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Pin Wang,1– 4 Jia-Zheng Sun,3,4 Hui-Ying Fang,3,4 De-Juan Yang,3,4 Guo-Sheng Ren3,4 1Department of General Surgery, the Third People’s Hospital of Chengdu, Chengdu, People’s Republic of China; 2Center of Breast and Thyroid Surgery, the Third People’s Hospital of Chengdu, Chengdu, People’s Republic of China; 3Chongqing Key Laboratory of Molecular Oncology and Epigenetics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 4Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of ChinaCorrespondence: Pin Wang, Email wangpin109@126.comBackground: Idiopathic granulomatous mastitis (IGM) is a chronic breast condition known for its aggressive nature and tendency for persistence and recurrence. Steroids are commonly used as the first-line treatment for IGM, but issues such as the optimal timing, and duration of treatment remain debated.Methods: We retrospectively analyzed 343 IGM cases treated at the Third People’s Hospital of Chengdu from September 2012 to September 2023. Based on inclusion and exclusion criteria, a total of 188 patients were included in the study. Patients were categorized into lump (78 cases), abscess (81 cases), and sinus tract stages (29 cases) according to their initial diagnosis upon admission. Prednisolone was initiated at 0.75 mg/kg/day, and after effective treatment, the dosage was adjusted by 5– 10 mg weekly, followed by a maintenance dose of 2.5– 5 mg/day. Clinical characteristics, treatment responses, adverse effects, recurrence rates, and follow-up data were assessed.Results: The median duration of prednisone treatment in our study was 87 days (range, 21– 281 days). Positive response rates to prednisolone were 78.2% in the lump stage, 60.5% in the abscess stage, and 62.1% in the sinus tract stage. Continuing low-dose prednisone for 3 months post-effective treatment reduced recurrence rates and side effect risks. Weight gain was the most common side effect (39.36%).Conclusion: Early steroid therapy, especially in the lump stage, demonstrated superior efficacy. Following a regimen of starting with a full dose, tapering slowly, and maintaining a low dose for around 3 months steroids treatment is recommended to minimize recurrence rate and adverse effects.Keywords: Idiopathic Granulomatous Mastitis (IGM), Steroids, Breast, Prednisolone

Idiopathic granulomatous mastitis (IGM) is a debilitating, chronic, inflammatory condition of the breast. Several studies have emerged evaluating intralesional steroid (ILS) injection and topical steroid administration as a treatment for IGM. However, there is a dearth of international consensuses with regards to the management of IGM. Therefore, we have systematically reviewed the effectiveness of ILS in the management of IGM. A systematic search was conducted in PubMed and Cochrane Library databases, the Google Scholar website and by citation searching up to June 15th, 2023. Eight articles were selected and analyzed. A total of 397 IGM patients were included in the review. The mean patient age was 35.7 years, ranging from 23–62 years. The mean pre-treatment diameter of lesions was 27.5 mm. A total of 184 patients were treated with ILS. The mean complete clinical response time was 2.6 months. The overall complete response rate was 92.8%. Complications following ILS were minor, with hematoma, skin atrophy and hyperemia being commonly described, while avoiding the systemic side effects of oral steroid use, such as weight gain and hirsutism, which were the most commonly reported side effects with oral steroids. The recurrence rates in the ILS group (6.6%) appear to be lower than in the oral steroid group (25.8%) and surgery group (26.3%). ILS seem to show a favorable outcome in terms of complete response rate, complete clinical response time and has a lower recurrence rate and complication rate when compared to other intervention strategies. However, more comparative studies with standardized protocols are necessary to ascertain the optimum type, dosage and frequency of ILS regimens.

Summary: Background: Refractory IGM causes patients to use antibiotics, steroid therapy, immunosuppressive agents for a very long time and even leads to surgical procedures resulting in the loss of breast tissue. Hyperbaric Oxygen Therapy (HBOT) is a frequently used method in the treatment of wounds that are difficult to heal. We thought that HBOT would be an alternative treatment method for refractory IGM patients. Methods: It is a retrospective cohort study on refractory IGM patients conducted at three tertiary care treatment centers between January 2021 and July 2023. The patients were evaluated in two groups: those who only took steroid treatment and those who received HBOT and steroid treatment. The demographic and clinical characteristics of the patients, the types of treatment applied and their responses to treatment were evaluated. Results: There were no significant differences generally in the demographic and clinical features in both groups. The incidence of multicentric GM was found to be higher in the HBOT group (66.67 %; p = 0.044). Although the recovery results were similar in both groups, the average daily steroid dose and duration of drug use were found to be higher in the group receiving only steroid treatment (16 mg vs. 4 mg and 270 days vs. 30 days) (p

Abstract Background Cystic neutrophilic granulomatous mastitis is a rare subtype of inflammatory mastitis characterized by a distinct histopathologic pattern, often associated with Corynebacterium species. This entity has been recently distinguished and should be differentiated from other types of chronic idiopathic mastitis due to its specific treatment. Case presentation A 44-year-old North African female patient, gravida 2, para 2, with no significant past medical history, presented with a 4-month history of a painful palpable mass in her left breast, with no history of trauma. Ultrasound imaging showed three lesions in the lower quadrant of the left breast, communicating with a superficial areolar abscess collection, creating a fistulous path to the skin. This ultrasound appearance was suspicious for suppurative mastitis; although, a necrotic tumor could not be ruled out. An ultrasound-guided needle biopsy revealed inflammatory and abscess features of the breast parenchyma without histological signs of malignancy. Steroid therapy and empirical antimicrobial treatment were started, and surgical excision was performed. Histologic features confirmed the diagnosis of cystic neutrophilic granulomatous mastitis. The patient recovered and was discharged due to clinical improvement. Conclusion Cystic neutrophilic granulomatous mastitis is a recently defined entity, and its association with infection by Corynebacterium species can be detected by Gram stain and/or microbiological culture. Various treatment modalities are suggested, but the optimal treatment still requires further investigation.

Background: Granulomatous mastitis is a rare and challenging condition that can mimic malignancy in the breast. This condition often presents with clinical and radiological features that overlap with those of breast cancer, making it difficult to differentiate between the two based solely on clinical assessment. Aims and Objective: The objective of this study is to highlight the diagnostic dilemmas, the clinico-pathological profile of such cases and what enables a correct diagnosis in such cases. MATERIALS AND METHODS: A retrospective study of 5 patients with histologically proven granulomatous mastitis attending OPD/IPD at a tertiary care center in south India during a period of 18 months from Jan 2022 – Jul 23. We present five cases of granulomatous mastitis highlighting the inconsistency of the clinical, imaging and initial biopsy findings, briefly review the relevant literature and discuss the challenges associated with its diagnosis. Results and Conclusion: This study highlights the importance of awareness of granulomatous mastitis and its clinicopathological characterstics. The study also emphasizes that a multidisciplinary approach involving Surgeons, radiologists, pathologists, and medical oncologists is crucial to accurately diagnose and manage this condition. Review of literature revealed few studies highlighting the clinic-radiological and histopathological profile of such cases of granulomatous mastitis mimicking malignancy however such studies are far less and encompass only isolated single case reports or occasional series of 2-3 cases. To our knowledge this is one of the largest case series with 5 cases highlighting the clinicopathological details and the diagnostic dilemmas.

Background: Fine needle aspiration cytology (FNAC) is an important diagnostic modality in palpable breast lesions. This together with imaging modality is important in distinguishing benign from malignant lesions of the breast. Granulomatous/inflammatory mastitis forms a small subset of breast lesions that may present as a breast lump. Clinical and radiological features in these cases may mimic malignant breast pathology. Aims and Objectives: The aim of this study was to study the frequency of granulomatous mastitis and other inflammatory mastitis with respect to other neoplastic lesions of the breast, presented in FNAC clinics and to correlate the cytological findings with the clinical presentation of granulomatous and other inflammatory mastitis. Materials and Methods: A retrospective study was conducted in the Department of Pathology in a tertiary care center in Eastern India for duration of 4 years 5 months. Details of all patients who underwent FNAC for breast lesions during the study period were recorded in terms of their clinical presentation, cytological findings, imaging, and ancillary investigations. The findings were then tabulated in a master sheet and analysis done by descriptive statistics using SPSS 25. Results: A total of 154 cases were included with 5 cases (3.2%) of granulomatous and 12 cases (7.8%) of inflammatory mastitis. Age range for granulomatous/inflammatory mastitis was 20–70 years. Lump and pain were the most common complaints followed by inflammatory skin changes and nipple discharge. Very few cases also showed nipple retractions and very occasional systemic symptoms like fever. History of lactation was seen among five cases. Three cases showed positive acid-fast bacilli in Ziehl–Neelsen stain. Radiology was discordant with cytological findings in three cases, where the former suggested a breast neoplastic process. Conclusion: Granulomatous/inflammatory mastitis is a rarely diagnosed entity in breast cytopathology with no standard guidelines for management. Antibiotics antitubercular therapy and corticosteroids are some proposed lines of medical management. In treatment-resistant cases, wide local excision may be done depending on available resources and surveillance opportunities.

