: A 62 year old female presented with complaints of lump in right breast for 10 days. Clinically, hard lump of size 8x6 cm was palpable in upper outer quadrant. Trucut biopsy showed features of Diabetic mastopathy. Patient undergone wide local excision and biopsy confirmed the diagnosis. Post operative period was uneventful. Discussion: Diabetic mastopathy is an uncommon tumor-like proliferation of fibrous tissue of the breast, clinically and radiologically mimicking breast cancer. Histopathologically, it involves periductal, perilobular and perivascular lymphocytic infiltration. Primary excision with adequate normal tissue margins is the treatment of choice Conclusion: Diabetic mastopathy is a rare clinical entity, however due to increase in prevalence of Diabetes, diagnosis of Diabetic mastopathy should be considered in patients with breast lumps

Breast tuberculosis with bone destruction mimicking breast cancer with bone metastasis: a case report and literature review

Breast tuberculosis with bone destruction mimicking breast cancer with bone metastasis: a case report and literature review

Idiopathic Granulomatous Mastitis: A Retrospective Cohort Study of Treatment Modalities in 83 Patients From Southern Thailand

Objective: Idiopathic granulomatous mastitis (IGM) is a rare condition that mimics breast cancer. Current treatment strategies include both surgical and medical therapy. This study aimed to report and describe the clinical signs, radiological findings, management, clinical course, and outcomes after treatment of IGM, from a major tertiary care institute in southern Thailand.Material and Methods: The medical records of 83 patients with IGM treated at our institute between January 2001 and April 2022 were retrospectively studied. Patient characteristics, clinical presentations, radiological findings, microbiological workups, tissue pathologies, treatment modalities, outcomes and follow-up data were reviewed and analyzed. The success rate, recurrence rate, and time to heal were compared between the different treatment modalities. Results: Overall, 83 patients were diagnosed with IGM. Due to insufficient follow-up periods, data from only 50 patients were used for the analysis. Initially, 34,3,8, and 5 were treated surgically, with steroids, anti-tuberculosis (TB) drugs, or other treatments, respectively; 32 (64%) achieved disease resolution. The median time to heal was 472 days, while the median time to heal after surgery, steroid therapy, anti-TB therapy, and others was 614.5, 333, 208.5, and 406 days, respectively. Surgery resulted in the longest time to heal; however, the difference was not statistically significant (p-value=0.23). Eighteen (36%) patients experienced recurrence.Conclusion: There was no significant difference among the treatment modalities in terms of time to heal and recurrence. Surgery resulted in the longest healing time, the highest incidence of complications, and a recurrence rate of approximately 50%. Surgical treatment should be reserved for aggressive diseases.

Primary breast tuberculosis mimicking breast cancer: an original study of imaging findings and differential diagnosis challenges.

Breast tuberculosis is a rare extrapulmonary manifestation of Mycobacterium tuberculosis, representing less than 0.1% of all breast pathologies in developed countries. However, in regions with high tuberculosis prevalence, such as India and Africa, its incidence is higher. The disease poses diagnostic challenges due to its ability to mimic breast carcinoma, leading to potential misdiagnosis and unnecessary surgical interventions. This study investigates the clinical and imaging characteristics of breast tuberculosis in a large cohort, with a specific focus on a rare case in a postmenopausal woman. A retrospective observational study was conducted on 1704 women who presented for mammography at the Alessandrescu-Rusescu National Institute for Mother and Child Health between 2019 and 2021. Clinical presentation, imaging results, and histopathological findings were analyzed to identify cases of breast tuberculosis. The study includes a comparative analysis with other granulomatous diseases and malignant breast conditions to highlight key diagnostic features. Among the 1704 patients, 714 (41.9%) presented with symptoms such as pain (35.4%), palpable lumps (13.2%), nipple discharge (4.3%), and breast appearance changes (2.1%). A rare case of primary breast tuberculosis was identified in a 69-year-old postmenopausal woman, presenting with a painless, palpable mass in the upper outer quadrant. Imaging demonstrated a hypoechoic mass with fine granular content and posterior acoustic enhancement, categorized as BIRADS 4A. The biopsy confirmed the diagnosis of breast tuberculosis. This study underscores the diagnostic complexity of breast tuberculosis, particularly in its ability to mimic malignancy. Through detailed imaging and clinical analysis, we emphasize the importance of biopsy in differentiating tuberculosis from breast cancer. Given the potential for misdiagnosis, clinicians should consider breast tuberculosis in differential diagnoses, especially in regions with high tuberculosis prevalence. Further research is needed to develop specific imaging criteria for earlier and more accurate diagnosis.

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.

