Periductal Mastitis Research Articles

7013 An Inpatient Perspective: Hyperprolactinemia and Granulomatous Mastitis

Abstract Disclosure: A. Le: None. J. Wade: None. K. Martz: None. D. Girgis: None. M. Shahlapour: None. M.H. Horani: None. Introduction: Mastitis is a highly prevalent condition impacting thousands of women every year. Most commonly associated with lactation, mastitis is estimated to impact 2-20% of lactating women particularly in the first 4-6 weeks of breastfeeding (Wilson et al., 2020). The majority of cases are associated with bacterial infection with Staphylococcus aureus precipitated by nipple trauma and hyperlactation in the setting of genetic predispositions and disturbances to the human milk microbiota (Fernández et al., 2020). In rare cases, mastitis is seen outside of the context of lactation. One cause of non-lactational mastitis is idiopathic granulomatous mastitis (IGM). The pathogenesis of IGM is poorly understood, but there has been a rare association between IGM and hyperprolactinemia reported in the literature (Nikolaev et al., 2016). Case Presentation: In January 2022, A 20 year old female with past medical history of type 2 diabetes mellitus and hypertension, initially presented to the emergency department with complaints of headache. Patient’s history is notable for two years of amenorrhea and periodic nipple discharge. MRI scan of the head revealed a 1.6 cm pituitary macroadenoma which correlated with a markedly elevated prolactin level at 533.3. She was discharged with a prescription for Cabergoline 0.5 mg BID. In July 2022, the patient presented to the ED complaining of severe left breast pain with associated discharge for 4 days. She admitted to being non-adherent to Cabergoline treatment since April 2022 due to lack of endocrine follow-up. CT of the breast at that time showed a 3.8 cm subareolar abscess. Aspiration of the abscess revealed non-purulent fluid and cultures of the aspirate were negative. In February 2023, patient presented for right breast pain with a similar workup to previous hospitalization. MRI of the brain revealed a 1.6 cm sellar mass is unchanged since January 2022. Prolactin level was elevated at 652.4. Patient stated she has been off Cabergoline for the prior 5 months. She was subsequently seen for right and left mastitis 3 times over the next 12 months. Upon endocrine consultation, the patient was counseled on the importance of Cabergoline treatment in regression of future mastitis episodes, and the patient has subsequently not returned to our service. Conclusion: This case demonstrates the rare association between prolactin secreting pituitary adenomas and granulomatous mastitis that clinicians need to consider in order to avert delays in treatment and unnecessary hospitalizations. Specifically, when working up a patient with a history of IGM and prolactinemia, it is imperative to monitor prolactin levels periodically over an extended course of time with appropriate MRI imaging of the pituitary gland to assess for regression of prolactinoma and episodes of IGM. Presentation: 6/1/2024

High cure rate and satisfaction in patients with periductal mastitis via the latissimus dorsi myocutaneous flap technique: a retrospective study.

Periductal mastitis (PDM) is a complex benign breast disease with a prolonged course and a high probability of recurrence after treatment. There is a variety of available treatments for PDM, but none of these options have been widely accepted. A standard strategy has been especially difficult to establish in patients with PDM accompanied by large tumors or large skin ruptures, as these seriously affect the appearance of the breasts after surgeries, which can lead to feelings of lower self-esteem among patients. Therefore, finding a reliable volume replacement has become a focus of our research efforts. With the widespread use of latissimus dorsi in breast reconstruction, we attempted to use the latissimus muscle (skin) flap for stage I repair in patients with large-defect PDM. Our study is the first of its kind to evaluate the clinical effect and patient satisfaction of the latissimus dorsi myocutaneous flap (LDMF) technique in PDM. Thirty-two patients with PDM and more than about 20% loss of breast volume admitted to the Department of Breast Surgery of Shanxi Bethune Hospital from March 2017 to July 2021 were enrolled. After lesion removal, the LDMF technique was applied to these patients for immediate completion of breast contour revision. All patients were periodically followed up to assess the efficacy of the procedure and their satisfaction with the breasts' shape. Three patients (9.4%) developed dorsal effusion after removal of the back drain; six patients (18.8%) developed mild limitation of the activity of the affected upper limb; and three patients (9.4%) experienced local recurrence of inflammation after the operation, all of whom underwent a second operation. The cure rate of the patients treated with LDMF was 90.6%, the overall satisfaction rate of the patients was 96.9%, and doctor's evaluation of satisfaction was 90.6%. In patients with poor results after anti-infective and local treatment and those with more than 20% defect volume following lesion removal, the LDMF technique yields a high cure rate and good patient satisfaction.