Purpose: Idiopathic granulomatous mastitis (IGM) poses diagnostic challenges due to its diverse clinical and radiological presentations, often mimicking malignancies. This study aimed to assess the diagnostic efficacy of multimodal ultrasound for mass and non-mass enhancements in Dynamic Contrast-Enhanced MRI (DCE-MRI) of IGM and breast cancer. Methods: A retrospective analysis involved patients confirmed histopathologically with IGM and BC. All patients underwent conventional ultrasound (C-US), ultrasound elastography (UE), contrast-enhanced ultrasound (CEUS), and DCE-MRI examinations. Blinded experienced radiologists assessed imaging findings. Diagnostic accuracy, sensitivity, and specificity were calculated for mass and non-mass enhancements. Results: For mass enhancements (ME), multimodal ultrasound demonstrated strong efficacy (AUC = 0.8651, 95 % CI: 0.7431 to 0.9871), exhibiting high sensitivity (83.3 %) and specificity (92.4 %) in differentiating IGM from breast cancer. However, for non-mass enhancements (NME), multimodal ultrasound showed limited accuracy (AUC = 0.6306) with lower sensitivity (65.6 %) and specificity (81.2 %) in distinguishing between IGM and breast cancer. Conclusion: Multimodal ultrasound displayed good diagnostic efficacy for mass enhancements in DCE-MRI for IGM and breast cancer, while for non-mass enhancement patterns, DCE-MRI remains the most valuable radiological modality for comprehensively assessing this condition's complexities.

Abstract Background Idiopathic granulomatous mastitis (IGM) results in notable clinical symptoms and breast deformity. This study aimed to evaluate the clinical feasibility of microwave ablation (MWA) for the treatment of IGM through comparison with surgical excision. Methods From June 2016 to December 2020, a total of 234 consecutive patients admitted to the hospital were retrospectively included in this study. IGM was pathologically confirmed via breast biopsy in all included patients. These patients were divided into the MWA group (n = 91) and surgical group (n = 143) based on the type of treatment. Patients in both groups received oral prednisone prior to intervention. The clinical remission rate, recurrence rate, operative pain, complications, and BREAST Q score were compared between the two groups. Results There were 340 lesions in the MWA group, and 201 lesions in the surgical group were ultimately included. Significant differences in the complete remission rate (96.7% vs. 86.7%, p = 0.020), recurrence rate (3.3% vs. 13.3%, p = 0.020), operation time (48.7±14.6 min vs. 68.1±36.4 min, p

Granulomatous mastitis (GM) is a benign granulomatous condition, and its pathogenesis may be related to autoimmune disorders. Cellular immunity, humoral immunity, immunoglobulins, and complement could all play a role in the disease process, showing certain clinical patterns. Corticosteroids can quickly control disease progression, and immunosuppressants can be used for complex and refractory GM cases. In traditional Chinese medicine (TCM), “healthy qi” is similar to immune system function. For GM with deficient healthy qi, TCM treatments such as internal and external herbal applications can help regulate immune function and shorten disease duration by staged and TCM treatment, regulating viscera, reinforcing healthy qi, and eliminating pathogenic factors.

Abstract Oral corticosteroids represents the most prevalent treatment for idiopathic granulomatous mastitis. Ductal lavage with triamcinolone acetonide and antibiotics followed by observation (DL-OBS) has emerged as a novel strategy, but a comparison of them remains lacking. Here in this multicenter, open-label, non-inferiority, randomized trial (ClinicalTrials.gov identifier: NCT03724903), we assigned 140 patients to oral corticosteroids (N = 71) and DL-OBS (N = 69), stratified by baseline M-score. The primary outcome is complete Clinical Response rate at 1 year. The non-inferiority margin is −15%. The primary outcome is 85.5% in DL-OBS and 87.3% in oral corticosteroids (difference: −1.8%; 95%CI, 13.2 to 9.5; Pnon-inferiority = .01) in intention-to-treat population, and 92.6% vs 98.2% (difference −5.6%; 95%CI −13.4 to 2.2; Pnon-inferiority = .01) in per-protocol population, respectively. The most common (>15%) adverse events were Cushingoid, epigastric pain and arthralgia in oral corticosteroids, and irregular menstruation in DL-OBS, respectively. Here, we report that DL-OBS shows similar efficacy to oral corticosteroids but with better safety profile.

Abstract Background Granulomatous mastitis (GM) is a rare, benign, inflammatory breast disease with an unknown etiology that predominantly affects women of reproductive age. The definitive treatment of GM is currently controversial; an appropriate therapeutic strategy has yet to be identified, and the disease’s high recurrence rate remains. This study aims to determine the recurrence rate for each GM treatment strategy to identify the most appropriate treatment modality. Methods The search for relevant articles was undertaken using three international databases, including Medline, Scopus, and Web of Science. Articles published in English until the end of 2021 evaluating the recurrence rate of GM were included. Using Stata 13.0, the pooled incidence and 95% confidence interval (CI) for the recurrence rate were determined. Results Sixty-five eligible studies were included in our study. The recurrence rates of systemic steroid use, topical steroid use, antibiotic use, methotrexate use, observation, drainage, excision, antibiotic use and surgery, steroid use and surgery, antibiotic and steroid use, methotrexate and steroid use were 24% (95% CI: 21–27%), 11% (95% CI: 6–21%), 18% (95% CI: 14–22%), 13% (95% CI: 7–22%), 11% (95% CI: 7–17%), 65% (95% CI: 50–78%), 13% (95% CI: 10–16%), 23% (95% CI: 14–36%), 7% (95% CI: 5–11%), 11% (95% CI: 6–18%), and 4% (95% CI: 2–8%), respectively. Drainage had the highest recurrence rate, while combined methotrexate and steroid treatment had the lowest rate. Conclusion The optimal treatment strategy for GM depends on the disease’s severity, consequences, and the patient's features. The study results indicate that combination therapy is preferable for minimizing the risk of relapse and reducing treatment complications.

Objective: Idiopathic granulomatous mastitis (IGM) is a benign inflammatory breast disease of unknown etiology that affects women in their reproductive period. The most commonly preferred option as first-line treatment is steroids, but the lack of a standard treatment protocol and high recurrence rate after treatment constitutes a recurring challenge during its management. The aim of this study was to investigate whether the decision to end the treatment should be made radiologically or clinically. Materials and Methods: This retrospective cohort study included IGM patients who had complete clinical recovery with steroids and were followed for a minimum of 30 months. Patient demographics, disease severity and findings, treatment regimens and duration, and magnetic resonance imaging (MRI) findings at clinical recovery were assessed for their relation to recurrence. Results: Eighty-nine patients who were clinically completely healed after steroid treatment for IGM were included in the study. At the time of clinical healing, 51 (57.3%) patients had a complete radiological response and 38 (42.7%) had a partial radiological response (PRR) on MRI. Overall, recurrence developed in 22 (24.7%) patients after a median 38.6-month follow-up. Patients who experienced recurrence were significantly older and had PRR when their treatment was stopped upon clinical healing. Conclusion: During the process of clinical healing, the imaging findings revealed that the remaining disease seems to be a significant predictor for recurrence in IGM patients. In patients with PRR, extending the treatment with either prolonged steroid therapy or by surgical excision of the occult residual disease may prevent recurrences in IGM patients.