Biomechanically tunable scaffolds for bone tissue regeneration and testbeds of cancer bone metastasis

Current challenges in bone regeneration and design of humanoid 3D bone metastases cancer testbeds can be overcome by designing bone-mimetic tissue engineering scaffolds with tunable mechanical and biological properties. This study employs three unnatural amino acids to modify montmorillonite clay (MMT), producing polymer clay nanocomposites (PCNs) to construct 3D bone-mimetic scaffolds. The modification of MMT clay with 5-aminovaleric acid, (±)-2-aminopimelic acid, and 4-(4-Aminophenyl) butyric acid is analyzed through x-ray diffraction (XRD) and fourier-transform infrared spectroscopy (FTIR), revealing changes in the interlayer spacing and functional groups. Molecular modeling elucidates the interaction energies in the amino acid intercalated nanoclays that influence the mechanical properties of the scaffolds. 4-(4-Aminophenyl) butyric acid-modified scaffolds exhibited the highest compressive strength, highlighting the critical influence of molecular interactions on the mechanical properties of the PCN. Despite being a small fraction of the scaffold, the presence and type of amino acids significantly affect the scaffold mechanical properties. Cell viability assays affirm biocompatibility of scaffolds. The amino acids within the nanoclays also impact mineralization on scaffolds seeded with human mesenchymal stem cells (hMSCs). Amino acid type also influences the amount of mineralization in the scaffolds. A sequential culture involving hMSCs and breast cancer cells (MCF-7) on the scaffold mimics breast cancer metastasis to bone. Enhanced mineralization by bone cells in the presence of MCF-7 cells is observed, emphasizing their osteoblastic characteristics. Hence, 3D scaffolds for bone regeneration and bone metastasis cancer testbeds can exhibit tunable mechanical properties and biological responses though a simulation guided choice of unnatural amino acids.

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.

Imaging findings after a total reconstructed breast with autologous fat transfer: what the radiologist needs to know.

Abstract Autologous fat transfer (AFT) is an upcoming technique for total breast reconstruction. Consequently, radiological imaging of women with an AFT reconstructed breast will increase in the coming years, yet radiological experience and evidence after AFT is limited. The surgical procedure of AFT and follow-up with imaging modalities including mammography (MG), ultrasound (US), and MRI in patients with a total breast reconstruction with AFT are summarized to illustrate the radiological normal and suspicious findings for malignancy. Imaging after a total breast reconstruction with AFT appears to be based mostly on benign imaging findings with an overall low biopsy rate. As higher volumes are injected in this technique, the risk for the onset of fat necrosis increases. Imaging findings most often are related to fat necrosis after AFT. On MG, fat necrosis can mostly be seen as oil cysts. The occurrence of a breast seroma after total breast reconstruction with AFT is an unfavourable outcome and may require special treatment. Fat deposition in the pectoral muscle is a previously unknown, but benign entity. Although fat necrosis is a benign entity, it can mimic breast cancer (recurrence). In symptomatic women after total breast reconstruction with AFT, MG and US can be considered as first diagnostic modalities. Breast MRI can be used as a problem-solving tool during later stage. Future studies should investigate the most optimal follow-up strategy, including different imaging modalities, in patients treated with AFT for total breast reconstruction.

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.

Evaluation of early results of triamcinolone acetonide treatment in the treatment of idiopathic granulomatous mastitis introduction.

Idiopathic granulomatous mastitis (IGM) is a rare, benign, chronic inflammatory breast disease with an unknown etiology. IGM patients may develop painful or painless masses, palpable lymph nodes, and skin findings that can mimic breast cancer, including retractions, skin edema, ulceration, and fistula formation. This presents a significant diagnostic challenge in clinical practice. The present study aimed to assess the early outcomes of triamcinolone acetonide treatment in patients with idiopathic granulomatous mastitis. After obtaining the necessary approvals from the ethics committee, patients who were admitted to the breast endocrine department of the general surgery clinic of our hospital between 2014 and 2022 with complaints of a mass, discharge, and fistula formation and who were histopathologically diagnosed with granulomatous mastitis after radiological examination by tru-cut biopsy were prospectively enrolled in the study. Among the 136 patients with granulomatous mastitis, the mean age was 30.09±4.14 years, the symptom duration averaged 3 weeks (range: 1-5), the follow-up period extended for 20 weeks (range: 3-72), and the mean recurrence duration was 1.08±0.28 months. Complaints included discharge (52.2%), mass (51.5%), redness (45.6%), and pain (27.2%). Masses were predominantly on the left side (61.0%) compared to the right side (38.0%). In conclusion, the heterogeneous phenotype of IGM and the lack of randomized controlled trials pose challenges. Long-acting triamcinolone acetonide proves effective in managing IGM by resolving the inflammatory process and the disease itself. Its low side effects and ease of use make it a valuable treatment modality.

