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Steroid therapy is known to be effective against granulomatous mastitis. We aimed to compare the efficacy of local versus systemic steroid administration in patients with idiopathic granulomatous mastitis.This prospective cohort study included 58 patients who had either local (n = 42) or systemic (n = 16) treatment due to granulomatous mastitis between 2015 and 2019. Recurrence rates were determined as per ultrasound and magnetic resonance imaging examinations and the rate of side effects was evaluated as per patient complaints and physical examinations at the end of a 2-year follow-up period.Median doses of 140 mg and 3810 mg were administered to the local and systemic group, respectively. Six (14.3%) patients in the local treatment group and 13 (81.3%) in the systemic treatment group had steroid-related side effects. The local treatment group had significantly fewer side effects than the systemic treatment group (P 0.001). The recurrence rates were similar in both groups (P 0.05).Local steroid injection was as effective as systemic steroid therapy. Compared to systemic therapy, local steroid administration can be considered as a new therapeutic protocol with a lower dose and side effect rate.

Background Idiopathic granulomatous mastitis (IGM) is a disease of unknown etiology, involving a chronic inflammatory process, characterized by noncaseating granuloma formation. IGM can mimic a tumor clinically and radiologically. Since we are a tertiary referral center, most of our patients (n = 56, 87.5%) are secondary admissions who have previously had antibiotics and steroid treatments; therefore, we accept these patients as resistant cases. Here, we aim to present our single-center series of 64 patients with resistant IGM who underwent methotrexate monotherapy. To the best of our knowledge, our study includes the highest number of patients described in the literature with IGM who have undergone this treatment. Methods This study included 64 patients, 56 of which were resistant cases, diagnosed with IGM between January 2013 and January 2020 at Istanbul University Cerrahpasa, Cerrahpasa Medical Faculty, General Surgery Breast Outpatient Clinic that were followed-up at least once. These patients were administered oral methotrexate monotherapy 15 mg/week for 24 weeks, and in relapsed cases, the treatment was up to 20 mg/week for 1 year. Folic acid 10 mg/week was given as a supplement to all patients. Results Complete recovery was observed in 52 (81.25%) of the 64 patients. Follow-up was discontinued by 4 patients. The dose was increased and the duration of treatment was extended up to 1 year when relapse was observed in 8 patients and complete response was then obtained in these cases. Only 3 patients (4.69%) experienced side effects and were switched to subcutaneous treatment due to nausea. Conclusion Considering the high patient compliance, low recurrence, minimal side effects, and overall success of the treatment, we believe that methotrexate monotherapy may be used in treatment-resistant IGM patients and may also be the first choice for first-line treatment in the future.

Background Granulomatous mastitis (GM) is a rare entity of benign origin. Multiple treatment strategies, including surgical procedures, can have sequelae of recurrence, nonhealing wounds, and protracted pain. Even after GM is diagnosed, the best management strategy remains controversial. We sought to evaluate intralesional steroid injection as a potential treatment for GM. Materials and methods Electronic medical records from 2003 to 2017 of patients diagnosed with benign breast lesions were retrospectively reviewed. Patients with pathologically confirmed GM were identified. All treatment methods were documented, which included observation, oral steroids, methotrexate, steroid injection, and surgical excision. Primary outcome was time to resolution. Effectiveness was based on relief of symptoms along with duration of symptoms from initial time of diagnosis to full relief. Analysis of variance was used to compare outcomes between groups. Results Of the 49 patients with confirmed GM diagnoses, 57% had observation only, 24% had steroid injection, and 19% had surgical resection. The average time to resolution differed significantly among the three groups (11.5 mo from the start of observation, 2.0 mo from the time of steroid injection, and 0.5 mo from the time of surgical excision, P Conclusions Intralesional steroid injection is an effective treatment of GM. Selective management is appropriate for patients with GM, and surgical resection is not required for most patients.

Background The presentation of idiopathic granulomatous mastitis can mimic breast cancer. Therefore, awareness of the condition is important for surgeons. The current series is the largest in a US population. Methods Retrospective chart review of patients treated at a county, safety-net hospital in Arizona. Cases were identified from January 2006 to January 2019. Sociodemographic information, clinical history, management, and outcomes were collected. Results There were 145 occurrences of idiopathic granulomatous mastitis among 120 women. Most of the patients (92%) were of Hispanic ethnicity and born outside (87%) of the United States. The average age was 35 years. Nearly all patients (95%) were parous, with an average of 3 pregnancies. Most (88%) presented with a palpable mass, and more than half (54%) of these masses were painful. Six patients had prolactinomas or hyperprolactinemia, 11 patients were pregnant, and 5 were postpartum. Early in the time period studied, 6 patients underwent excision of the masses. The remaining 114 underwent planned observation after biopsy confirmation of the diagnosis. Two patients were lost to follow-up, and the other 112 patients with idiopathic granulomatous mastitis resolved spontaneously. Nineteen had more than 1 episode. Average time to resolution was 5 months (range 0–20). Adjusted log-normal regression analysis found that later age of first live birth was associated with greater time to resolution (P Conclusion Idiopathic granulomatous mastitis is a self-limited, benign condition that waxes and wanes and eventually resolves without resection. After diagnosis, medications are unnecessary, and operations can be limited to drainage procedures for fluid collections.