Introduction: Granulomatous inflammatory lesions of the breast can be considered as primary or idiopathic inflammation of the breast; therefore, investigating the relationship between inflammatory parameters including neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio can be useful in the prognosis of idiopathic granulomatous mastitis. The present study was conducted with aim to investigate the relationship between blood parameters related to lymphocytes in response to the treatment of idiopathic granulomatous mastitis (IGM). Methods: This prospective cohort study was conducted in 2020 on 34 patients with IGM referred to the breast clinic of Kurdistan University of Medical Sciences. The course of lymphocyte parameters with disease symptoms, diagnostic and treatment process were measured. For patients with a definite diagnosis of IGM, if there was a mass, aspiration was performed under ultrasound guidance, and needle sampling and routine tests, including complete blood count were performed. The evaluation time was at the beginning of the diagnosis, one month and 6 months after the complete blood count. Data analysis was done using SPSS statistical software (version 24) and variance analysis and Tukey tests. P0.05). Also, no significant relationship was observed between the variables of mass number, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio with the treatment outcome in the examined patients (P>0.05). Conclusion: According to the results, it can be said that referring to the mean ratio of neutrophil to lymphocyte and platelet to lymphocyte is not a reliable indicator to evaluate the response to the treatment of IGM.

Introduction: Idiopathic granulomatous mastitis is a rare chronic inflammatory disease of the breast with unknown causes. Despite of developed countries, the incidence of this disease is increasing in Middle Eastern countries. The many challenges related to the etiology of this disease make it necessary to have a comprehensive study to investigate the underlying causes and achieve a better treatment; therefore, the present study was conducted with aim to investigate the underlying causes of granulomatous mastitis.Methods: In this systematic review study, in order to find related articles, PubMed, Web of Science, Embase, Google Scholar, Cochrane Library and Scopus databases were searched with suitable keywords including granulomatous mastitis, risk factors, and mastitis. The search was done in English language and continued from March 2021 to June 2022. The screening process of articles was done at the title, abstract and content levels, respectively. The required information of the articles with inclusion criteria was extracted and entered into the SPSS software, and finally the results were interpreted according to the general conditions of the study.Results: A total of 71 articles with a total sample size of 4735 patients were included in the study. The mean age of the patients was 34.98 ± 8.46 years. In terms of race, 3749 (79.17%) of these patients were Caucasian. Also, 3251 (91.47%) of the patients mentioned a history of pregnancy and 2721 (83.67%) a history of breastfeeding. The history of taking contraceptive pills (22.79%), smoking (13.88%), trauma (5.7%) and high prolactin tests (19.7%) were also measured.Conclusion: According to the results of this study, Caucasian race, history of pregnancy and breastfeeding, and the use of contraceptive hormones are the most factors related to this disease.

We present the case of a 42-year-old Hispanic patient who consulted with a left breast mass that showed clinical and imaging signs of breast cancer. During preprocedural examination before needle biopsy, the patient was found to have bilateral, purplish-brown skin lesions on her lower legs, suggestive of erythema nodosum. This clinical finding raised the diagnostic suspicion of granulomatous mastitis, which was later confirmed by histopathology. Granulomatous mastitis is a rare, nonmalignant entity that should be considered in patients of childbearing age who present with a breast mass. The coexistence with erythema nodosum contributes to the clinical suspicion of granulomatous mastitis; the mechanism of this association and the optimal treatment approach remain unknown.

Yifei Zeng,1,2 Dongxiao Zhang,1 Na Fu,1 Wenjie Zhao,1 Qiao Huang,1 Jianchun Cui,3 Yunru Chen,4 Zhaolan Liu,4 Xiaojun Zhang,5 Shiyun Zhang,6 Khattak Mazher Mansoor3 1Department of Galactophore, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People’s Republic of China; 2Beijing University of Chinese Medicine, Beijing, People’s Republic of China; 3Liaoning Provincial People’s Hospital (Department of Thyroid and Breast Surgery, People’s Hospital of China Medical University), Shenyang, People’s Republic of China; 4Centre for Evidence-Based Chinese Medicine, School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, People’s Republic of China; 5Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China; 6Guang’ Anmen Hospital, China Academy of Chinese Medical Science, Beijing, People’s Republic of ChinaCorrespondence: Dongxiao Zhang, Department of Galactophore, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23, Art Museum Back Street, Dongcheng District, Beijing, 100010, People’s Republic of China, Tel +86 17862968916, Email morningdong@163.comBackground: This study aimed to explore the risk factors and clinical characteristics of granulomatous mastitis (GM) using a case-control study and establish and validate a clinical prediction model (nomogram).Methods: This retrospective case-control study was conducted in three hospitals in China from June 2017 to December 2021. A total of 1634 GM patients and 186 healthy women during the same period were included and randomly divided into the modeling and validation groups in a 7:3 ratio. To identify the independent risk factors of GM, univariate and multivariate logistic analyses were conducted and used to develop a nomogram. The prediction model was internally and externally validated using the Bootstrap technique and validation cohort. The receiver operating characteristic (ROC) curve and calibration curve were used to evaluate the discrimination and calibration of the prediction model. Decision curve analysis (DCA) and clinical impact curve (CIC) were used to evaluate the clinical significance of the model.Results: The average age of GM patients was 33.14 years (mainly 20– 40). The incidence was high within five years from delivery and mainly occurred in the unilateral breast. The majority of the patients exhibited local skin alterations, while some also presented with systemic symptoms. On multivariate logistic analysis, age, high prolactin level, sex hormone intake, breast trauma, nipple discharge or invagination, and depression were independent risk factors for GM. The mean area under the curve (AUC) in the modeling and validation groups were 0.899 and 0.889. The internal and external validation demonstrated the model’s predictive ability and clinical value.Conclusion: Lactation-related factors are the main risk factors of GM, leading to milk stasis or increased ductal secretion. Meanwhile, hormone disorders could affect the secretion and expansion of mammary ducts. All these factors can obstruct or injure the duct, inducing inflammatory reactions and immune responses. Additionally, blunt trauma, depressed mood, and diet preference can accelerate the process. The nomogram can effectively predict the risk of GM.Keywords: granulomatous mastitis, risk factors, case-control study, nomogram, prediction model

PurposeThe major aim of our meta-analysis was to review the effectiveness of various treatment modalities for achieving successful remission and preventing recurrence for women with idiopathic granulomatous mastitis (IGM). This knowledge is instrumental in developing evidence-based guidelines for clinicians to improve management strategies and outcomes for patients with IGM.MethodsA systematic literature search was performed on MEDLINE (Ovid), Embase (Elsevier), PubMed, Cochrane Library, Web of Science, and Google Scholar; studies published to 19 January 2022 were included. A meta-analysis of 57 observational studies was performed. The results of two randomized controlled trials were also examined.ResultsThere were 3,035 IGM patients across the observational and randomised studies. Overall recurrence and remission rates across all treatment strategies in 59 studies are 87.9% (2,667/3035) and 13.5% (359/2667), respectively. The studies reported 19 different treatment strategies, comprising observation, medical monotherapies, surgery, and combinations involving medical therapies, with and without surgery. Among monotherapy treatment, surgical management had the highest pooled remission rate (0.99 [95% confidence interval (CI) = 0.97–1.00]); among combination therapy, this was steroids and surgery (0.99 [0.94–1.00]). Antibiotic monotherapy had the lowest remission rate (0.72 [0.37–0.96]). The highest recurrence rates belonged to treatments that combined antibiotics and surgery (0.54 [0.02–1.00]), and antibiotics, steroids, and surgery (0.57 [0.00–1.00]). Most successful for preventing recurrence were observation (0.03 [0.00–0.10]), methotrexate (0.08 [0.00–0.24]), and steroids and surgery (0.05 [0.01–0.12]). There is a significant association between longer follow-up duration and recurrence rate reported, p = 0.002.ConclusionCombination therapies, especially those incorporating antibiotics, steroids, and surgery, have demonstrated higher remission rates, challenging the use of antibiotic monotherapy. There is an increased emphasis on the need for personalised, multi-pronged approach for preventing IGM recurrence, with longer follow-up care. More prospective future work in IGM research, with standardised diagnostic criteria, treatment protocols, and reporting guidelines will be important for developing treatment protocols and guidelines clinicians can adhere to in the clinical management of IGM patients.Systematic review registration: PROSPERO (CRD42022301386).

