Diagnosis and Treatment of Idiopathic Granulomatous Mastitis (Report of 33 Cases)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 YUEn-qiao ¹ , ZHAOLiu-hua ¹ , TANGZu-xiong ² , ZHAOJing ² ,  LIUJian-xia ²

1. Department of General Surgery, Affiliated Wujiang Hospital of Nantong University, Suzhou 215200, Jiangsu Province, China;
2. Department of General Surgery, The First Affiliated Hospital of SooChow University, Suzhou 215006, Jiangsu Province, China;

Corresponding author：

LIUJian-xia, Email: liujx64@126.com

Keywords：

Mastitis; Granuloma; Diagnosis; Treatment; Steroid

DOI：

10.7507/1007-9424.20150256

Video：

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Objective To summarize the clinical characteristics of idiopathic granulomatous mastitis (IGM) and its experiences of diagnosis and treatment. Method The clinical data of 33 patients with IGM from January 2005 to December 2014 were analyzed retrospectively. Results The mean age of the patients was 33 years. The pathological examination showed that 28 patients (85%) were typical granuloma, and 5 patients (15%) were immature granuloma, whom were confirmed after exclusion of other pathogens. Twenty-nine patients were received drugs treatment, among which 21 patients were cured by taking prednisone orally, 6 patients were cured by the combination of prednisone and methotrexate, 2 patients failed to be cured, and 13 patients relapsed after stopping taking medicine. Four patients with abscess ulceration were received surgical treatment, and 2 patients relapsed after the surgery. Fifteen recurrent patients all were took prednisone and methotrexate orally, among which 1 patient stopped taking medicine because of liver function damage, 1 patient was not fully relieved, and other 13 patients were cured again. Conclusions The clinical manifestations of IGM have no specificities. The diagnosis mainly relies on pathological examination. In the early phase of this disease, the treatment method of steroid or combined immunosuppressant has good effects. In case of ulceration and protracted course, surgical treatment should be considered as early as possible.

Citation： YUEn-qiao, ZHAOLiu-hua, TANGZu-xiong, ZHAOJing, LIUJian-xia. Diagnosis and Treatment of Idiopathic Granulomatous Mastitis (Report of 33 Cases). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(8): 985-988. doi: 10.7507/1007-9424.20150256 Copy