Background Idiopathic granulomatous mastitis is a rare inflammatory breast pathology that, due to its rarity, remain challengeable for diagnosis. The disease has been suggested to have multiple etiologies. In this study the clinical manifestations and risk factors of idiopathic granulomatous mastitis (IGM) were assessed. Methods and materials In this case-control study 30 cases with idiopathic granulomatous mastitis and 60 control subjects in clinical centers in (XXX) in 2020 were enrolled and clinical manifestations and risk factors were determined and compared across the groups. Results The breast mass (40%), pain (23.3%), and discharge (36.7%) were significantly higher in idiopathic granulomatous mastitis versus control subjects (P = 0.001). Passive smoking was seen in 3 cases (10%) and none of the subjects in case and control groups, with significant difference (P = 0.035). Age, contraceptive use, tuberculosis, malignancy, family history, breastfeeding duration, child count, and gravid were significantly different between the groups (P > 0.05). Conclusions Our study showed that breast mass, pain, and discharge are main clinical manifestations in idiopathic granulomatous mastitis cases and passive smoking is the main risk factor for this disease. The role of pregnancy, lactation, smoking and use of oral contraceptive in the etiology of the disease still remains unclear.

Objectives The aim of this study is to review the clinical presentations, diagnostic methods, treatment options and outcome of patients with Granulomatous Mastitis (GM). Material and methods In a retrospective study, we indentified 206 women who met the required histological criteria of (GM). Results Thirty eight (18%) of these women had taken antibiotics before their diagnosis of GM. The most common symptoms in remaining 168 symptomatic women were breast mass. The most common ultrasonographic and mammographic finding was large irregular hypo echoic masses and an irregular mass, respectively. As a diagnostic tool, fine needle aspiration (FNA) was performed in 33 (19.5%) and core needle biopsy with or without ultrasound was done in 92 (55%) of patients while successful rate was 13 (39%) and 87 (94.5%), respectively. The remaining 43 (25.5%) of women underwent surgical excisions. Only 6 (3%) patients improved with antibiotics and 200 (97%) of women who did not respond to antibiotics, were treated with steroid and among them 144 (72%) improved. Treatment with combination of methotrexate and steroid was done in 56 (28%) patients and was effective in 40 (71%) of them. Sixteen (8%) patients were treated with a combination of steroid and bromocriptine which was effective in 5 (31%) patients. A wide surgical excision was performed in 11 (5.5%) patients who were nonresponsive to steroid and methotrexate and bromocriptine therapy. Conclusion Our findings indicate that clinical and imaging findings of (GM) have overlapped with malignancy. The best diagnostic method is core needle biopsy. Corticosteroids are in the first line of treatment with a good therapeutic response.

Background Idiopathic granulomatous mastitis (IGM) is becoming more commonly recognized and reported more often. Currently, many recommend corticosteroids in its management. Methods A retrospective chart review was conducted from January 2002 to June 2013. Data were collected regarding sociodemographic information, clinical history, treatment, and outcomes. Results Thirty-seven patients were found with IGM. Thirty-five patients were Hispanic born outside the United States. Early in the time period reviewed, 5 patients had masses excised and 5 patients were lost to follow-up. Twenty-seven cases of IGM resolved with observation. Corticosteroids were not used in the management. The average time to resolution was 7.4 months. Three patients (11%) had recurrent episodes after resolution. Conclusions IGM is a self-limited benign condition that will resolve spontaneously without treatment. Patience with the natural history of IGM is important, as the process often includes periods of exacerbation before resolution.