Multimodality Imaging of Benign and Malignant Diseases of the Nipple-Areolar Complex.

The nipple-areolar complex (NAC), a unique anatomic structure of the breast, encompasses the terminal intramammary ducts and skin appendages. Several benign and malignant diseases can arise within the NAC. As several conditions have overlapping symptoms and imaging findings, understanding the distinctive nipple anatomy, as well as the clinical and imaging features of each NAC disease process, is essential. A multimodality imaging approach is optimal in the presence or absence of clinical symptoms. The authors review the ductal anatomy and anomalies, including congenital abnormalities and nipple retraction. They then discuss the causes of nipple discharge and highlight best practices for the imaging workup of pathologic nipple discharge, a common condition that can pose a diagnostic challenge and may be the presenting symptom of breast cancer. The imaging modalities used to evaluate and differentiate benign conditions (eg, dermatologic conditions, epidermal inclusion cyst, mammary ductal ectasia, periductal mastitis, and nonpuerperal abscess), benign tumors (eg, papilloma, nipple adenoma, and syringomatous tumor of the nipple), and malignant conditions (eg, breast cancer and Paget disease of the breast) are reviewed. Breast MRI is the current preferred imaging modality used to evaluate for NAC involvement by breast cancer and select suitable candidates for nipple-sparing mastectomy. Different biopsy techniques (US -guided biopsy and stereotactic biopsy) for sampling NAC masses and calcifications are described. This multimodality imaging approach ensures an accurate diagnosis, enabling optimal clinical management and patient outcomes. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.

Periductal Mastitis, a Disease with Distinct Clinicopathological Features from Granulomatous Lobular Mastitis.

Periductal mastitis (PDM) is a chronic inflammatory lesion of the breast with an unknown etiology, and it is difficult for clinicians to differentiate it from granulomatous lobular mastitis (GLM), although they have different treatment strategies and prognosis. This study aimed to investigate the differences in their clinicopathologic features to inform treatment strategies. Between 2011 and 2020, 121 patients diagnosed with PDM and 57 patients with GLM were retrospective analysis. Patient data were extracted on demographics, clinical presentation, pathologic characteristics, treatments and clinical response. Histopathological evaluations were performed on core needle biopsy specimens. Immunohistochemical stains using antibodies against CD3, CD4, CD8, CD20, and CD138 was performed to define immune cell infiltration. PDM patients had a higher median age compared to GLM patients (38 vs 32, p<0.001). PDM was primarily located in the areolar area, while GLM predominantly affected the peripheral quadrant of the breast (56.20% vs 75.44%, p<0.001). Histopathologically, more ductal dilatation (90.08% vs 3.51%, p<0.001), ductal wall thickening (47.93% vs 1.75%, p<0.001), and ductal rupture (44.63% vs 5.26%, p<0.001) were observed in PDM. GLM presented with significantly more granuloma (94.74% vs 10.74%, p<0.001), microabscess (68.42% vs 28.93%, p<0.001), and lipid vacuole (40.35% vs 8.26%, p<0.001) formation than PDM. Immunohistochemical analysis revealed a significant presence of CD20+ B lymphocytes in PDM and a higher prevalence of CD8+ T lymphocytes in GLM, indicating differing immune responses. Treatment outcomes varied, with PDM patients responding well to surgery and anti-mycobacterial therapy, while GLM patients showed favorable responses to steroid therapy. PDM is a specific entity with a similar clinical presentation but distinct histopathological features and immune profiles to GLM. Further research is needed to elucidate the pathogenesis and optimize therapeutic approaches for these breast inflammatory conditions.

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.