Efficacy of a HER2-Targeted Thorium-227 Conjugate in a HER2-Positive Breast Cancer Bone Metastasis Model.

Human epidermal growth factor receptor 2 (HER2) is overexpressed in 15-30% of breast cancers but has low expression in normal tissue, making it attractive for targeted alpha therapy (TAT). HER2-positive breast cancer typically metastasizes to bone, resulting in incurable disease and significant morbidity and mortality. Therefore, new strategies for HER2-targeting therapy are needed. Here, we present the preclinical in vitro and in vivo characterization of the HER2-targeted thorium-227 conjugate (HER2-TTC) TAT in various HER2-positive cancer models. In vitro, HER2-TTC showed potent cytotoxicity in various HER2-expressing cancer cell lines and increased DNA double strand break formation and the induction of cell cycle arrest in BT-474 cells. In vivo, HER2-TTC demonstrated dose-dependent antitumor efficacy in subcutaneous xenograft models. Notably, HER2-TTC also inhibited intratibial tumor growth and tumor-induced abnormal bone formation in an intratibial BT-474 mouse model that mimics breast cancer metastasized to bone. Furthermore, a match in HER2 expression levels between primary breast tumor and matched bone metastases samples from breast cancer patients was observed. These results demonstrate proof-of-concept for TAT in the treatment of patients with HER2-positive breast cancer, including cases where the tumor has metastasized to bone.

Diabetic Lymphocytic Mastopathy: A Case Report

Diabetic mastopathy (DM) is a recently described pathological entity, rare and benign; occurring in young patients with type I diabetes, or autoimmune disease. Clinically, it mimics breast cancer. Iconographic examinations provide little information. The diagnosis of certainty is histological. We present a case of diabetic mastopathy in a diabetic patient who had been on insulin for 16 years and had multiple degenerative complications. We review the clinical, radiological and evolutionary aspects of this condition.

Tuberculosis of the breast: A case report in a tertiary health institution, South-South Nigeria

Tuberculosis (TB) of the breast is a rare disease that typically affects women of reproductive age, mainly between 15 and 25 years of age. TB of the breast has a non-specific clinical presentation and may present as a breast lump, abscess, or sinus, and it may sometimes mimic breast cancer. Histological diagnosis is necessary to avoid mismanagement of potentially curable breast disease. We present a case of an 18-year-old female with a left upper quadrant breast lump of 1-year duration. The fine-needle aspiration cytology of the breast lump was negative for malignancy. However, histological diagnosis of the excised breast lump confirmed TB of the breast.

3D collagen microchamber arrays for combined chemotherapy effect evaluation on cancer cell numbers and migration.

Breast cancer metastasis involves complex mechanisms, particularly when patients are undergoing chemotherapy. In tissues, tumor cells encounter cell-cell interactions, cell-microenvironment interactions, complex nutrient, and drug gradients. Currently, two-dimensional cell culture systems and animal models are challenging to observe and analyze cell responses to microenvironments with various physical and bio-chemical conditions, and microfluidic technology has been systematically developed to address this dilemma. In this study, we have constructed a combined chemotherapy evaluation chip (CCEC) based on microfluidic technology. The chip possesses 192 diamond-shaped microchambers containing MDA-MB-231-RFP cells, and each microchamber is composed of collagen to mimic breast cancer and its surrounding microenvironment. In addition, by adding medium containing different drugs to the medium channels of CCEC, composite drug (paclitaxel+gemcitabine+7rh and paclitaxel+fluorouracil+PP2) concentration gradients, and single drug (paclitaxel, gemcitabine, 7rh, fluorouracil, PP2) concentration gradients have been established in the five collagen regions, respectively, so that each localized microchamber in the regions has a unique drug microenvironment. In this way, we evaluated the composite and single chemotherapy efficacy on the same chip by statistically analyzing their effects on the numbers and migration of the cell. The quantitative results in CCECs reveal that the inhibition effects on the numbers and migration of MDA-MB-231-RFP cell under the composite drug gradients are more optimal than those of the single drugs. Besides, the cancer cell inhibition effect between the groups composed of two drugs has also been compared, that is the paclitaxel+gemcitabine, paclitaxel+fluorouracil, and paclitaxel+PP2 have better cell numbers and migration inhibition effects than paclitaxel+7rh. The results indicate that the bio-mimetic and high-throughput combined chemotherapy evaluation platform can serve as a more efficient and accurate tool for preclinical drug development and screening.

