Granulomatous mastitis in multiparae during pregnancy and lactation: Observational study (STROBE compliant).

ABSTRACT: The incidence of granulomatous mastitis (GLM) in multiparae as seriously affected the quality of life and breastfeeding of pregnant women after delivery, but the treatment is rarely reported. In this article, the development, healing, and lactation of 13 cases were reported and a retrospective analysis was performed. 10 cases of GLM were treated at the Breast Disease Prevention and Treatment Center of Haidian Maternal & Child Health Hospital of Beijing and 3 cases of GLM were treated in the Breast Department of Weihai Municipal Hospital of Shandong province from February 2017 to May 2019.Among the 13 patients, conservative symptomatic treatment was adopted during pregnancy and lactation: anti-infective therapy consisting of oral cephalosporin antibiotic for patients; ultrasound-guided puncture and drainage of pus or incision and drainage after abscess formation. Observation continued during the sinus tract phase. Postpartum breastfeeding was encouraged, especially on the affected side. In this study, the median healing time was 20 months and the average healing time was 30.4 months in 5 healthy breast lactation cases. In 8 cases of bilateral breast lactation, the median healing time was 30 months and the average healing time was 26.5 months. Linear regression test analysis: whether the affected breast was breast-fed after delivery had no effect on the postpartum wound healing time, P = .792. The wounds of 13 patients healed well after lactation, and none of them recurred since the last follow-up visit. There were no adverse events in all infants.Conservative symptomatic treatment for GLM of multiparous women during pregnancy and lactation and encouraging breastfeeding after delivery have no effect on infant health and the recovery time of patients.

Granulomatous lobular mastitis: Clinical update and case study.

BACKGROUND: Granulomatous lobular mastitis (GM) is a rare chronic benign inflammatory breast condition. It can present a diagnostic challenge and mimic inflammatory carcinoma. It causes significant morbidity for affected patients. OBJECTIVE: The aim of this article is to provide a clinical update and case study for general practitioners, who are usually the first to see the patient. DISCUSSION: GM is usually idiopathic. The condition presents with a large painful lump with erythema. There is often ulceration, abscess and sinus formation. Triple assessment is needed to confirm diagnosis. GM may last for 12 months or more before healing occurs. Options for management are conservative/supportive care, oral prednisone or methotrexate, or surgical excision. At present, there is no universally accepted management strategy for GM; therefore, treatment will depend on the symptoms, extent of disease and patient preferences. Supporting the patient in coping with the long-term nature of GM and the chronic discharging lesions is essential.

Factors related to recurrence of idiopathic granulomatous mastitis: what do we learn from a multicentre study?

BACKGROUND: Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory disease of the breast with unknown aetiology. Its treatment is controversial and the recurrence rate is high. The objectives of this study were to examine the demographic, sociocultural and clinical characteristics observed among a large cohort of IGM patients from Turkey and to identify factors related to the recurrence of IGM. METHODS: The study was designed as a multicentre retrospective study including 22 breast centres in Turkey. A total of 720 IGM patients are included in the study. Patient data were obtained from the patient's files and electronic records based on the study protocol. Patients' demographic, clinical, radiological, treatment and recurrence of IGM related characteristics were recorded. RESULTS: Our results revealed a statistically significant association between IGM recurrence and history of pregnancy, breastfeeding, breast infection and smoking (P < 0.05). Having a chronic systematic disease, oral contraceptive, analgesic and herbal medicine consumptions, treatment choice, education, place of birth and current residence were not found to be associated with IGM recurrence (P > 0.05). CONCLUSION: Our findings show that history of pregnancy, breastfeeding, breast infection and smoking were the risk factors for IGM recurrence. As current treatment methods did not affect IGM recurrence, recurrence-related factors, such as breast infection and smoking, should be considered to eliminate while focusing on less invasive local treatment research.

Granulomatous Lobular Mastitis.