1.	Kessler E, Wolloch Y. Granulomatous mastitis:a lesion clinically simulating carcinoma. Am J Clin Pathol, 1972, 58(6):642-646.
2.	Gautier N, Lalonde L, Tran-Thanh D, et al. Chronic granulomatous mastitis:Imaging, pathology and management. Eur J Radiol, 2013, 82(4):e165-e175.
3.	Kok KY, Telisinghe PU. Granulomatous mastitis:presentation, treatment and outcome in 43 patients. Surgeon, 2010, 8(4):197-201.
4.	Boufettal H, Essodegui F, Noun M, et al. Idiopathic granulomatous mastitis:a report of twenty cases. Diagn Interv Imaging, 2012, 93 (7/8):586-596.
5.	Imoto S, Kitaya T, Kodama T, et al. Idiopathic granulomatous mastitis:case report and review of the literature. Jpn J Clin Oncol, 1997, 27(4):274-277.
6.	Going JJ, Anderson TJ, Wilkinson S, et al. Granulomatous lobular mastitis. J Clin Pathol, 1987, 40(5):535-540.
7.	Akcan A, Akyildiz H, Deneme MA, et al. Granulomatous lobular mastitis:a complex diagnostic and therapeutic problem. World J Surg, 2006, 30(8):1403-1409.
8.	Fletcher A, Magrath IM, Riddell RH, et al. Granulomatous mastitis:a report of seven cases. J Clin Pathol, 1982, 35(9):941-945.
9.	Hugon-Rodin J, Plu-Bureau G, Hugol D, et al. Management of granulomatous mastitis:a series of 14 patients. Gynecol Endocrinol, 2012, 28(11):921-924.
10.	Joseph KA, Luu X, Mor A. Granulomatous mastitis:a New York public hospital experience. Ann Surg Oncol, 2014, 21(13):4159-4163.
11.	Pereira FA, Mudgil AV, Macias ES, et al. Idiopathic granulomatous lobular mastitis. Int J Dermatol, 2012, 51(2):142-151.
12.	Ikeda D M, Hylton N M, Kuhl C K. BI-RADS:magnetic resonance imaging. Breast Imaging Reporting and Data System:ACR BI-RADS-breast imaging Atlas, 2003:1-114.
13.	Binesh F, Kargar S, Zahir ST, et al. Idiopathic granulomatous mastitis, a clinicopathological review of 22 cases. J Clin Exp Pathol, 2014, 4:157.
14.	Van Casteren C, Jacquemyn Y, Himpe E, et al. Idiopathic ganuloma-tous mastitis. BMJ Case Rep, 2012:2012. pii:bcr2012006187. doi:10.1136/bcr-2012-006187.
15.	Diesing D, Axt-Fliedner R, Hornung D, et al. Granulomatous mastitis. Arch Gynecol Obstet, 2004, 269(4):233-236.
16.	Seo HR, Na KY, Yim HE, et al. Differential diagnosis in idiopathic granulomatous mastitis and tuberculous mastitis. J Breast Cancer, 2012, 15(1):111-118.
17.	Dehertogh DA, Rossof AH, Harris AA, et al. Prednisone manage-ment of granulomatous mastitis. N Engl J Med, 1980, 303(14):799-800.
18.	张东伟, 杨学伟, 杨维良, 等. 51例肉芽肿性乳腺炎的诊治分析.中华普通外科杂志, 2009, 24(8):676-677.
19.	Gurleyik G, Aktekin A, Aker F, et al. Medical and surgical treatment of idiopathic granulomatous lobular mastitis:a benign inflamma-tory disease mimicking invasive carcinoma. J Breast Cancer, 2012, 15(1):119-123.
20.	Ocal K, Dag A, Turkmenoglu O, et al. Granulomatous mastitis:clinical, pathological features, and management. Breast J, 2010, 16(2):176-182.
21.	Akbulut S, Yilmaz D, Bakir S. Methotrexate in the management of idiopathic granulomatous mastitis:review of 108 published cases and report of four cases. Breast J, 2011, 17(6):661-668.
22.	Kim J, Tymms KE, Buckingham JM. Methotrexate in the manage-ment of granulomatous mastitis. ANZ J Surg, 2003, 73(4):247-249.
23.	陈迪, 章乐虹.类固醇激素联合甲氨喋呤治疗肉芽肿性小叶性乳腺炎一例.中华乳腺病杂志:电子版, 2010, 4(6):754-756.
24.	Schmajuk G, Genovese MC. First report of idiopathic granuloma-tous mastitis treated with methotrexate monotherapy. J Rheumatol, 2009, 36(7):1559-1560.
25.	Kayahan M, Kadioglu H, Muslumanoglu M. Management of patients with granulomatous mastitis:analysis of 31 cases. Breast Care (Basel), 2012, 7(3):226-230.
26.	Néel A, Hello M, Cottereau A, et al. Long-term outcome in idiopathic granulomatous mastitis:a Western multicentre study. QJM, 2013, 106(5):433-441.
27.	Al-Khaffaf B, Knox F, Bundred NJ. Idiopathic granulomatous mastitis:a 25-year experience. J Am Coll Surg, 2008, 206(2):269-273.
28.	Lin CH, Hsu CW, Tsao TY, et al. Idiopathic granulomatous mastitis associated with risperidone-induced hyperprolactinemia. Diagn Pathol, 2012, 7:2.