Abstract Background Increasing evidence has suggested that Corynebacterium kroppenstedtii is associated with some cases of granulomatous mastitis, mostly based on pathology or microbiology. We aimed to identify the clinical characteristics and treatment regimens for granulomatous mastitis with Corynebacterium kroppenstedtii infection. Understanding these clinical features is essential for patient care. Methods We retrospectively collected data on 201 patients who were pathologically diagnosed with granulomatous mastitis and had microbiological results of either Corynebacterium kroppenstedtii or no bacterial growth and recorded and analysed their demographics, clinical characteristics, and clinical outcomes. Results There were 107 patients in the CK group and 94 patients in the negative group. Sinus formation (x2 = 13.028, p = 0.000), time to complete remission at the first treatment period (Z = -3.027, p = 0.002), diameter of breast mass at first-time medical consultancy (Z = -2.539, p = 0.011) and recurrence (x2 = 4.953, p = 0.026) were statistically significant. Age (Z = -1.046, p = 0.295), laterality (x2 = 4.217, p = 0.121), time to presentation since the last delivery (x2 = 0.028, p = 0.868), BMI (Z = -0.947, p = 0.344), lactation time (Z = -1.378, p = 0.168), parity (x2 = 1.799, p = 0.180), gravida (Z = -0.144, p = 0.885), history of lactational mastitis or abscess (x2 = 0.115, p = 0.734), local trauma (x2 = 0.982, p = 0.322), hyperprolactinemia (x2 = 0.706, p = 0.401), erythema nodosum (x2 = 0.292, p = 0.589), and nipple discharge (x2 = 0.281, p = 0.596) did not demonstrate statistical significance. Regarding recurrence related to therapeutic strategy, except for surgery combined with immunosuppressants (x2 = 9.110, p = 0.003), which was statistically significant, none of the other treatment regimens reached statistical significance. The recurrence rate of patients in the CK group using rifampicin in their treatment course was 22.0% (x2 = 4.892, p = 0.027). Conclusions Granulomatous mastitis accompanied by Corynebacterium kroppenstedtii more easily forms sinuses and has a higher recurrence rate. Both of the clinical characteristics may indicate that Corynebacterium kroppenstedtii plays an important role in the development and progression of granulomatous mastitis. Lipophilic antibiotics may be essential for granulomatous mastitis with Corynebacterium kroppenstedtii infection.

Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory condition of the breast that is commonly found in young women of childbearing age with a history of recent breastfeeding. In our study, we aimed to present the detailed clinical and morphological features of IGM cases, diagnostic clues, and treatment. The most common clinical presentation is a unilateral, breast induration, nipple retraction, and even a multiple sinus formation often associated with an inflammation of the overlying skin. It usually mimics with breast abscess, rarely inflammatory breast cancer. Although etiology is still unknown. Many factors, including autoimmunity, infection, chemical agent, lactation, and hormonal imbalance, are supposed to play a role for etiology. Therefore, thorough history taking, examination, imaging, and histopathology make a proper diagnosis that determines the optimal management to be administered. We are presenting three cases of granulomatous mastitis from our clinical practice with varying clinical features. After the necessary investigation, we diagnose it as IGM. There is no definitive treatment guideline still now. In literature, many therapeutic operations, including conservative treatment, surgery, steroid, and immunotherapy, have been shown. However, we successfully treated this patient by conservative treatment, by incision and drainage, surgical debridement, or by in a combination of both, followed by regular dressing, antibiotics, and other supportive measures with no use of the steroid.

Introduction:For approximately half a century, synthetic steroids have been the most commonly used medical treatment for idiopathic granulomatous mastitis (IGM). We present the outcomes of patients who experienced relapse after systemic peroral steroid treatment (SPST) and achieved remission.Methods:This study included a total of 78 patients who were diagnosed with IGM and started on SPST from 2010 to 2020.Results:The mean age of the patients included in the study was 33.4±6.8 years (minimum-maximum: 19.0-53.0 years) and 94.9% of all patients were premenopausal. After the clinicalopathological diagnosis, while complete remission was achieved in 46.2% of the patients receiving SPST at the first session, 53.8% showed resistance to therapy and/or had a relapse. In the group of patients who experienced relapse, the rate of bilateral disease, abscess drainage, and secondary side effects of SPST were significantly higher (p

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.

Idiopathic granulomatous mastitis (IGM) is a rare inflammatory breast disease that can be clinically and radiologically mistaken for carcinoma. Although its etiology remains uncertain, potential associations with pregnancy, lactation, hormonal imbalances, autoimmunity, smoking, and various microorganisms have been suggested. This study aimed to evaluate the relationship between IGM and oral health. We included 42 female patients diagnosed with IGM based on histopathological evaluations conducted between September 2018 and October 2023. The reference group consisted of 47 female patients with clinically, radiologically, and laboratory-proven non-specific mastitis and 36 healthy female individuals. The oral health of all participants was evaluated by an experienced dentist using the "Decayed, Missing and Filled Teeth" (DMFT) index and the "Simplified Oral Hygiene Index" (OHI-S). The ages of IGM patients included in this study ranged from 29 to 51 years, with a mean age of 34.88 ± 4.87 years. The most common clinical findings were pain (n = 38), palpable breast mass, erythema, induration, and dermal sinus. Comparison of the OHI-S and DMFT index values among participants revealed that those diagnosed with IGM had significantly higher values than those in the reference group (P < 0.05). Our findings suggest a potential involvement of poor oral health in the etiology of IGM. Future studies should consider oral health as a factor in IGM etiology and explore the oral microbiota in samples obtained from the affected tissue.

Idiopathic granulomatous mastitis (IGM) is a noncancerous, chronic inflammatory disorder of breast with unknown causes, posing significant challenges to the quality of life due to its high refractoriness and local aggressiveness. The typical symptoms of this disease involve skin redness, a firm and tender breast mass and mastalgia; others may include swelling, fistula, abscess (often without fever), nipple retraction, and peau d’orange appearance. IGM often mimics breast abscesses or malignancies, particularly inflammatory breast cancer, and is characterized by absent standardized treatment options, inconsistent patient response and unknown mechanism. Definite diagnosis of this disease relies on core needle biopsy and histopathological examination. The prevailing etiological theory suggests that IGM is an autoimmune disease, as some patients respond well to steroid treatment. Additionally, the presence of concurrent erythema nodosum or other autoimmune conditions supports the autoimmune nature of the disease. Based on current knowledge, this review aims to elucidate the autoimmune-favored features of IGM and explore its potential etiologies. Furthermore, we discuss the immune-mediated pathogenesis of IGM using existing research and propose immunotherapeutic strategies for managing this condition.

Introduction: Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory disease of the breast tissue with unknown etiology. Due to the appearance of most cases of the disease in reproductive age and in women with a history of pregnancy and breastfeeding, the present study was performed with aim to investigate fertility indicators in IGM.Methods: This retrospective study was conducted in 2018-2019 on 240 women, including 80 patients with idiopathic granulomatous mastitis and 160 healthy individuals, referred to the breast clinic of Kurdistan University of Medical Sciences-Iran. Data related to the variables of age, BMI, number of pregnancies, duration of breastfeeding, age of first pregnancy, age of first menstrual period and history of taking contraceptive pills were collected by referring to patients' records in order to determine the relationship of each of these variables with the disease. Data analysis was done using SPSS software (version 25) and independent t-test and Fisher test. P0.05).Conclusion: The present study showed that patients with IGM had a higher BMI, more number of pregnancies, and a longer duration of breastfeeding compared to non-affected people; Age, age of first pregnancy, age of first menstruation, and history of OCP use had no significant relationship with IGM.

Corynebacterium spp. are Gram-positive bacteria, and recent studies have proposed a potential link between granulomatous mastitis and Corynebacterium kroppenstedtii infections, posing a challenge in selecting appropriate antibiotics, particularly in pregnant women. A young pregnant woman presented with a palpable lump in her left breast. Subsequent assessment revealed the presence of necrotising granulomatous mastitis attributed to C. kroppenstedtii. Initially treated with amoxicillin/clavulanate, the patient showed no improvement. Consequently, clindamycin was administered based on culture and sensitivity results, which resulted in a favourable response with no recurrence of symptoms. This report aims to emphasise the efficacy of clindamycin as a treatment option for granulomatous mastitis caused by C. kroppenstedtii.