Efficacy and safety of rifampicin-based triple therapy for non-puerperal mastitis: A single-arm, open-label, prospective clinical trial

ObjectivesTo assess the efficacy and safety of rifampicin-based triple therapy (rifampicin, isoniazid, and ethambutol) for treating NPM. MethodsThis single-center, single-arm, prospective clinical trial was conducted at the Second Hospital of Shandong University (Jinan, China). Patients with pathologically diagnosed granulomatous lobular mastitis and periductal mastitis received triple drugs, i.e., rifampicin (450 mg/day), isoniazid (300 mg/day), and ethambutol (15 mg/kg/day), until complete response or the investigator decided to discontinue treatment. The primary endpoint was the complete response rate (CRR) assessed by the investigator. The secondary endpoints included the overall remission rate (ORR), recurrence rate (RR), and safety. ResultsA total of 218 patients were enrolled in the study between January 1, 2013 and October 31, 2020. With a median follow-up time of 48 months, the CRR and the ORR were 78.44% and 94.04%, respectively. While 13 patients (5.96%) demonstrated no response and 19 relapsed (8.72%). Adverse events (AEs) were not common. The most common AEs during treatment were liver dysfunction (1.83%), gastrointestinal reactions (1.83%), fatigue (1.83%), erythema (1.38%), and menstrual disorders (0.92%). ConclusionRifampicin, isoniazid, and ethambutol demonstrated promising response rates with acceptable safety profiles in patients with NPM. Further confirmatory trial is warranted in the future. Trial registrationThe study was approved by the Ethics Committee of the Second Hospital of Shandong University and retrospectively registered at the China Clinical Trial Registration Center (registration number: ChiCTR2100049591).

SAT612 Granulomatous Mastitis: An Unusual Presentation Of Prolactinoma

Abstract Disclosure: H.R. Alkaissi: None. E. Kim: None. S. McFarlane: None. Background: Granulomatous mastitis (GM) is a rare, benign inflammatory breast disease of unclear etiology with clinical presentation that is similar to inflammatory breast cancer and periductal lobular mastitis. It occurs mainly in younger females and during the postpartum period. Prolactin (PRL) is an essential hormone of pituitary and extrapituitary origin that promotes lactation and the development of mammary glands within breast tissues. In addition to its lactogenic effect, it has over 300 other effects, several of which are immunomodulatory, including the expression and secretion of proinflammatory cytokines from macrophages. Clinical Case: A 37-year-old African American woman presented with right breast pain and swelling for a few weeks. Her medical history includes amenorrhea for five years. She is gravida 1, para 1 with normal spontaneous vaginal delivery at the age of 20. Physical exam showed non-bloody, non-purulent nipple discharge bilaterally, otherwise unremarkable. A breast ultrasound showed a 1 cm complex cystic mass. Biopsy showed benign breast tissue, with noncaseating granulomas formed by macrophages (CD68 positive on immunohistochemistry). Ziehl-Neelsen staining for acid-fast bacilli was negative. Staining for fungi was also negative. Prolactin level was 237 ng/mL. TSH, IGF-1, and ACTH were within normal. Pituitary MRI showed a focus of abnormal signal and diminished enhancement measuring 2.8x3.2x4.2 mm within the left side of the pituitary gland is compatible with a microadenoma. The patient was started on bromocriptine 2.5mg daily. Discussion: Our patient represents a rare case of granulomatous mastitis in the setting of microprolactinoma, likely long-standing, given the five years history of amenorrhea. The immunomodulatory effect of PRL on several immune system cells, including B-cells, T-cells, and macrophages, might be an underlying mechanism. In a recent study of 25 samples of GM, metagenomics studies identified unusual organisms in 68% of the samples. Of these, Corynebacterium kroppenstedtii was the most common (60%), followed by Pseudomonas oleovorans (16%), Epstein-Barr virus (4%), Acinetobacter baumannii (4%), and Tepidiphilus thermophilus (4%). In addition, 50% of the patients had elevated PRL, and elevated immunological markers, such as C3 and IgA [1]. This suggests that GM results from an interaction between the presence of certain pathogens in a host with elevated PRL that mediates proinflammatory response.

Hallazgos por resonancia magnética de las mastitis inflamatorias de etiología desconocida

Inflammatory mastitis of unknown etiology includes the entities periductal mastitis and idiopathic granulomatous mastitis. These relatively uncommon processes usually affect women of childbearing age. They usually present as a palpable mass that is painful on palpation. These lesions have an insidious clinical course and are difficult to diagnose. In some cases, they can resemble malignant disease, especially in some very developed cases where they can resemble inflammatory carcinoma. When considered all together in the appropriate clinical context, the magnetic resonance imaging signs enable us to approach a specific diagnosis. These entities share clinical and radiological characteristics with malignant processes, so biopsies are fundamental to rule out malignancy.

Identification of periductal mastitis and granulomatous lobular mastitis: a literature review.