BACKGROUND: Granulomatous lobular mastitis (GLM) is a rare disorder that can clinically mimic breast carcinoma. The recommendation for diagnosis and treatment of GLM has not yet been established. OBJECTIVES: To assess a series of GLM patients, including their clinical presentation, diagnosis, treatment and outcome. METHODS: We retrospectively analyzed the clinical data and treatment of 17 female patients with biopsy-proven GLM. Breast tissue was obtained by a core needle biopsy (15 patients) or open biopsy (2 patients). Images were reviewed by an experienced radiologist. RESULTS: The mean age of the patients at diagnosis was 44.6 ± 12.6 years. Five patients (29%) presented with bilateral disease, and seven (41%) presented with a mass, suggesting the initial diagnosis of breast carcinoma. Treatment comprised observation alone (23%), antibiotics (58.8%) and/or corticosteroids (with or without methotrexate) (35%). At the end of the study 70.6% of the patients demonstrated complete remission. None of the patients developed any systemic (granulomatous) disease or breast carcinoma during the follow-up period (4.7 ± 3.8 years). CONCLUSIONS: Core needle biopsy is mandatory for the diagnosis of GLM and the exclusion of breast carcinoma. The recommended treatment modalities are observation alone or corticosteroids; surgery should be avoided. GLM is a benign disease with a high rate of resolution and complete remission.

Mastitis crónica granulomatosa tuberculosa. Diagnóstico y tratamiento en 28 casos / Chronic tuberculous granulomatous mastitis. Report of 28 cases

Objetivos. Realizar un estudio de las características clínicas de la mastitis granulomatosa tuberculosa (MGT), la utilidad diagnóstica de las pruebas complementarias y los resultados del tratamiento en un área geográfica con muy alta incidencia de tuberculosis. Material y métodos. Estudio descriptivo, prospectivo, realizado desde enero de 2010 a mayo de 2012. El diagnóstico de mastitis tuberculosa se estableció mediante la identificación o el cultivo de Mycobacterium tuberculosis, o por estudio molecular (reacción en cadena de la polimerasa) tras biopsia con Tru-cut. También se incluyeron aquellas pacientes con mastitis granulomatosa sin detección de bacilo de Koch, reactores intensos >= 15 mm tras la inoculación del derivado proteico purificado. El tratamiento antituberculoso se realizó en los primeros 2 meses mediante rifampicina 600 mg, isoniacida 300 mg, pirazinamida 1.500 mg y etambutol 1.200 mg. Posteriormente, durante 4 meses, 2 veces por semana con isoniacida 800 mg y rifampicina 600 mg, para aquellas pacientes con resección total de la lesión, y durante 7 meses para las pacientes a las que no se realizó exéresis. Resultados. Se incluyeron 28 pacientes. Se realizó mamografía a 12 (42,8%), con lesiones BIRADS 0 (33,3%), BIRADS III (16,7%) y BIRADS IV (50%), y ecografía mamaria a todas las pacientes. El derivado proteico purificado fue realizado a 27 pacientes (96,4%), siendo el 53,6% reactores intensos y el 25% reactores francos. El diagnóstico de MGT se realizó a través de la histopatología en todas las pacientes. Se realizó tumorectomía completa de la lesión previa al inicio del tratamiento antituberculoso en 24 casos (85,8%). No hubo recidiva de la MGT en ninguna paciente. Conclusiones. El diagnóstico definitivo de MGT debe realizarse mediante el estudio histopatológico debido a la baja precisión de las técnicas de imagen. La utilización del tratamiento antituberculoso oral unido a la cirugía logró en todos los casos la curación de la enfermedad