Squamous Cell Carcinoma of The Skin Mimicking Breast Cancer: A Case Report

Squamous cell carcinoma (SCC) is the second most common skin cancer and it often occurs in sun-exposed areas such as head and neck skin. Invasive SCC located on breast skin is a rare entity and may clinically mimic breast cancer. We report a case of a 39 years old female with a non-eroded, vegetative, growing lesion on the right breast skin, initially mimicking breast cancer both clinically and histopathologically. After surgery with clear margins, adjuvant radiotherapy was administered, by considering the pathological risk factors for recurrence. At 14 months, the patient is disease-free and under regular follow-up. Invasive SCC of the breast skin is a rare entity and may have different etiology/behavior or directly develop de novo when compared to SCCs located on sun-exposed skin. Medical history and physical examination in conjunction with histopathological examination of the biopsy specimen are critical for the accuracy of the diagnosis and the correct treatment decision in patients presenting with a mass invading breast skin.

A descriptive study of chronic granulomatous mastitis in Central India

Background: Chronic granulomatous mastitis is a rare benign breast condition that can mimic breast cancer. The present study was undertaken to assess the demographics, clinical presentation, etiology, diagnostic tools and management of patients with CGM.Methods: This descriptive observational study was conducted in total 83 women who presented with breast lump with tenderness associated with fever for more than 4 weeks of duration in the Department of General Surgery at Tertiary Care Centre from June 2018 to December 2020.Results: In all cases breast lump was chief complaint, of maximum (38.5%) had this illness since last 1 to 4 months. 48 patients had past history of tuberculosis. Axillary lymph node was enlarged in 24.1% and body temperature was raised in 57.8% of cases. Skins over the lump were presented with indurated with multiple pus discharging sinuses (50.6%) and palpable mass with erythema and ulcerative skin lesion (49.4%). On biopsy all the patients presented with granulomatous mastitis and on USG, hypoechoic mass was presents in all cases. Patients were managed medically by IV antibiotic and AKT (57.8%) and IV antibiotic with oral corticosteroid (42.2%). Incision and drainage were done in 74 cases while 8 required wide local excision and in 1 patient mastectomy was done.Conclusions: The histopathology remains the optimal diagnostic tool. Corticosteroid therapy has been shown to be efficacious for CGM, but in the existence of many complications, surgical treatment has been first method of choice. We consider that wide local excision is the better treatment choice if possible.

Idiopathic granulomatous mastitis: experience at a New York hospital.

Idiopathic granulomatous mastitis (IGM) often mimics breast cancer. Presentation includes pain, palpable mass, suppuration or suspicious imaging. Widely reported in Asia and the Middle East, IGM is diagnosed after excluding specific granulomatous mastitis (SGM). Aetiology remains unknown. Lactation, prolactinaemia, ethnicity, autoimmune disease and Corynebacteria are associated. Treatment is controversial and the prevalence rising. Surgery and non-operative treatments including antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), steroids, methotrexate and observation have advocates. A retrospective chart review of 63 patients with IGM from 2008 to 2018 was undertaken focusing on birthplace, age, clinical presentation, wound cultures, imaging, treatments and outcomes. Sixty-one of 63 patients were Hispanic; 53 were Mexican-born women aged 23-46. Clinical presentation included pain, painful mass, painless mass, suppuration and abnormal imaging. Some 31/61 ultrasound examinations and 17/33 mammograms were deemed Breast Imaging Reporting and Data System (BI-RADS) score 4 or 5. Management included antibiotics (43), incision and drainage (24), NSAIDs (29), steroids (8), lumpectomy (18) and observation (12). Some 12/20 patients with painless masses resolved with observation, 3 received NSAIDs, 2 received steroids and 3 underwent lumpectomies. Antibiotics resolved 8/43 cases, 5 needed incision and drainage, 26 received NSAIDs, 6 received steroids and 5 underwent lumpectomies. Nineteen patients had indolent disease or recurrence. Excluding malignancy is critical, treatment challenging and recurrence common in IGM. A preponderance of patients were Mexican-born, similar to other reports from the USA. Over 50% of IGM cases had suspicious BI-RADS scores. Best management remains a challenge and ranges from observation to lumpectomy.

Long-term cultured microvascular networks on chip for tumor vascularization research and drug testing.