Idiopathic granulomatous mastitis is a rare breast condition of unclear etiology. Its course is often rapidly progressive, slow to resolve, and can have a high rate of recurrence. Clinical presentation can mimic breast abscess, infectious mastitis, and carcinoma of the breast, generating a diagnostic challenge. Histopathological analysis is required to make the diagnosis after common conditions are excluded. There is no standard treatment, however surgical excision, steroid treatment, and observation are commonly reported approaches. Here, we describe a complex case of a multiparous patient presenting with idiopathic granulomatous mastitis at 32 weeks gestation. In this review, we highlight the importance of collaboration amongst a multidisciplinary team for effective diagnosis and treatment. We discuss the use of oral corticosteroids in the antenatal period and illustrate the patient support required to both facilitate successful breastfeeding in the postpartum period and promote recovery.

Mendrika Fifaliana Rakotoarisaona,1 Tsiory Irintsoa Razafimaharo,1 Naina Harinjara Razanakoto,1 Fandresena Arilala Sendrasoa,1 Anne Ducournau,2 Christine Devalland,3 Anne-Sophie Dupond,2 Irina Mamisoa Ranaivo,4 Lala Soavina Ramarozatovo,1 Fahafahantsoa Rapelanoro Rabenja1 1Department of Dermatology, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar; 2Department of Dermatology, Nord Franche-Comté Hospital, Trevenans, France; 3Department of Pathology, Nord Franche-Comté Hospital, Trevenans, France; 4Department of Dermatology, University Hospital Morafeno, Toamasina, MadagascarCorrespondence: Mendrika Fifaliana Rakotoarisaona, Department of Dermatology, University Hospital Joseph Raseta Befelatanana, Rue Dr Davioud Jacques, Antananarivo, 101, Madagascar, Tel/Fax +261 34 61947 34, Email lulubslj@gmail.comIntroduction: Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory disease. Neoplastic and infectious etiologies must be ruled out. IGM is a diagnostic challenge for countries with high tuberculosis endemicity like Madagascar since it may clinically and radiologically mimic breast tuberculosis. We report a case of IGM associated with erythema nodosum in a Malagasy.Case Report: A 29-year-old primiparous woman came to a dermatological consultation for typical erythema nodosum lesions that appeared one month after a breast swelling. She had no particular medical history. Examination revealed typical erythema nodosum lesions on the legs, voluminous tender mass in the right breast. Bacteriological samples and tuberculosis test were negative. Imaging showed mastitis on the right breast with no evidence of malignancy. Histology revealed a non-caseating granulomas on the lobule of the right breast. As part of an etiological work-up, COVID-19 serology was performed with a positive IgG antibody. The diagnosis of IGM associated with erythema nodosum was evocated. The evolution was favorable under systemic corticosteroid therapy.Discussion: The cause of this uncommon lesion remains obscure. The extramammary localizations such as erythema nodosum and arthralgia suggest an autoimmune origin. This pathogenesis is also reinforced by a good response to systemic immunosuppression. In our patient, the etiological assessment of the mastitis revealed a chronic infection with SARS-CoV-2. Histopathology is the gold standard for the IGM diagnosis which demonstrates a lobulocentric granulomas without caseous necrosis. Oral corticosteroid therapy is the initial choice of treatment.Conclusion: Now, with several cases of concomitant IGM and EN reported, dermatologists should be aware that erythema nodosum can be one of the presenting signs of IGM, since the two conditions appear to be associated. The particularity of our case lies in the incidental discovery of SARS-CoV-2 infection. Is a chronic granulomatous disease associated with SARS-CoV-2 infection, a coincidence?Keywords: corticosteroid, erythema nodosum, granulomatous mastitis, Madagascar

Granulomatous mastitis (GM) is a long-term inflammatory disease of the breast that usually occurs in women of reproductive age. Autoimmune mastitis is one of the most common pathological breast conditions necessitating tailored treatment. However, GM as a first clinical manifestation of sarcoidosis is uncommon. Simultaneous occurrence of GM, erythema nodosum (EN), and arthritis, termed "GMENA" syndrome, is a rare clinical entity associated with autoimmune rheumatic diseases. Herein, we report the case of a 31-year-old female patient with GMENA syndrome, who presented with a painful nodule of the left breast. Initial treatment entailed antibiotics under the presumption of a breast abscess, yielding negligible improvement. During this period, the patient developed polyarthritis and bilateral EN on the lower extremities. Histopathologic examination of the breast tissue exhibited noncaseating granulomas. The patient responded positively to prednisolone and methotrexate treatment. Literature review revealed a coherent pattern across GMENA cases. Our findings suggest that the "GMENA" syndrome represents a unique acute manifestation of sarcoidosis and highlight the necessity for heightened awareness, accurate diagnosis, and tailored therapeutic approaches for GMENA syndrome. Further research is warranted to elucidate its cause and optimize patient management. This case highlights the importance of identifying and effectively managing such interrelated clinical presentations.

BackgroundIntralesional steroid injection has recently evolved as a novel treatment modality for localized idiopathic granulomatous mastitis (= IGM). We aimed to explore the therapeutic efficacy of local steroid injections (LSI) in patients with severe IGM.MethodsFifty-one patients diagnosed with severe IGM were included in the study and treated with either local steroid injection (LSI) alone (n = 25) or combined LSI with systemic oral steroid treatment (OST) (n = 26). The local steroid injection protocol included an intralesional triamcinolone acetonide injection into the palpable granulomas every 4-week, and topical administration of steroid-containing pomades twice a day on the affected surface of the breast. Patients with a combined LSI and OST received low-dose oral methylprednisolone (

Idiopathic granulomatous mastitis (IGM) is a rare inflammatory condition of the breast. IGM is a benign condition, and is more typical in women of child-bearing age, with a recent history of pregnancy and breast feeding. Its clinical presentation can mimic inflammatory breast cancer or breast abscess. The etiology of IGM is not well defined, but proposed to be a localized immune reaction to the breast tissue without the presence of an underlying infectious condition.Here we report a case of a healthy 35-year-old female, with no story of pregnancy and lactation, who presented with sudden left breast lump, swelling and pain. She underwent first diagnostic ultrasound of the affected breast, then breast MR imaging was performed. A biopsy of the lesion was obtained, which revealed chronic granulomatous inflammation, confirming the diagnosis of GM. Furthermore, the patient was found to have had hyperprolactinemia secondary to a prolactinoma of the pituitary gland (PitNET) many years before, during her 20s, for which she had been treated with surgery.

Idiopathic Granulomatous Mastitis (IGM) is a benign inflammatory disease of the breast that is difficult to treat, as there is no definitive protocol for management and it has a higher recurrence rate. The present case series presents five patients who exhibited clinical symptoms such as breast swelling, pain and nipple discharge, and were diagnosed with IGM. They were treated with a multimodality approach (surgical and/or conservative management) based on their symptoms. All patients were successfully treated for IGM using the multimodality approach. While a recurrence was observed in one out of five patients, it was further successfully treated with additional conservative management. The proposed multimodality treatment is effective in treating IGM. It eliminates the risk associated with surgical intervention among patients clinically diagnosed with IGM. It also eliminates the risk of corticosteroid side-effects among patients whose initial clinical diagnosis and postoperative histopathological examination is negative for IGM.

Key Clinical Message Idiopathic granulomatous mastitis (IGM) is a challenging chronic inflammatory disease in diagnosis with unknown etiology. Although the most appropriate treatment protocol has not yet been identified, prednisolone was used in our patient as an effective and practical choice in the treatment of IGM. Abstract Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory disease of the breast and mimics disorders such as breast cancer and breast abscess. Due to the uncommon of this disease, there is no definitive etiology, or treatment. A 38‐year‐old woman presented with a 3‐week history of painful right retro‐areolar mass. She had no history of breast trauma and a family history of breast cancer. She had a history of breastfeeding her second child for 12 months in the past year. Diagnostic tests and investigations led to the IGM diagnosis. Therefore, the patient was successfully treated with a course of corticosteroids, but after 2 months, during treatment, she developed Brucellosis. Despite the patient's Brucella infection and treatment with anti‐Brucella drugs, prednisolone as an anti‐inflammatory corticosteroid therapy was influential in the treatment of IGM.