Background Granulomatous mastitis is a rare benign breast condition commonly affecting women of child-bearing age. It is characterised histopathologically by the presence granuloma and microabscess formation. It is frequently mistaken for inflammatory breast carcinoma both clinically and mammographically. The aim of this study was to retrospectively review the clinical presentation, radiological investigation, histopathological features, treatment and outcome of granulomatous mastitis of women presenting to Ripas Hospital between October 1997 and June 2009. Results Forty-three patients with a mean age of 34 years presented with a diagnosis of granulomatous mastitis. All patients presented with a palpable breast lump; 24 (56%) patients also experienced pain in the lump and 3 (7%) patients also had associated nipple discharge on presentation. The role of radiological imaging is found to be limited in differentiating GM from other inflammatory and malignant conditions of the breast. Forty (93%) patients underwent a surgical procedure as the main treatment; in the form of excision or incision and drainage of the breast lesions. Mean follow-up was 15 (range 1–80) months with recurrence in 10 (23%) patients. Conclusion Granulomatous mastitis presents clinically with a palpable breast lump. The diagnosis is often only made histopathologically after surgical excision or core biopsy. Complete surgical excision or incision and drainage of the lesion are the main treatment modalities. Treatment with corticosteroids and immunosuppression remains controversial and there is tendency for this condition to recur after treatment.

In both women and men, breast lumps are the most common presentation of breast cancer. The following cases illustrate the pathological entity of granulomatous mastitis, which can present simulating breast cancer – including the first description of this condition in a male. These cases demonstrate the difficulty in clinical diagnosis and emphasizes that although there may be clues from the history, clinical awareness that this condition can mimic breast cancer in all aspects of the triple assessment process should arouse suspicion. The importance of histological diagnosis by core or excision biopsy is stressed, as with accurate diagnosis of granulomatous mastitis there is a mandate to avoid unnecessary surgery.

Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory lesion of the breast clinically simulating carcinoma. The purpose of this report is to review the clinicopathological features of this clinical entity in a series of 18 cases diagnosed in our institute. The notes of patients and the slides of the biopsy specimens of 18 cases with IGM were reviewed. Special stains for organisms and immunohistochemistry for T and B markers using the primary antibody was done. The diagnosis of IGM was made according to the criteria of Kessler and Wolloch. All but two patients were of reproductive age and all were parous. The main clinical finding was a unilateral, firm, discrete mass. All patients underwent excisional biopsy and recurrence was seen in three patients. In two of these patients who had recurrences, the prolactin level was high and reexcision combined with antiprolactinemic therapy was performed. The third patient was treated by reexcision and oral prednisone. There was granulomatous inflammation, centered mainly on breast lobules in all patients. T cell domination was observed. Exclusion of the other causes of a granulomatous lesion is necessary to make the diagnosis of IGM. The treatment of choice is unclear. Because of the clinical concern of malignancy, fine-needle aspiration cytology or core biopsy can be useful in some cases. To differentiate it from other granulomatous lesions, incisional biopsy or surgical excision of the lesion is necessary. In patients with delayed wound healing or recurrence after excisional biopsy, or those patients who have had an incisional biopsy only, if prolactin level is normal, reexcision and oral prednisone usage may be curative. In patients with a high prolactin level who have recurrence, medical treatment to control prolactin level may be useful in the management of these women.

Digital Mammography (DM) is extensively used for breast imaging however, lesion visibility is often limited by overlapping tissues, which affects lesion characterization. Digital breast tomosynthesis (DBT) reduces the effect of overlapping tissues and helps in revealing obscured findings. We aimed to describe the mammographic findings in granulomatous and non-granulomatous mastitis and assess the utility of adjunctive DBT in lesion characterization.DM and DBT images of histo-pathologically diagnosed cases of granulomatous (GM) and non-granulomatous mastitis (NGM) were reviewed according to the BI-RADS lexicon. Presence of contiguous/ interconnected lesions, tubular densities, interspersed hypodensities/fat densities within the involved areas were also assessed. The perceived utility of adjunct DBT was scored from 0-2.Of 33 reviewed patients (24 GM, 9 NGM; median age 39 years, range 24-78); 13/33 (39.4%) were under 35 years of age. DBT detected masses in 24/33 (72.7%), whereas only 15/33 (45.4%) were visible on DM alone. Contiguous or inter-connected lesions were found in 10/33 (30.3%) cases. Tubular extensions were seen in 14 cases and interspersed hypodensities in 15. None of the enlarged lymph nodes had irregular shape or indistinct margins or loss of fatty hilum. DBT was able to categorize more lesions as BIRADS 4a or below, as compared to DM alone.Mammographic presence of multiple contiguous iso-dense masses, reniform contour of axillary lymph nodes with preserved fatty hilum despite a large area of breast involvement favour a benign etiology; especially if DBT reveals tubular extensions or lesions with inhomogenous low density areas within.