Non-puerperal mastitis (NPM) is a breast disease with poor clinical manifestations, which seriously affects women's health and quality of life. Due to the low incidence rate of the disease and the paucity of related research, there is much misdiagnosis and mis-management of periductal mastitis (PDM) and granulomatous lobular mastitis (GLM). Therefore, understanding the differences between PDM and GLM, in terms of etiology and clinical manifestations, is crucial for patient treatment and prognosis. At the same time, choosing different treatment methods may not achieve the best treatment effect, so the appropriate treatment method can often reduce the patient's pain and reduce the recurrence of the patient's disease. The PubMed database was searched for articles published from 1 January 1990 to 16 June 2022 using the following search terms: "non-puerperal mastitis", "periductal mastitis", "granulomatous lobular mastitis", "mammary duct ectasia", "idiopathic granulomatous mastitis", "plasma cell mastitis", and "identification". The key findings of the related literatures were analyzed and summarized. We systematically described the key points in the differential diagnosis, treatment, and prognosis of PDM and GLM. The use of different animal models for research and novel drugs to treat the disease were also described in this paper. The key points in the differentiation of the two diseases are clearly explained, and the respective treatment options and prognosis are summarized.

Evaluation of core-needle biopsy in Breast Imaging Reporting and Data System 3 breast mass

Background/aim A crucial approach for finding breast cancer sooner is the triple examination of breast diseases. Our goal was to determine if ultrasound-guided core biopsies were required to investigate clinically ambiguous breast tumors that lacked imaging features suspicious for malignancy in Breast Imaging Reporting and Data System 3. Patients and methods A prospective study was performed on 50 patients fulfilling our eligibility criteria who presented with symptomatic indeterminate breast masses chosen according to our selection criteria and underwent an ultrasonography-guided core biopsy in the period from January 2021 to March 2022. Results A total of 50 clinically ambiguous breast masses were investigated, of which 47 (94%) were benign lesions, including 34 (68%) lesions were fibroadenomas, six (12%) lesions were fibrocystic disorder without ductal hyperplasia, one (2%) lesion was fibrocystic disease with ductal hyperplasia with no atypia, and six (12%) lesions showed periductal mastitis. Two (4%) lesions were proliferative breast lesions with focal atypia. One (2%) lesion was infiltrating duct carcinoma grade 2. Conclusion Ultrasound-guided core biopsy is necessary for investigating clinically indeterminate breast mass in symptomatic patients with Breast Imaging Reporting and Data System 3 finding on imaging, for early detection of malignancy and atypical hyperplastic changes.

A Case of Subareolar Abscess with Mass Beneath the Nipple during Chronic Mastitis in a Male Patient

A Case of Subareolar Abscess with Mass Beneath the Nipple during Chronic Mastitis in a Male Patient

Inflammatory diseases of the breast.

Inflammatory disorders of the breast are common benign breast conditions. Lactational mastitis occurs in breastfeeding women and may be associated with breast abscess in severe cases. Non-lactational inflammatory disorders are less common and include idiopathic granulomatous mastitis, periductal mastitis, and tuberculous mastitis. While these disorders have some similarities in their presentation, each disorder requires a specific treatment regimen for resolution, and correct diagnosis is crucial for appropriate treatment. In this chapter, we will review the presentation, diagnosis, and management of each of these distinct clinical entities.

Female tabagism associated mastitis: a case report related to low quality cigarettes consumption in Magé, Rio de Janeiro

Objective: to report a case of periductal mastitis, whose initial presentation has been necrosis of nipple in a client of the Public Unified Health System (SUS) in the city of Magé / Rio de Janeiro. The public healthcare system client had reported prolonged use of cheap cigarettes which she used to smoke and which she could afford. Method: case report qualitative study, anchored in anamnesis and physical examination with emphasis on patient social history and pathophisiology of benign breast mastitis related to tobacco use. Result: According to anamnesis and physical examination, it is suggested that a chronic inflammatory process in breast ducts had occurred. A chronic breast inflammatory process may be linked with toxins eliminated in cigarette combustion, nevertheless an overwhelming patient social vulnerability and issues concerning self-care must be regarded by primary health care nursery. Conclusion: Quitting smoking may imply multifactorial aspects, including willpower, psychiatric and somatic disorders, poverty and little access to healthcare system in Brazil. Body care should have been emphasized concerning medical and nursing management. In Magé, mastitis diagnosis associated with tobacco use has been somewhat frequent, and recurrent non-puerperal breast abscess complicates most cases. Often, poor female patients with low self steem have consumed cheaper cigarettes, perhaps less subject to appropriate quality control.