1. Kessler E, Wolloch Y. Granulomatous mastitis:a lesion clinically simulating carcinoma. Am J Clin Pathol, 1972, 58(6):642-646.
2. Gautier N, Lalonde L, Tran-Thanh D, et al. Chronic granulomatous mastitis:Imaging, pathology and management. Eur J Radiol, 2013, 82(4):e165-e175.
3. Kok KY, Telisinghe PU. Granulomatous mastitis:presentation, treatment and outcome in 43 patients. Surgeon, 2010, 8(4):197-201.
4. Boufettal H, Essodegui F, Noun M, et al. Idiopathic granulomatous mastitis:a report of twenty cases. Diagn Interv Imaging, 2012, 93 (7/8):586-596.
5. Imoto S, Kitaya T, Kodama T, et al. Idiopathic granulomatous mastitis:case report and review of the literature. Jpn J Clin Oncol, 1997, 27(4):274-277.
6. Going JJ, Anderson TJ, Wilkinson S, et al. Granulomatous lobular mastitis. J Clin Pathol, 1987, 40(5):535-540.
7. Akcan A, Akyildiz H, Deneme MA, et al. Granulomatous lobular mastitis:a complex diagnostic and therapeutic problem. World J Surg, 2006, 30(8):1403-1409.
8. Fletcher A, Magrath IM, Riddell RH, et al. Granulomatous mastitis:a report of seven cases. J Clin Pathol, 1982, 35(9):941-945.
9. Hugon-Rodin J, Plu-Bureau G, Hugol D, et al. Management of granulomatous mastitis:a series of 14 patients. Gynecol Endocrinol, 2012, 28(11):921-924.
10. Joseph KA, Luu X, Mor A. Granulomatous mastitis:a New York public hospital experience. Ann Surg Oncol, 2014, 21(13):4159-4163.
11. Pereira FA, Mudgil AV, Macias ES, et al. Idiopathic granulomatous lobular mastitis. Int J Dermatol, 2012, 51(2):142-151.
12. Ikeda D M, Hylton N M, Kuhl C K. BI-RADS:magnetic resonance imaging. Breast Imaging Reporting and Data System:ACR BI-RADS-breast imaging Atlas, 2003:1-114.
13. Binesh F, Kargar S, Zahir ST, et al. Idiopathic granulomatous mastitis, a clinicopathological review of 22 cases. J Clin Exp Pathol, 2014, 4:157.
14. Van Casteren C, Jacquemyn Y, Himpe E, et al. Idiopathic ganuloma-tous mastitis. BMJ Case Rep, 2012:2012. pii:bcr2012006187. doi:10.1136/bcr-2012-006187.
15. Diesing D, Axt-Fliedner R, Hornung D, et al. Granulomatous mastitis. Arch Gynecol Obstet, 2004, 269(4):233-236.
16. Seo HR, Na KY, Yim HE, et al. Differential diagnosis in idiopathic granulomatous mastitis and tuberculous mastitis. J Breast Cancer, 2012, 15(1):111-118.
17. Dehertogh DA, Rossof AH, Harris AA, et al. Prednisone manage-ment of granulomatous mastitis. N Engl J Med, 1980, 303(14):799-800.
18. 张东伟, 杨学伟, 杨维良, 等. 51例肉芽肿性乳腺炎的诊治分析.中华普通外科杂志, 2009, 24(8):676-677.
19. Gurleyik G, Aktekin A, Aker F, et al. Medical and surgical treatment of idiopathic granulomatous lobular mastitis:a benign inflamma-tory disease mimicking invasive carcinoma. J Breast Cancer, 2012, 15(1):119-123.
20. Ocal K, Dag A, Turkmenoglu O, et al. Granulomatous mastitis:clinical, pathological features, and management. Breast J, 2010, 16(2):176-182.
21. Akbulut S, Yilmaz D, Bakir S. Methotrexate in the management of idiopathic granulomatous mastitis:review of 108 published cases and report of four cases. Breast J, 2011, 17(6):661-668.
22. Kim J, Tymms KE, Buckingham JM. Methotrexate in the manage-ment of granulomatous mastitis. ANZ J Surg, 2003, 73(4):247-249.
23. 陈迪, 章乐虹.类固醇激素联合甲氨喋呤治疗肉芽肿性小叶性乳腺炎一例.中华乳腺病杂志:电子版, 2010, 4(6):754-756.
24. Schmajuk G, Genovese MC. First report of idiopathic granuloma-tous mastitis treated with methotrexate monotherapy. J Rheumatol, 2009, 36(7):1559-1560.
25. Kayahan M, Kadioglu H, Muslumanoglu M. Management of patients with granulomatous mastitis:analysis of 31 cases. Breast Care (Basel), 2012, 7(3):226-230.
26. Néel A, Hello M, Cottereau A, et al. Long-term outcome in idiopathic granulomatous mastitis:a Western multicentre study. QJM, 2013, 106(5):433-441.
27. Al-Khaffaf B, Knox F, Bundred NJ. Idiopathic granulomatous mastitis:a 25-year experience. J Am Coll Surg, 2008, 206(2):269-273.
28. Lin CH, Hsu CW, Tsao TY, et al. Idiopathic granulomatous mastitis associated with risperidone-induced hyperprolactinemia. Diagn Pathol, 2012, 7:2.

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Diagnosis and Treatment of Idiopathic Granulomatous Mastitis (Report of 33 Cases)

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