compounds with anticancer and antitumor activity. Onchidium is an airbreathing and shell-less sea slug from gastropod mollusc in the family Onchidiidae, that is distributed with a good abundance in Persian Gulf. Methods: Adult Onchidium were collected from Persian Gulf during spring of 2010. Eggs were freeze dried and used for protein extraction by homogenization in acid acetic (0.1N). After centrifugation, supernatants were freeze dried. Freeze dried extract dissolved in ammonium acetate buffer and it was subjected to gel filtration on a Sephadex G50 column (1.4×60). Purified molecules were separated by SDS-PAGE under denaturing conditions in 12.5% polyacrylamide gels which was calibrated with SDS-PAGE polypeptide high range standards. A 320 kDa protein separated and their in vitro anti-proliferative and cytotxic effects on human breast cancer cell line (T47D in RPMI-1640 culture medium) examined by MTT assay. Results: This protein showed growth inhibitory activity against T47D cells with LC50 values ranging 0.240 to 0.923 nM. This result suggests that separated 320 kDa protein has potent activity against breast cancer cell line. To understand the mechanism of their anti-cancer action, the effect of this compound on the location of cells in the cell cycle was examined using fluorescent activated cell-sorting analysis. This protein was added to T47D culture medium at varying doses, and then at 24 hr the cells were examined for cell cycle location. The addition of separated 320 kDa protein to these cells caused a dose-dependent block in the cell cycle in the G2/M phase. Conclusion: Although these primeval results showed anti-proliferative capacity of this protein, the modulation of apoptotic pathways deserves further evaluation as an anticancer strategy. Disclosure of Interest: None Declared

Surgery, steroids, and/or observations alone have been proposed for patients with nonlactational mastitis (NLM), but most of these studies were retrospective. The optimal treatment for these patients remains unclear. This prospective, single-arm, proof-of-concept trial aimed to evaluate the feasibility and safety of ductal lavage as a novel treatment for patients with NLM.Eligible patients with NLM received an intraductal infusion of corticosteroids and antimicrobial agents and returned the next day for a breast massage. This cycle was repeated for 2 wk, and we followed up these patients for 1 y. Patients did not receive surgery or steroids after ductal lavage. The primary endpoint was the time to complete response (CR).This trial included 32 patients with a median (range) age of 32 (20-53). Skin erythema and tenderness were the major symptoms. The median (range) visual analog score was 5 (0-9). There were 21 (65.6%), 4 (12.5%), and 7 (21.9%) patients diagnosed as idiopathic granulomatous mastitis, periductal mastitis, and unspecific NLM, respectively. During the ductal lavage, the median (range) number of cannulated ducts at first attempt was 5 (3-8). Ductal lavage significantly reduced the visual analog score and mastitis score (M-score) (P 0.01). Within a median follow-up of 15.6 mo, 93.8% (30/32) of patients achieved CR. The median (range) time to CR was 6 (0.5-21) mo. Three patients (10.0%) relapsed. No adverse events associated with ductal lavage were observed.Ductal lavage for patients with NLM is feasible and safe, and a definitive randomized controlled trial for further investigation is warranted.ClinicalTrials.gov, NCT02794688.

Highlights • Mammary tuberculosis (TM) is an extremely rare condition. • The differential diagnosis between breast cancer and breast tuberculosis is very important. • It was possible to identify the Mycobacterium tuberculosis in between nucleic acid probes and PCR., Introduction Our work has been reported in line with the SCARE criteria [21]. Mammary tuberculosis (TM) is an extremely rare condition (Khanna et al., 2000 [1]). It has been estimated to be 0.1% of breast lesions examined histologically, but it reaches 3–4% in countries such as India and Africa where the disease shows a high incidence. This disease can present a diagnostic problem in radiological and microbiological investigations, and thus extreme caution is necessary. Presentation of case A 26 year-old Eritrean female with a personal history of HIV infection came to our Emergency Department showing generalized limphoadenopathy and weakness in addition to a huge right breast mass. Our examination revealed a tender mass measuring 12 × 10 cm that involved all right breast. Her skin was not erythematous and local temperature was normal. She was painless. Fine needle aspiration (FNA) showed a milky and greenish shaded fluid. Conclusions Nowadays the differential diagnosis between breast cancer and breast tuberculosis is very important, mostly in Italy and in particular in Sicily, where the massive influx of immigrants has compelled physicians to reconsider the presence of !tuberculosis.