The vascular structure of the tumor microenvironment (TME) plays an essential role in the process of metastasis. In vitro microvascular structures that can be maintained for a long time will greatly promote metastasis research. In this study, we constructed a mimicking breast cancer invasion model based on a microfluidic chip platform, and the maintenance time of the self-assembled microvascular networks significantly improved by culturing with fibroblasts (up to 13 days). Using this model, we quantified the invasion ability of breast cancer cells and angiogenesis sprouts caused by cancer cells, and the intravasation behavior of cancer cells was also observed in sprouts. We found that cancer cells could significantly cause angiogenesis by promoting sprouting behaviors of the self-assembled human umbilical vein endothelial cells, which, in turn, promoted the invasion behavior of cancer cells. The drug test results showed that the drug resistance of the widely used anti-cancer drugs 5-Fluorouracil (5-FU) and Doxorubicin (DOX) in the 3D model was higher than that in the 2D model. Meanwhile, we also proved that 5-FU and DOX had the effect of destroying tumor blood vessels. The anti-angiogenic drug Apatinib (VEGFR inhibitor) enhanced the drug effect of DOX on MDA-MB-231 cells, further proving the promoting effect of angiogenesis on the invasion ability of cancer cells. These results indicate that our model is of great value in reconstructing TME and drug testing in vitro.

A case of idiopathic granulomatous mastitis that canmimic a breast cancer

Introduction: Idiopathic granulomatous mastitis (IGM) is an uncommon and persistent inflammatory breast disease with no identified cause. It affects women of reproductive age who have previously breastfed. Diagnosis of IGM is difficult because clinical and radiological features might mimic breast cancer. We report an unusual case of IGM in a breastfeeding mother mimicking breast cancer. Observation: A 32-year-old female patient, with no particular pathological history, has been presenting for 3 months mass of the right breast with erythema. A few weeks later, she presented a suppuration and ulceration of the right breast. The breast examination revealed a painless and poorly marginated mass, mobile in relation to the muscle plane and adherent to the skin at the junction of the external quadrants measuring 40*40mm. Breast ultrasound showed a heterogeneous hypoechoic irregular mass in the outer quadrants with surrounding edema, and dilatation of the milk ducts, classified as BI-RADS 4. Histologically, there was an epithelioid and gigantocellular granulomatous reaction of the mammary parenchyma, with a polymorphic inflammatory infiltrating of lymphocytes, plasma cells, and neutrophils. The patient received corticosteroids, bromocriptine, amoxicillin and clavulanic acid associated with topical care of the lesion. The evolution was favorable with the regression of the mass after 18 months. Discussion: IGM is an uncommon and benign condition that is frequently misdiagnosed. It mostly occurs in young women during the genital period. IGM does not have any pathognomonic mammographic characteristics. Breast ultrasound can show a nodular hypoechoic image with irregular contours with a long axis parallel to the skin. IGM is characterized by lobulocentric non-caseating granulomas made up of epithelioid histiocytes mixed with Langhan's multinucleate giant cells on histological examination. The treatment of IGM is not well established. The management of the disease is based on its clinical form. IGM is a gradual and recurrent disease that has a major impact on the quality of life and requires close surveillance. Conclusion: IGM is an uncommon and persistent inflammatory disorder of the breast that can be difficult to diagnose. Breast cancer is the predominant differential diagnosis, with the possibility of an association. Increased awareness of this disorder will lead to more accurate and timely diagnosis and treatment.

Idiopathic Granulomatous Mastitis; Radio-pathologic findings and Grading based on Clinical Presentation and treatment outcome in 224 patients

Background: Idiopathic granulomatous mastitis (IGM) is a rare inflammatory disease of the breast with unknown etiology. Clinico-radiologic findings can mimic breast cancer. Further pathologic evaluation to rule out malignancy is mandatory. Recognizing the severity of the disease is crucial to choosing the most effective therapeutic modality. The aim of this study is to evaluate clinical and radio-pathologic features of IGM, and the treatment outcome in a large series of IGM patients in Iran.Methods: The retrospective charts of 243 patients suspicious of IGM, between December 2007 and September 2017 were reviewed. Patients with confirmed diagnosis of IGM were classified into four grades of severity. Demographic information, clinical and radio-pathologic findings, severity and treatment outcomes were collected.Results: Overall, 224 patients were confirmed to have IGM. Breast mass and erythema were the most common clinical findings. Mammographic findings mimicked malignancy in 34%. Lobulo-centric non-caseating granulomas were the most common pathologic finding. Also, 61.5% of the patients had mild to moderate symptoms and 49.5% of them recovered completely by observation. In addition, 53 (25.9%) patients had severe symptoms and 30.8% of them were resistant to treatment. Conclusion: IGM is a diagnostic challenge. Its diagnosis is based on exclusion and a close cooperation between the clinician, the radiologist and the pathologist. Mild to moderate cases can be managed conservatively; however, severe cases may need further aggressive medical or surgical treatments.