Treatment and Management Experience of Idiopathic Granulomatous Mastitis in a Low-income Country / Experiência de tratamento e manejo da mastite granulomatosa idiopática em um país de baixa renda

Abstract Objective Reporting our experience of the management and treatment of Idiopathic granulomatous mastitis (IGM) in a low-income country by describing patients characteristics and therapy with emphasis on conservative surgical excision and postoperative care as the cornerstone of treatment. Methods A retrospective cohort of women with histopathological diagnosis of IGM from 2014 to 2018 at Instituto Nacional Materno Perinatal in Lima, Peru. Patients' characteristics, clinical presentation, treatment, management, postoperative care, and follow-up were analyzed. Results Thirty-eight patients with histopathological diagnosis of IGM were identified. Their average age was 35.9 years and 23 (60.5%) reported previous use of hormonal contraceptives. Nine (23.7%) patients had chronic mastitis with previous treatment. The time from the onset of symptoms to the first clinic consult was 5.1 months on average. Twenty-one (55.3%) patients had the lesion in the right breast, with a mean size of 6.9 cm. Conservative surgical excision was performed in all patients. Additionally, 86.8% required corticosteroids and 78.9% were treated with antibiotics. Complete remission was obtained at 141 days on average (range 44 to 292 days). Six (15.8%) women reported ipsilateral recurrence and 5 (13.2%), contralateral. The latency time was 25.5 months on average. Conclusion The conservative surgical treatment demonstrated and close follow-up made for a high cure rate, but with recurrence similar to that reported in the literature. Use of gloves is an alternative to manage post operative wounds in a low-income country. The most frequent adverse effect was breast surgical scar.

The therapeutic dilemma of idiopathic granulomatous mastitis

INTRODUCTION@#Idiopathic granulomatous mastitis (IGM) is a rare, benign, chronic breast condition that can cause repeated abscesses or mass formation in bilateral breasts. The condition can severely impact the quality of life of affected women. This study aims to evaluate effective treatment modalities, as well as understand the demographics and clinical presentation of patients with IGM.@*METHODS@#An 11-year retrospective review was performed of patients diagnosed with IGM from 1 January 2008 to 31 December 2018 at a tertiary breast unit.@*RESULTS@#A total of 77 patients were included in the study. The median age at presentation was 36 years old. IGM presented most commonly as a breast lump (98.1%). The median number of flares was 2 (1-12). Of the 77 patients, 68.8% (53) were treated with antibiotics, 50.6% (39) with steroids, and 44.2% (34) underwent surgery, in the course of their IGM treatment. Forty-five (59.2%) of the 76 patients with IGM required a multimodal treatment approach to achieve remission. There was no significant difference in the number of flares no matter the initial treatment (@*CONCLUSION@#IGM is a clinical diagnosis. It is a rare, relapsing breast inflammatory condition that affects young females with no superior treatment modality. Smoking is associated with higher number of flares of IGM and should be discouraged in IGM patients.

Idiopathic granulomatous mastitis. Diagnostic strategy and therapeutic implications in Omani patients

Idiopathic granulomatous mastitis [IGM] is a rare benign disorder of the breast whose aetiology is controversial, and is often misdiagnosed clinically and radiologically as mammary malignancy; as a result, it may be incorrectly treated. Although no standard treatment is available for this chronic disease, surgery with or without corticosteroids has been tried with controversial results. This study discusses the clinical presentation, diagnosis, management, recurrence, and follow-up data of IGM with a review of relevant literature. From 2009-2012, the Breast Unit at Sultan Qaboos University Hospital, Oman, conducted a clinical study on 20 patients with breast lumps. Their clinical and radiological examinations were indeterminate, and a diagnosis of granulomatous mastitis was established only by histopathology. The majority of the patients were cases of unknown aetiology, who presented with a unilateral breast mass. A few patients had a mass with an abscess, along with axillary lymphadenopathy. A total of 4 patients were suspected of malignancy using radiology. In all patients, sterilised pus was sent for culture and sensitivity. Microscopy showed the characteristic pattern of granulomatous inflammation. All patients were treated with antibiotics for 6 weeks, and the mean follow-up period was 15 months [11-33 months]. All patients had complete remission with no further recurrence. This single largest study of cases of IGM in Oman highlights the pitfalls in diagnosing this non-neoplastic disease of unknown aetiology and uncertain pathogenesis. It emphasises IGM's excellent response to antibiotics, which is crucial, as IGM is a disease which is notoriously difficult and controversial to treat

Mastite granulomatosa lobular idiopática: relato de caso / Idiopatic lobular granulomatous mastitis: case report

Introdução: A mastite granulomatosa lobular idiopática (MGLI) é uma doença inflamatória crônica rara, benigna e autolimitada, cuja etiologia é desconhecida. A incidência permanece incerta, geralmente acomete mulheres em idade fértil com história recente de gestação e aleitamento. Relato de caso: Paciente com 37 anos, feminina, branca. Referia nodularidade em mama direita associada à dor há três meses. Fez uso de antibiótico por trinta dias sem melhora do quadro. Negava febre ou trauma local, não estava amamentando. Ao exame, palpava-se área endurecida, irregular, com, aproximadamente, 11,Ox12,O cm em quadrante superior interno. À ultrassonografia (US) mamária havia diversas coleções em quadrante superior interno e periareolar. Realizada drenagem de coleções em mama direita, bem como biópsia de parênquima mamário. O anatomopatológico foi compatível com MGLI com formação de abscesso. Conclusão: A MGLI é uma condição inflamatória que pode mimetizar neoplasia e abscesso mamários. Os achados do exame físico e radiológicos são inespecíficos. A histopatologia confirma o diagnóstico na presença de granuloma não caseoso em unidades lobulares. Em virtude da tendência à recorrência e à resolução lenta, seguimento prolongado é indispensável.

Introduction: The idiopathic lobular granulomatous mastitis (ILGM) is a rare chronic inflammatory disease, benign and self-limited, whose etiology is unknown. The incicknce remains uncertain, usually affects women of childbearing age with a recent history of pregnancy and lactation. Case report: A 37-year-old, white woman reported nodularity in the right breast associated with pain ftr three months. She used antibiotic ftr thirty days without improvement. Fever or local trauma was not nursing. On examination, there was hardened and irregular area with approximately 11.Oxl2. 0 em in the upper inner quadrant. At ultrasound (US), breast had several collections in the upper inner quadrant and periareolar. The lesion was biopsied and drained. The pathology was compatible with ILGM with abscess. Conclusion: ILGM is an inflammatory condition that can mimic cancer and breast abscess. The findings of physical examination and radiological findings are nonspecific. Histopathology confirms the diagnosis in the presence of noncaseating granuloma in lobular units. Given the tendency to recurrence and slow recovery, extenckd ftllow-up is essential.