BackgroundAutoimmunity may play a major role in the pathogenesis of idiopathic granulomatous mastitis (IGM). The therapeutic potential of ozone therapy has recently been shown in rheumatological diseases, and this study aimed to assess the clinical efficacy of ozone therapy (OT) in refractory IGM.MethodsPatients with biopsy-verified IGM and incomplete response after steroid therapy (n = 47) between 2018 and 2021 were enrolled. Of these, 23 cases in cohort A had standard treatment with further steroid therapy (ST), and 24 were treated with systemic OT via autohemotherapy (AHT) in addition to steroid therapy (cohort B).ResultsThe median age was 33 years (range, 24–45). Patients in cohort B had a higher complete response rate after completion of a four-month ozone therapy than those in the ST-group (OT-group, 37.5% vs. ST-group, 0%; p = 0.002). At a median follow-up of 12 months (range, 12–35), the patients treated with OT had a lower one-year recurrence in the affected breast than cases in cohort A treated with ST (OT-group, 21% vs. ST-group, 70%; p = 0.001). No significant side effects were observed in patients in cohort B related to AHT. Furthermore, OT significantly decreased the total steroid treatment duration (median week of steroid use; 26 weeks in cohort A vs. 12 weeks in cohort B; p = 0.001).ConclusionSystemic OT increases the complete response rate and decreases the duration of steroid treatment in patients with refractory IGM. Therefore, ozone therapy is an effective, well-tolerated, and safe novel complementary therapeutic modality.

Granulomatous mastitis (GM) is a refractory chronic mastitis, which belongs to the category of “acne mammary abscess” and “ulcer” in Traditional Chinese External Medicine. According to yin-yang syndrome differentiation, the disease can be divided into yin syndrome, yang syndrome, and half-yin and half-yang syndrome. Among them, the theories and treatment of yin syndrome and yang syndrome are relatively comprehensive in Traditional Chinese External Medicine. However, the half-yin and half-yang syndrome lacks a specific theoretical elaboration and treatment system, which is a special and complex syndrome of the disease, limiting the improvement of the clinical efficacy of the disease. The core pathogenesis of GM with half-yin and half-yang syndrome is “obstruction of nutritive and defensive phases, and yin-yang obstruction.” The clinical features are local yin syndrome complicated with yang syndrome, and the disease is lingering and difficult to cure. For syndrome differentiation, it is advisable to “attach more importance to the local while less importance to the whole body.” The treatment should be based on the general principle of “eliminating yin and transforming yang.” For the use of herbs, it is recommended to adopt the methods of “the combination of the herbs in cold and warm nature, mainly with herbs in warm nature, attaching more importance to use the herbs with the function of ascending and less to descending.” Finally, restore the normal circulation of qi and blood as well as the balance of yin and yang to achieve the purpose of treatment.

Ahmet Burak Ciftci,1 Ömer Faruk Bük,1 Kür&scedil;at Yemez,1 Süleyman Polat,1 &Idot;rem Melike Yaz&inodot;c&inodot;o&gbreve;lu2 1Department of General Surgery, Samsun University, Samsun Training and Research Hospital, Samsun, Turkey; 2Department of Pathology, Samsun University, Samsun Training and Research Hospital, Samsun, TurkeyCorrespondence: Ahmet Burak Ciftci, Department of General Surgery, Samsun University, Samsun Training and Research Hospital, Bar&inodot;&scedil; Bulvar&inodot;, Kad&inodot;köy Mahallesi, No: 199 PK:55090 ilkad&inodot;m, Samsun, Turkey, Tel +90 530 527 7302, Fax +90 362 277 8865, Email aburak.ciftci@samsun.edu.trBackground: Idiopathic granulomatous mastitis (IGM) is a rare inflammatory disease of the breast with a high recurrence rate. The serum albumin to globulin ratio (AGR) is a relatively novel biomarker in inflammatory diseases, and one whose role in the recurrence of IGM remains unknown. This study primarily investigated the potential risk factors for IGM recurrence and whether AGR can be used as a predictive factor.Methods: Patients diagnosed with IGM from pathology reports between 2016 and 2021 were enrolled in the study, and their medical records were analyzed retrospectively. The patients were divided into two groups – recurrence and non-recurrence. Clinical, demographic characteristics, and laboratory parameters were compared.Results: Eighty-five patients were included in the study, recurrence being detected in 16 (18.8%) of these, with a median follow-up time of 39.99± 18.93 months. No relationship was determined between childbearing, breastfeeding, disease severity, or therapeutic approaches and IGM recurrence. While AGR was significantly lower in the recurrence group (p < 0.001), neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) results were comparable in the two groups (p = 0.472 and p = 0.421, respectively). Multivariate analysis identified low AGR (odds ratio (OR): 50.7, 95% CI 5.93– 434.1 P < 0.001) and smoking (OR: 4.45, 95% CI 1.04– 18.9 P = 0.044) as independent risk factors for IGM recurrence.Conclusion: The study findings indicated that AGR at a cut-off value of ≤ 1.179 at diagnosis and smoking exhibited a remarkable performance in predicting the recurrence of IGM. Developing new risk stratification systems for IGM recurrences and using AGR in these classifications may increase the success of treatment.Trial Registration: This study was registered with ClinicalTrials.gov, NCT05409586.Keywords: idiopathic granulomatous mastitis, recurrence, albumin-to-globulin ratio, risk factors

Granulomatous Mastitis (GM) is a rare entity encountered in day-to-day practice. Aetiologies range from infections like tuberculosis, lactation, certain medications to being idiopathic. Clinical and radiological pictures in these cases often mimic breast carcinoma that poses diagnostic dilemmas to the treating physician. However, sometimes they may be asymptomatic. Definitive diagnosis is made using cytology followed by histomorphology by demonstration of granulomas, which are collections of histiocytes along with giant cells and inflammatory cells. Ancillary studies like Ziehl-neelsen (ZN) stain, Periodic Acid Schiff (PAS) stain, Cartridge Based Nucleic Acid Amplification Test (CBNAAT) are used to detect or rule out certain aetiologies of granulomatous inflammation. Idiopathic Granulomatous Mastitis (IGM) is mainly a diagnosis of exclusion, where all the possible aetiologies have been ruled out by detailed history and investigations. Treatment approaches are mainly conservative, depending on the cause or may be anti-inflammatory and steroids in case of IGM. Appropriate and timed diagnosis of such cases is essential to prevent over diagnosis of carcinoma and unnecessary mastectomies. This is a series of 14 such cases which were diagnosed using cytology or histology and ancillary tools. They belonged to four categories (namely-Tuberculous mastitis, IGM, Post-chemotherapy GM and sarcoid granuloma of breast). Tuberculous cases shared majority of the series, whereas, sarcoid granuloma was a single isolated entity. All these cases presented with lump in breast with other associated presentations. Immediate tissue diagnosis helped in ruling out malignancy and adopting a conservative approach for management.