Objectives. To explore the clinical features of tuberculous granulomatous mastitis (TGM), the diagnostic utility of complementary tests, and the results of treatment in a geographical area with a high incidence of tuberculosis. Material and methods. A descriptive, prospective study was performed from January 2010 to May 2012. The diagnosis of tuberculous mastitis was established by identification or culture of Mycobacterium tuberculosis, or by molecular studies (polymerase chain reaction) after Tru-cut biopsy. We also included those patients with granulomatous mastitis without detection of Koch bacillus but who were intense reactors ( >= 15 mm) after inoculation of purified protein derivative. Tuberculosis treatment was administered in the first 2 months with 600 mg of rifampicin, 300 mg of isoniazid, 1,500 mg of pyrazinamide, and 1,200 mg of ethambutol. Subsequently, twice-weekly treatment with 800 mg of isoniazid and 600 mg of rifampicin was administered for 4 months in those patients with total resection of the lesion and for 7 months in patients who did not undergo resection. Results. We included 28 patients. Mammography was performed in 12 patients (42.8%). The lesions were classified as BIRADS 0 (33.3%), BIRADS III (16.7%) and BIRADS IV (50%). Breast ultrasound was performed in all patients. Purified protein derivative was performed in 27 patients (96.4%); 53.6% were intense reactors and 25% were clear reactors. TGM diagnosis was made by histopathology in all patients. Complete lumpectomy was performed prior to the start of tuberculosis treatment in 24 patients (85.8%). There were no recurrences in any of the TGM patients. Conclusions. Due to the low accuracy of imaging techniques, the definitive diagnosis of TGM should be made by histopathological study. In all patients, cure was achieved with the use of oral tuberculosis treatment together with surgery

Idiopathic granulomatous mastitis. Experience at a cancer center.

BACKGROUND: Idiopathic granulomatous mastitis (IGM) is a benign breast disease that has been described as a rare granulomatous inflammation (GI). It can mimic inflammatory breast cancer. MATERIAL AND METHODS: We included women with a diagnosis of IGM referred to an oncologic hospital between January 01, 2007 and to March 31, 2011, with diagnosis of breast cancer, in whom biopsy reported GI, without other cause related. The aim of this study was to review the clinical, radiologic and pathologic characteristics of a cohort of women with IGM. RESULTS: We analyzed 58 patients; mean age was 38 ± 12 years. Mammography showed diffuse asymmetry (n = 19) and focal asymmetry (n = 13); breast ultrasound showed heterogeneous and hypoechoic areas (n = 28) and lumps (n = 21) as the most frequent lesions. All biopsies showed lobulocentric GI. Treatment included antibiotics (n = 20), steroids (n = 8), both treatments (n = 20), surgical excision (n = 3) and observation (n = 7). Forty-three patients (74%) had complete remission; mean time to remission was 9.5 ± 5.8 months. Fifteen (26%) had partial remission. Any patient had progression or relapse. CONCLUSIONS: IGM is a benign breast condition that may mimic breast inflammatory cancer. Ultrasonography and mammography findings reveal characteristic data that can be useful for establishing the diagnosis; however, biopsy is the gold standard for its diagnosis and should be taken in any patient even with a mild suspicion of cancer.

Mastitis granulomatosa idiopática: lesión benigna de aspecto clínico-radiológico maligno / Idiopathic granulomatous mastitis: a benign lesion with malignant clinical-radiological characteristics

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Mastitis granulomatosa crónica idiopática / Chronic idiopathic granulomatous mastitis

La mastitis granulomatosa crónica idiopática (MGCI) es una enfermedad inflamatoria benigna con una baja incidencia. Se ha asociado a una respuesta inmunológica anormal, la utilización de anticonceptivos orales, así como la existencia de algún organismo infeccioso, como posible causante de una reacción alérgica de tipo cuerpo extraño. Afecta principalmente a mujeres en edad fértil. Generalmente es unilateral y se manifiesta por una o más masas inflamatorias. El aspecto mamográfico puede simular el desarrollo de un carcinoma intraductal, enfermedad de Paget o procesos inflamatorios mamarios de origen benigno de diferentes etiologías. Histopatológicamente se caracteriza por una lobulitis crónica, necrotizante, no caseificante, que presenta formación de granulomas. El diagnóstico de MGCI debe fundamentarse en este patrón histológico combinado con la exclusión de otras lesiones granulomatosas de la mama. Aunque se han planteado varias alternativas terapéuticas, tanto quirúrgicas como médicas, el tratamiento ideal de la MGCI no ha sido aún establecido. Las resecciones quirúrgicas del tejido afectado asociado o no con corticoides orales es la terapia más utilizada (AU)