Background: Granulomatous lobular mastitis (GLM) is an uncommon benign breast condition characterized by non-caseating Granulomatous inflammation arising from the lobules of the breast. Current therapeutic options include observation, percutaneous aspiration, antibiotics, steroids, methotrexate, and surgical procedures. This study evaluated the effectiveness of therapeutic modalities on the duration of disease and recurrence rate. Study design: A retrospective analysis was performed of clinical, radiographic, and therapeutic data for patients presenting with GLM from January 2008 until October 2018. All patients had a core breast biopsy demonstrating granulomas. Patients with other known sources of granulomas were identified. The use of observation, steroids, methotrexate, abscess aspiration, and surgical procedures was evaluated. Results: There were 285 female patients, predominantly Hispanic (n = 265, 93%) with mean age of 35.6 ± 8.7 years at time of diagnosis. The majority of patients (n = 213, 75%) presented with a mass, mean size 4.2 ± 2.5 cm. Twelve (4%) patients had coexisting autoimmune diseases. Antibiotics were utilized in 217 (76%) patients for courses that averaged 3.4 ± 2.2 weeks. Glucocorticoids were used in 80 (28%) patients, and methotrexate was used in 16 (5%). Incision and drainage or surgical excision was performed for 76 (27%) of patients. The median duration of disease was 16 (IQR: 7–33) weeks and the overall recurrence rate was 22%. Both duration of disease and recurrence rate were highest amongst patients treated with a surgical intervention. Conclusions: The self-limited course of disease and relatively low recurrence rate, in addition to longer disease duration and increased recurrence rate noted in patients treated with incision and drainage and/or surgical excision, appears to justify the infrequent use of surgical procedures in the management of GLM.

Background The oncologic efficacy of breast-conserving therapies has been established in recent decades. Oncoplastic breast surgery (OBS), as a leap forward in breast conservation, offers concomitant techniques of oncologic and plastic surgeries that grant better esthetic results. The outcomes of our oncoplastic surgeries from 2007 to 2012 are reported. Methods A series of 258 cases with breast masses (18 benign and 240 carcinomas) were operated on by OBS techniques and prospectively followed. Neoadjuvant and adjuvant oncologic treatments were also delivered as indicated. Results Free margins were obtained in 95% of cancer patients. During the 26 months of follow-up, local recurrence happened in 7 (2.9%) patients, of which 1 underwent oncologic therapies and 6 underwent completion mastectomy. Complications postponed adjuvant therapies in 3 (1.2%) patients. Postsurgically, metastases were diagnosed in 8 (3.3%) patients. Two patients (.8%) died of cancer. Conclusions Outcomes of OBS are oncologically acceptable with low frequencies of positive margins and recurrence, while cosmetic results are much improved by OBS.

BACKGROUND: Tuberculous mastitis is usually reported in multiparous postpartum women and is an unusual cause of gynecomastia in adolescent men. METHODS: We describe an illustrative case and review all cases of tubercular mastitis reported in men in the English literature. RESULTS: Our search yielded 24 cases of male tubercular mastitis. Most presented with an isolated breast lump. Constitutional symptoms were rare (21.4%), and associated tuberculosis foci, mostly inactive, were seen in 43.8%. Breast parenchymal involvement, chest wall masses, pectoral muscle abscesses, cold abscesses tracking through the chest wall, and empyema necessitatis presented as breast lumps. Fine-needle aspiration cytology was the most common diagnostic modality, and acid-fast bacilli were demonstrable in a minority (33%). A combination of granulomatous mastitis, necrosis, and clinical response to antitubercular therapy was the most common mode of establishing the diagnosis. Most patients responded to antitubercular therapy alone. CONCLUSION: Tubercular mastitis is a rare cause of breast masses in men, and a high index of suspicion can prevent diagnostic delays. Most patients respond to antitubercular therapy alone.

The diagnosis of breast cancer is often made by fine-needle aspiration cytology (FNAC) Over a 4-year period, there were 1104 cases reported as carcinoma by FNAC at the Royal Marsden Hospital and in four of these the diagnosis was subsequently proven to be benign. This is an incidence of 0.36% and represents a positive predictive value in the series of 99.6%. The benign conditions that led to false positive cytodiagnosis were radiation-induced changes, granulomatous mastitis, and fibroadenoma. Although the reliability of FNAC of breast is high, clinicians should be aware of the limitations and pitfalls.

Resume La mastite granulomateuse idiopathique (MGI) est une mastopathie benigne rare. Les auteurs rapportent un cas de MGI dans sa forme bilaterale chez une jeune fille de 15 ans ayant consulte pour une mastite bilaterale. La biopsie a confirme le diagnostic. L’evolution etait bonne apres prescription de corticoides. La mastite granulomateuse pose un reel probleme diagnostique, essentiellement avec le cancer du sein. Le diagnostic de cette entite est histologique. Le traitement, non consensuel, doit etre le moins agressif possible. L’evolution est marquee par le risque de recidive.