Idiopathic granulomatous mastitis (IGM) is a rare benign chronic inflammatory disease of the breast with an unknown etiology, characterized by the presence of sterile non-caseous granulomas and the formation of microabscesses in the lobules of the breast. The exact prevalence of this disease is still unknown. This is mainly due to the relatively small number of the reported cases, as well as the diagnostic difficulties. The aim of the study: to highlight the clinical experience of managing a patient with IGM, to explain the role of pathomorphological examination in diagnostic search, to discuss differential diagnosis and treatment modalities according to the review of English-language literature sources. When the patient visited the clinic, the chief complaint was pain in the right breast. On examination, a painless mass with indistinct border and stone-like density up to 2.5 cm was revealed at the union of the inner quadrants of the right breast. The patient underwent a number of tests: ultrasound, MSCT, mammography, MRI, which were indicative of breast cancer. The final diagnosis was made after the double histopathologically verified examination with differential diagnosis. Considering the young age of the patient, the successful experience of conservative management of patients covered in the world literature, the possible cosmetic effects after surgery, it was decided to treat with cytostatics and glucocorticoids. A 3.5- and 7.0-month follow-up of treatment results by a mammologist showed neither visible pathological changes in the breasts nor palpatory nodular or tumor mass. The state after idiopathic granulomatous mastitis was reconvalescence. The paper also discusses other methods of treatment: surgery, drug therapy such as corticosteroids (topical, oral), immunosuppressants (methotrexate, azathioprine) or a conventional follow-up of patients with mild symptoms. However, considering severe pain and significant aesthetic defects as a result of inadequate therapy, the follow-up is not dominant in the patient management. A delay in the diagnosis can lead to treatment errors, causing chronic changes and increasing the inflammatory size in the breast, influence the severity of the disease and subsequent therapy. Conclusions. The clinical case of the patient with IGM, diagnostic search and effective conservative treatment tactics have been described. The significance and indispensability of pathohistological examination in the diagnostic search have been explained. The most effective treatment regimens for IGM patients have been discussed.

Abstract Background Granulomatous mastitis (GM) is a chronic inflammatory mastitis disease that requires long-term treatment and has a high recurrence rate. Case management has been proven to be an effective mechanism in assisting patients with chronic illness to receive regular and targeted disease monitoring and health care service. The aim of this study was to investigate the application of a hospital-to-community model of case management for granulomatous mastitis and explore the related factors associated with its recurrence. Methods This was a prospective study on patients with granulomatous mastitis based on a case management model. Data on demographic, clinical and laboratory information, treatment methods, follow-up time, and recurrence were collected and analyzed. The eight-item Morisky Medication Adherence Scale (MMAS-8) was used to investigate patients' adherence to medications. Logistic regression models were built for analysis of risk factors for the recurrence of granulomatous mastitis. Results By October 2021, a total of 152 female patients with a mean age of 32 years had undergone the entire case management process. The mean total course of case management was 24.54 (range 15–45) months. Almost all the patients received medication treatment, except for one pregnant patient who received observation therapy, and approximately 53.9% of the patients received medication and surgery. The overall recurrence rate was 11.2%, and “high” medication adherence (RR = 0.428, 95% CI 0.224–0.867, P = 0.015) was significantly associated with a lower rate of recurrence, while the rate of recurrence with a surgical procedure + medication was higher than that with medication alone (RR = 4.128, 95% CI 1.026–16.610, P = 0.046). Conclusion A case management model for patients with granulomatous mastitis was applied to effectively monitor changes in the disease and to identify factors associated with disease recurrence. “Low” medication adherence was a significant risk factor for the recurrence of granulomatous mastitis. Patients treated with medication and surgery were more likely to experience recurrence than those treated with medication alone. The optimal treatment approach should be planned for granulomatous mastitis patients, and patient medication adherence should be of concern to medical staff.

Abstract Background Granulomatous mastitis is a rare inflammatory disease of the breast, typically seen in woman of child-bearing age. No definitive etiology has been described. In rare instances, this condition has been reported to be associated with extramammary manifestations such as erythema nodosum and arthritis. We describe this rare condition in an adolescent female. Case presentation A 16-year-old, Hispanic female presented with right-sided painful breast swelling, polyarthritis, and erythema nodosum on bilateral shins and lower thighs. Physical examination was negative for lymphadenopathy and pulmonary, gastrointestinal, and cardiovascular findings. Ophthalmologic examination for uveitis and serologic tests for autoimmune diseases were negative. Diagnosis of idiopathic granulomatous mastitis was made by exclusion of other etiologies and conditions. Confirmation was made by histopathologic examination demonstrating noncaseating granuloma within breast lobules with neutrophils and microabscess formation. After wide local excision and a short course of trimethoprim–sulfamethoxazole, our patient was placed on naproxen and prednisone, the latter being tapered off over 3 months, with steady and complete resolution of all symptoms. Conclusion This is the first reported case of idiopathic granulomatous mastitis in a pediatric patient who also had extramammary manifestations, including erythema nodosum and polyarthritis. In this case-based review, we summarize the phenotype, risk factors, prognosis, and treatment options of this rare condition, chiefly to make the readers cognizant of such a diagnostic possibility in similar clinical presentation in the future.

Idiopathic granulomatous mastitis (IGM) is a rare, benign, inflammatory breast disease that primarily affects parous women within a period of five years post-partum. Cystic neutrophilic granulomatous mastitis (CNGM) is clinically identical to IGM, but histopathology demonstrates distinct central lipid vacuoles rimmed by neutrophils with an outer cuff of epithelioid histiocytes/granulomas, with inconsistent presence of Coryneform bacteria within the vacuoles. There is no consensus on the treatment for either IGM or CNGM, which may be managed surgically with wide local excision or mastectomy or medically with antibiotics, steroids, and steroid-sparing immunosuppressive agents. We present a 30-year-old woman with plaque psoriasis and CNGM whose breast symptoms resolved after treatment with the tumor necrosis factor alpha (TNF-α) inhibitor adalimumab, which has not previously been described as a treatment option for CNGM.

INTRODUCTION: The objective of this study was to evaluate the volume changes and the findings of deformation in the breasts with granulomatous mastitis and to compare the findings with the contralateral normal breasts. METHODS: This retrospective study included histopathologically proven 15 granülomatous mastitis (GM) patients. Breast diameters in three planes and the volume were measured on Magnetic resonance imaging (MRI). Parenchymal edema, nipple retraction, and deformation of the breast were noted. RESULTS: The measurements were only showed significant increase in sagittal diameter (124.4+-26 mm and 116+-22.9 mm, for diseased and normal breasts, respectively) and volume (329.3 cc [IQR: 245–572 and 281.6 cc [IQR: 217.3–310.3] for diseased and normal sides, respectively) in the breasts with GM when compared with normal side (p

A 36-year-old woman with a 6-month history of painful unilateral mammary nodules and abscesses was initially treated by gynecologists under the diagnosis of idiopathic granulomatous mastitis (IGM). IGM is an entity that has not been described in classical dermatological textbooks and is considered a rare inflammatory breast disease assumingly associated with trauma, infection, or autoimmune system manifestations. In this patient, the lesions were refractory to conventional treatment of IGM comprising of surgical incisions, systemic antibiotics, dexamethasone, and methotrexate. At the initial visit to the dermatology department, a working diagnosis of localized hidradenitis suppurativa (HS) of breast was established, and treatment with systemic doxycycline was initiated. After the diagnostic incisional biopsy, the inflamed nodule deteriorated into a painful ulceration, implying a pathergy phenomenon. Histopathological features were consistent with the granulomatous type of pyoderma gangrenosum (PG). Treatment with systemic methylprednisolone and mycophenolate mofetil was unsuccessful. Subsequently, the patient developed nodules in the inguinal and axillary areas, typical for HS. Finally, adalimumab treatment resulted in the complete resolution of all lesions without relapse even after the biologic therapy was discontinued. Although in this case, IGM was not confirmed histopathologically, we noted several etiopathological and therapeutic similarities between IGM, PG, and HS and summarized them in a unique table. Further observations are needed to ascertain the potential associations among the three entities.

Granulomatous mastitis (GM) is a chronic inflammatory disease of the breast that usually occurs in women of reproductive age. However, GM during pregnancy is unusual and only one case of GM in the accessory breast has been reported so far. Here, we report an extremely rare case of GM in the accessory axillary breast of a pregnant woman. A 24-year-old pregnant woman had persistent pain and swelling in the right axilla that did not improve with antibiotic administration. Despite incision and drainage for subcutaneous abscess, the incised skin gradually became ulcerated, exposing the subcutaneous granulomatous tissue. Corynebacterium species were isolated in the bacterial culture of drained pus. Lower back pain, pain in several joints, and erythema nodosum on the lower legs appeared later. Based on the result of bacterial culture and the above disease course, the patient was clinically suspected of having GM. The axillary mass was surgically removed after childbirth, and the excised mass was histopathologically confirmed as GM. Treatment for GM should be considered individually and carefully in accordance with the patients’ condition. Unnecessary surgery should be avoided. However, early addition of surgical interventions may yield good outcomes, especially for pregnant women because of limited treatment options.