Management of idiopathic granulomatous mastitis: a prospective study.

Idiopathic granulomatous mastitis (IGM) is an evolving problem with varied presentation. No definite treatment guidelines are available at present that may reduce rate of recurrence. Current evidence suggests a ductal pathology behind IGM, which leads to periductal mastitis, leakage and sinus/fistula formation. Thus, excision of the sinus/fistulous tract with en-bloc wide local excision (WLE) of the lesion could be curative. The objective of this study was to look for the basic aetiology of IGM and evaluate the effectiveness of WLE with total or partial duct excision as a curative approach. An institutional prospective comparative study was conducted over 4 years (2015-2019), in which 59 cases of IGM were randomly divided into three groups. After necessary investigations, patients in group A received steroid therapy, those in group B received WLE and patients in group C received WLE with total or partial duct excision as the mode of treatment. Postoperative follow-up was between 6 months and 3 years. Histopathological examination (HPE) was found to be the most suitable diagnostic procedure. Patients in group B showed the highest rate of recurrence (73.6%), followed by group A (35.0%) and group C (5.0%). Patients in group C had a significantly lower chance of recurrence compared with both group A and group B (p<0.05). HPE reports of excised ducts from patients in group C showed ductal disruption and leakage along with periductal granuloma in 70% of cases. The presence of duct granuloma indicates the association of ductal pathology in IGM. IGM is therefore a disease of the mammary ducts and en-bloc duct excision is curative in non-responding cases.

A Case of Subareolar Abscess in a Male Breast: Usefulness of Fine Needle Aspiration Cytology

A Case of Subareolar Abscess in a Male Breast: Usefulness of Fine Needle Aspiration Cytology

Modified techniques versus Hadfield\u2019s procedure in patients with periductal mastitis

BackgroundPeriductal mastitis (PM) is a rare disease characterized by chronic inflammation of the terminal mammary ducts. Complete removal of terminal lactiferous ducts with Hadfield procedure is a previously defined technique in treatment but carries various complications risks. This study aims to evaluate the effectiveness of modified techniques in the treatment of PM.MethodsTwenty women who underwent surgery due to PM between January 2012 and December 2019 were retrospectively analyzed. Types of PM were determined. All patients were operated on with three different incisions [Hadfield’s operation with periareolar incision (n:11), periareolar combined radial incision (n:7), and round block incision (n:2)].ResultsThe mean age was 37.5 ± 6.5 years (range: 24–49). Sixty percent of patients had type 3 PM. In Hadfield’s procedure, NAC retraction (n:2), seroma (n:1), and hematoma (n:1) were seen. In the periareolar incision combined radial incision group only one patient had complications (seroma) and none in the round block method. Follow-up was 12 ± 1.5 months and disease relapse occurred in two patients in the Hadfield group. Patients who underwent round block were more satisfied with the appearance of the nipple.ConclusionsIn the treatment of PM, the main principle of surgical treatment is the excision of the affected canal with a clear margin. Apart from the classical Hadfield procedure, the round block method and periareolar combined radial incision techniques can be performed in the treatment of PM.

Pattern of benign breast diseases in Abakaliki, South Eastern Nigeria, A 5 year retrospective study

Background: There is a rise in the trend of benign breast diseases (BBDs) currently; this is made possible through public awareness of the disease. Aim: To determine the pattern of BBDs in a 5-year retrospective study was the aim of this study. Materials and Methods: A 5-year retrospective study and all histopathologically proven BBDs from January 2015 to December 2020 were reviewed. Software, version 21 of the statistical package for the social sciences (SPSS) was used for data analysis. Results: Cases of BBDs diagnosed within the study period were 143 and were made up of 5 (3.5%) males and 138 (96.5%) females, with a ratio of 1: 28. Among the females, the most commonly affected age group was 21–30 years contributing 57.8% (80/138), followed by ≤20 years contributing 36.2% (50/138). Among males ≤20 years of age group are mostly affected and contributing 60% (3/5). Fibroadenoma accounted for 62.9% (90/143), followed by fibrocystic disease (FCD) contributing 16.8% (24/143). The less common breast diseases in this study were fat necrosis, lipoma, granulomatous mastitis, periductal mastitis, and cysticercosis accounting for 0.7% each. Conclusion: Fibroadenoma remains the most common BBD although higher than in the earlier study, followed by FCD in our centre. Females constituted most of the affected individuals (21–30 years). The practice of breast self-examination should be encouraged to detect and treat lumps which may be malignant early enough to reduce morbidity and mortality.