Chronic idiopathic granulomatous mastitis (CIGM) is a benign inflammatory disease with a low incidence. This entity has been associated with an abnormal immune response, oral contraceptive use and the existence of an infectious organism as a possible cause of an allergic reaction to a foreign body. CIGM mainly affects women of childbearing age, is usually unilateral and is manifested by one or more inflammatory masses. The mammographic appearance may mimic the development of intraductal carcinoma, Paget's disease or benign inflammatory processes of the breast of various etiologies. Histopathologically, CIGM is characterized by chronic, necrotizing, non-caseating lobulitis, which shows formation of granulomas. The diagnosis of CIGM should be established on the basis of this pattern, combined with exclusion of other granulomatous lesions of the breast. Although various medical and surgical therapeutic options have been proposed, the optimal treatment of CIGM has not yet been established. The most commonly used treatment is surgical resection of affected tissue with or without oral corticosteroid therapy (AU)

Mastitis granulomatosa idiopática: revisión de 4 casos diagnosticados y tratados en una unidad de patología mamaria / No disponible

Objetivo: La mastitis granulomatosa idiopática es una enfermedad benigna inflamatoria de la mama poco común con ausencia de manifestaciones específicas. La importancia diagnóstica reside en el hecho que dicha entidad se presenta clínica y radiológicamente como una neoplasia maligna de mama. El diagnóstico de certeza se obtendrá con una biopsia de la lesión y los hallazgos histopatológicos típicos. Se pretende también, aportar nuestra experiencia en el manejo terapéutico dado que los resultados clínicos y estéticos fueron excelentes. Material y métodos: Presentamos 4 casos diagnosticados y entre junio de 2008 y enero de 2011. Resultados: La forma de presentación en 3 de los 4 casos fue la aparición de un nódulo mamario. En un caso la forma de presentación fue una ulceración cutánea con masa subyacente. En todos los casos tras exámenes radiológicos catalogados como de alta sospecha de malignidad se practicó biopsia de la lesión estableciendo el diagnóstico definitivo de mastitis granulomatosa. En 3 de los 4 casos se realizó tratamiento médico con prednisona en pauta descendente con remisión completa de la enfermedad y sin presencia de recidivas. En uno de los casos se procedió a la resección quirúrgica mediante tumorectomía obteniendo un resultado estético pobre con posterior recidiva que se trató exitosamente con corticoides. Conclusiones: La mastitis granulomatosa es un proceso inflamatorio mamario benigno infrecuente con expresión clínica y radiológica que conlleva a sospechar un proceso neoplásico mamario cuyo diagnostico definitivo es el examen histopatológico y con excelente respuesta al tratamiento médico con corticoides(AU)

Background: Idiopathic granulomatous mastitis is a rare benign inflammatory breast disease with no specific manifestations. The diagnostic importance is the fact that this entity presents itself clinically and radiologically as a malignant breast neoplasm. Definitive diagnosis is obtained with a biopsy of the lesion and the typical histopathological findings. It is also intended to contribute the therapeutic management experience as the clinical and aesthetic results were excellent. Material and methods: We present 4 diagnosed and treated cases between June 2008 and January 2011. Results: The way of presentation in 3 of the 4 cases was the appearance of a breast lump. In one case the way of presentation was a skin ulceration with an underlying mass. In all cases after X-ray examinations classified as highly suspicious of malignancy underwent biopsy of the lesion establishing the definitive diagnosis of granulomatous mastitis. In 3 of the 4 patients underwent medical treatment with prednisone in decreasing doses to the complete remission of the disease and free of relapse. In one case we proceeded to surgical resection by lumpectomy obtaining a poor aesthetic outcome with subsequent relapse that was successfully treated with corticoids. Conclusions: Granulomatous mastitis is a rare benign inflammatory breast disease with clinical and radiological expression that leads to suspect a neoplastic breast process which definitive diagnosis is the histopathological examination with excellent response to medical treatment using corticoids(AU)