IntroductionGranulomatous mastitis (GM) is a chronic inflammatory breast disease. In recent years, the role of Corynebacterium in GM onset has received more and more attention. This study aims to detect the dominant bacterium in GM patients and analyze the association between clinical characteristics and infectious factors.MethodsIn this study, 88 samples from 44 GM patients, six acute lactation mastitis (ALM) patients, and 25 non-inflammatory breast disease (NIB) patients were divided into a GM pus group, a GM tissue group, an ALM pus group, and a NIB tissue group; then, 16S ribosomal DNA sequencing was used to explore their microbiota. The clinical data of all 44 GM patients were also retrospectively collected and analyzed to determine their relationship with infection.ResultsThe median age of the 44 GM patients was 33 years, and 88.6% of patients had primary-onset cases, while 11.4% were recurrences; additionally, 89.5% of patients were postpartum and 10.5% were nulliparous. The serum prolactin level was abnormal in nine patients (24.3%). Samples from 15 GM patients (34.1%) had a Corynebacterium abundance of >1% (1.08–80.08%), with eight (53.3%) displaying an abundance of >10%. Corynebacterium was the only genus with significant differences between the GM pus group and the other three groups (p < 0.05). Corynebacterium kroppenstedtii was the predominant Corynebacterium species. Among clinical characteristics, a statistical difference in breast abscess formation was observed according to Corynebacterium abundance in Corynebacterium-positive and- negative patients (p < 0.05).DiscussionThis study explored the relationship between Corynebacterium infection and GM, compared the clinical characteristics between Corynebacterium-positive and- negative patients, and provided support for the role of Corynebacterium species-in particular, C. kroppenstedtii-in the pathogenesis of GM. The detection of Corynebacterium can predict GM onset, especially in patients with high prolactin levels or a history of recent lactation.

Objective: Granulomatous mastitis (GM) is a challenging inflammatory disorder of the breast. In this study we aimed to present the detailed clinical and morphological features of GM cases, diagnostic clues for specific and idiopathic etiologies, the difficulties in evaluating trucut biopsies, and the results of different therapeutic approaches. Material and Method: We retrospectively analysed the clinical, radiological and morphological features of 114 GM cases diagnosed with fine needle aspiration, and trucut, incisional, and excisional biopsy. Results: The mean age was 35.8. Only eight cases were older than 45 years. Bilateral involvement was observed in 4 (3.5%) cases. The most common clinical symptoms were breast mass/abscesses, tenderness, and skin changes. Microbiological culture was positive in 4 cases for gram-positive bacteria. Only 3 cases showed a positive tuberculin/PCR test for tuberculosis. The major USG finding was a hypoechoic well-defined or ill-defined mass/abscess; MRI finding was heterogeneous non-mass contrast enhancement. Cases diagnosed with cytology (35 cases) did not have breast malignancy either in their history or clinical follow up period. Fine needle aspiration cytology materials revealed epitheloid granulomas mixed with neutrophils, lymphocytes accompanied by giant cells, and suppurative necrosis. Histopathological reevaluation of 65 trucut/incisional/ excisional biopsies revealed granuloma formation in 65 (100%), Langhans type giant cells in 59 (90.7%), microabscess formation in 41 (63%), caseous necrosis in 1 (1.5%), neutrophilic cysts in 30 (46.1%), eosinophilic infiltration in 48 (73.8%), interlobular inflammation in 14 (21.5%), fat necrosis in 5 (7.6%), ductal ectasia in 6 (9.2%), and lactational changes in 4 (6.1%) cases. Granulomas were lobulocentric in 58 cases, foreign body type/fat necrosis-related in 6 case, and periductular in 1 case. Cystic neutrophilic granulomatous mastitis was observed in one case. We also evaluated the histochemical stains of these 65 biopsies. Only one sample was positive for acido-resistant bacilli (ARB) by the EZN method and one sample was positive for gram-positive bacilli by gram stain. Conclusion: Small, superficial trucut biopsies may cause difficulties in determining the etiology and differential diagnosis of granulomatous mastitis. For optimal management and timing the appropriate therapy, the ideal biopsy procedure, special stains, and a multidisciplinary team consisting of the surgeon, pathologist, and radiologist are the most important issues.

Idiopathic granulomatous mastitis is a rare benign breast disease of unknown aetiology mostly presenting as a breast abscess but not responding to usual conservative management with incision and drainage and frequently mimics breast cancer. We present a case 31-year-old female presented with complaints of right breast pain and redness who was initially diagnosed and treated as a case of breast abscess with repeated incision and drainage and antibiotics but did not improve. Later histopathology revealed granuloma with giant cell reaction and the patient was given a trial of steroids which showed no improvement. Wide local excision with a long course of broad-spectrum antibiotics was performed which led into remission. This case report highlights the importance of considering idiopathic granulomatous mastitis as differentials in non-responding breast abscesses. Histopathology for diagnosis and trial of wide local excision with a long course of broad-spectrum antibiotics as treatment may be done for management.

Granulomatous mastitis (GM) is an underdiagnosed and understudied benign inflammatory disease of the breast whose accurate diagnosis is confounded by mimicry of other breast pathologies (infectious mastitis and abscess, malignancy) and limited clinician knowledge of the disease. GM disproportionately affects minority women, furthering health disparities for a demographic already disadvantaged in the care of breast diseases. The first step in diagnosis is ultrasound followed by core needle biopsy yielding granulomatous inflammation. To far lesser degree, mammography, and MRI may play a role in narrowing the differential. A high index of clinical suspicion and multidisciplinary approach is required. The presence of Corynebacterium kroppensteddti may indicate one subtype of granulomatous mastitis called cystic neutrophilic granulomatous mastitis; disease stratification, and individualized therapy are on the horizon.

Background Although the etiopathogenesis of idiopathic granulomatous mastitis (IGM) is still controversial, recently autoimmunity and immune dysregulation have been emphasized. The aim of this study is to investigate the clinical utility of autoantibodies in IGM. Material and Methods Rheumatoid factor (RF), antinuclear antibody (ANA), anti-double stranded DNA antibody (anti-ds-DNA), anti-cyclic citrullinated peptides antibody (anti-CCP) and perinuclear anti-neutrophil cytoplasmic antibody (pANCA) levels were investigated in pathologically diagnosed IGM patients (Group IGM) and healthy women (Group C). IGM patients were divided into two groups as those with active symptoms and signs (Group IGMA) and those without clinical and radiological findings (Group IGMR). Results While, in Group IGM, the positivity of RF, ANA, anti-ds-DNA, pANCA and anti-CCP was 13.1%, 3.3%, 1.6%, 0%, and 3.3%, respectively, in Group C, they were 13.3%, 0%, 0%, 0%, and 0%, respectively. The differences were not statistically significant (p > .05). In Groups IGMA, IGMR and C, RF positivity was 10%, 16.1%, and 13.3%, respectively. The ANA positivity of Groups IGMA, IGMR and C was 0%, 6.5%, and 0%, respectively. Groups IGMA, IGMR and C’s anti-ds-DNA positivity were 0%, 3.2%, and 0%, respectively. In all groups, pANCA was negative. The anti-CCP positivity of Groups IGMA, IGMR and C was 6.7%, 0%, and 0%, respectively. Conclusion Our findings did not support the clinical utility of autoantibodies including RF, ANA, anti-ds-DNA, pANCA and anti-CCP in IGM.

Idiopathic granulomatous mastitis (IGM) is a rare form of chronic inflammatory breast disease. Although it is a benign breast lesion, it may be sometimes difficult to distinguish from breast cancer. The cause of IGM is unknown, but may be associated with autoimmunity, abnormal hormone levels and infection. While the clinical manifestations of IGM involve various manifestations of inflammation, the diagnosis is principally established by histopathology, characterized by non-caseating granulomas and microabscess formation centered on the breast lobules. Therapeutic options for IGM range from observation to various medical treatments, such as steroids, immunosuppressants, and antibiotics, to surgical intervention, particularly if secondarily infected. Given that the controversy on etiology and treatment choices, we accomplished the present review through reviewing IGM-related literature published in ‘Pubmed’ and ‘Web of science’ databases during 1997 to 2020, aiming to provide the basis for rational clinical diagnosis and treatment.