Six Cases of Male Subareolar Abscess

Six Cases of Male Subareolar Abscess

Idiopathic granulomatous mastitis: introducing a diagnostic algorithm based on 5years of follow-up of 152 cases from Turkey and a review of the literature.

The goals of this study were to report our clinical experience in a single center at a high-volume tertiary university hospital in Istanbul and to introduce a diagnostic algorithm based on a 5-year follow-up of 152 women with biopsy-proven idiopathic granulomatous mastitis (IGM). IGM is an uncommon, non-malignant, chronic inflammatory disease of the mammary gland with an unknown etiology. The symptoms, clinical presentation, and radiologic findings of IGM may resemble carcinomas. To our knowledge, this study comprises the largest series of IGM, especially with a 5-year follow-up, yet reported in the English literature. The present study reported our single-center clinical experience at a tertiary university hospital in Istanbul, Turkey, and introduced a diagnostic algorithm using our treatment protocol based on a 5-year follow-up of 152 women with biopsy-proven IGM. Our database of 10years' experience containing over 700 patients with IGM was evaluated. However, to assess recurrence and resistance to treatment, only the 152 patients with a long follow-up period of 5years were included in the study group. The analysis included 152 women with biopsy-proven IGM who were treated between January 2009 and March 2014. The clinical data of the presentation, histopathology, and treatment modalities were analyzed by reviewing the medical records. Of the 152 patients diagnosed with granulomatous mastitis, 32 (21%) recovered by expectant management, while 14 (9%) responded to antibiotics, 65 (43%) received corticosteroids, 20 (13%) had antituberculosis medication, 16 (11%) underwent excision, and 5 (3%) responded to non-steroidal anti-inflammatory drugs. Fifty-one patients (33%) had recurrence; of these, 30 achieved a cure with second-line treatment, 16 underwent excision, and 5 achieved a cure with observation. IGM is a rare benign breast disorder, and clinicians need a high index of suspicion to diagnose it, as IGM can be mistaken for breast cancer. Unlike periductal mastitis, IGM does not evolve secondary to nicotine addiction and is typically seen in women of childbearing age with a recent history of pregnancy and lactation. The diagnosis can be challenging, and an evaluation with a multidisciplinary team is necessary. There is no consensus concerning the definitive treatment approach. We suggested a diagnostic algorithm in the present study, using our treatment protocol based on the 5years' follow-up of 152 women.

Clinicopathological evaluation of idiopathic granulomatous mastitis patients: A retrospective analysis from a tertiary care hospital in Turkey

Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory disease of the breast with unknown etiology that is characterized by granuloma formation. We analyzed the clinical, radiological, and therapeutic approaches; the recurrence rate of the disease; and the pathological findings diagnosed with mastitis in a retrospective study. We evaluated a total of 77 patients subjected to core needle or excisional biopsy with preliminary diagnosis of mastitis between January 2017–December 2019 who diagnosed with IGM, nonspecific mastitis/abscess, or periductal mastitis/plasma cell mastitis as a result of their pathological assessment. The mean age was 39.24 ± 10.6. Though 65 patients were diagnosed with IGM (84.4%), other diagnoses were reported as nonspecific mastitis/abscess (n = 9), periductal mastitis (n = 2) and plasma cell mastitis (n = 1). Recurrence occurred in 30 (39%) patients during follow-up. In patients without IGM, the number of 5-year postpartum mastitis diagnoses was significantly higher (p = 0.0008) while number of 2-year postpartum mastitis diagnoses was lower (p = 0.255) compared to those in IGM patients. The rates of axillary lymphadenopathy, bacterial culture, parity, and menopausal status were not different in patients without IGM. Linear correlation analysis did not reveal a significant relationship between radiological preliminary diagnosis and pathological diagnosis with BI-RADS classification. A detailed assessment, accompanied with clinical, radiological, and pathological findings, should be performed to achieve an accurate diagnosis and effective patient management in IGM. Furthermore, IGM should always be considered in the differential diagnosis of mastitis among breast masses.