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BackgroundGranulomatous mastitis (GM) is a benign, chronic, inflammatory disease lacking clear treatment guidelines. The purpose of this American Society of Breast Surgeons (ASBrS) prospective, multisite registry was to characterize the presentation of GM and identify treatment strategies associated with symptom resolution and optimal cosmesis.MethodsASBrS members entered data into a registry on patient demographics, treatment, symptoms, and cosmesis over a 1-year period. Initial symptoms were graded as mild, moderate, or severe. The Chi-square test and logistic regression were used to identify factors related to symptom improvement and cosmesis.ResultsOverall, 112 patients with a mean age of 36 years were included. More patients were Hispanic (49.1%) and from the Southwest (41.1%), and management included observation (4.5%), medical (70.5%), surgical (5.4%), or combination treatment (19.6%). Immunosuppression was used in 83 patients (74.1%), including 43 patients who received intralesional steroid injections. Patients with severe symptoms were more likely to undergo surgical intervention compared with those with mild or moderate symptoms (21.4% vs. 0% and 7.5%, respectively; p = 0.004). Within 1 year, 85 patients (75.9%) experienced symptom improvement and/or resolution at a median of 3 months. Receipt of immunosuppressive therapy was predictive of improvement or resolution at 1 month (odds ratio 4.22; p = 0.045). One-year physician-assessed cosmesis was excellent or good for 20/35 patients (57.1%) and was not associated with type of treatment or symptom severity.ConclusionAlthough GM can have a protracted course, the majority of patients in this registry resolved within 1 year, with good cosmetic result. Treatment with immunosuppression appears to be most beneficial, and a symptom-based algorithm may be helpful to guide treatment.

Background: Granulomatous mastitis is a relatively rare benign inflammatory disease of the breast, but it is sometimes difficult to distinguish from breast cancer by imaging. We experienced a case that was definitively diagnosed as granulomatous mastitis from the surgical specimen. The mass appeared as a large cystic lesion on imaging, which is unusual for granulomatous mastitis, and was initially suspected to be an encapsulated papillary carcinoma. Case presentation: A 43-year-old woman presented with a painful mass in her right breast. Ultrasonography revealed a cystic mass lesion with internal solid components, with partially indistinct cyst walls and abundant blood flow. Additionally, lymphadenopathy of one axillary lymph node was observed. Magnetic resonance imaging findings showed irregularly spreading enhanced nodules within the cystic lesion, raising the suspicion of encapsulated papillary carcinoma. Although the histological findings from a needle biopsy were consistent with granulomatous mastitis, the possibility of malignancy could not be ruled out based on imaging, prompting a diagnostic probe lumpectomy. However, the surgical specimens did not reveal any tumorous lesions, and we reached a final diagnosis of granulomatous mastitis. Postoperatively, the patient was followed-up without steroid therapy and has been free from recurrence of mastitis for 22 months after surgery. Conclusions: We report a case of granulomatous mastitis that was detected as a large cystic lesion with a well-defined border on imaging and a definitive diagnosis was made from a surgical specimen. [ABSTRACT FROM AUTHOR]

Copyright of Osmangazi Journal of Medicine / Osmangazi Tip Dergisi is the property of Eskisehir Osmangazi University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Numerous underlying causes can lead to inflammatory breast disorders. A wide range of non-specific symptoms may be presenting symptoms, which could cause a delay in diagnosis and thus improper therapy. Studies on artificial intelligence (AI) are rapidly developing and offer a wide range of possible uses in breast imaging. Artificial intelligence-based computer-assisted diagnosis (AI-CAD) holds promise in the field of mammography. It demonstrated diagnostic performances that are equivalent to or even better than those achieved by stand-alone methods. The current work aimed to identify whether AI can improve the performance of mammography in diagnosing inflammatory breast diseases and excluding the underlying malignancy in cases resistant to treatment that may reduce the need for interventional procedures such as biopsy. Methods: Our study was a retrograde one done on 34 patients with pathologically proven inflammatory breast lesions. Results: Suppurative breast lesions gave high false positive results. This was also the case with granulomatous mastitis; while simple inflammatory lesions gave true negative results on AI interrogation. Conclusions: Artificial intelligence can be of great value in diagnosing simple inflammatory breast lesions thus following up on such lesions can usually be sufficient without asking for unneeded biopsies. On the other hand, our study showed that AI had high false positive results in suppurative lesions and granulomatous mastitis. Consequently, ultrasonography can be more reliable in their diagnosis. [ABSTRACT FROM AUTHOR]

Idiopathic granulomatous mastitis is a rare, chronic inflammatory disease of the breast of uncertain etiology that can mimic breast cancer. In rare instances, it may emerge secondary to trauma to the breast. We present a case of a 66-year-old woman who initially underwent a benign stereotactic core-needle biopsy of her left breast complicated by a small hematoma which initially remained unchanged mammographically and sonographically for 1 year; then, it enlarged unexpectedly at the 21-month interval follow-up prompting an ultrasound-guided biopsy revealing granulomatous mastitis. [ABSTRACT FROM AUTHOR]

Granulomatous mastitis (GM), a benign inflammatory disease of the breast, often mimics breast cancer on presentation. We present a case of GM during pregnancy manifesting as a breast mass, sudden onset of plantar pain, and erythema nodosum (EN). A 31‐year‐old pregnant Japanese woman, gravida 2, para 1, was referred to our hospital with severe plantar pain on both soles, causing difficulty walking. This pain worsened and EN appeared on both lower legs, followed by a left breast mass. Ultrasound findings suggested malignancy; however, aspiration biopsy confirmed GM. Her arthritis and EN resolved 2 days after commencing oral prednisolone and her walking improved. EN with/without arthritis is commonly associated with GM, especially during pregnancy. The described manifestations with a breast mass are suggestive of this diagnosis. [ABSTRACT FROM AUTHOR]

Cat scratch disease rarely presents as a breast or axillary mass mimicking carcinoma both clinically and radiologically. Diagnosing breast/axillary cat scratch disease is challenging due to its rarity and nonspecific findings. Here, we reported 2 patients with breast cat scratch disease and reviewed 14 patients with cat scratch disease involving breast/axilla from the past 30 years. It mainly affects women (median age: 48), consistently presenting as axillary lymphadenopathy, and demonstrates ipsilateral breast mass in half of patients (50%, 8/16). The breast mass was most commonly located in the upper outer quadrant (88%, 7/8), indicating the possibility of disease extension from axillary adenopathy. Around half of patients (56%, 9/16) reported cat exposure. Histologically, most patients (93%, 14/15) presented as necrotizing granulomas, with characteristic stellate-shaped necrosis in 5 patients. Although pathologic differential diagnoses between cat scratch disease and cancer are straightforward, distinguishing cat scratch disease from other granulomatous mastitis poses diagnostic challenges. Silver stains should be included in the diagnostic workup panel when highly suspecting cat scratch disease clinically. However, they were only able to highlight the causative microorganism in 54% (7/18) patients, and the gram stain was negative in all 12 tested patients. In contrast, polymerase chain reaction (PCR) for the causative microorganism was consistently positive in all 3 tested patients, while serologic test confirmed diagnosis in 85% (11/13) patients; 1 patient with negative serology showed a positive PCR result. Therefore, upfront PCR tests with or without serologic study should be considered to confirm the diagnosis of cat scratch disease in a timely manner. [ABSTRACT FROM AUTHOR]

Copyright of Practical Pharmacy & Clinical Remedies is the property of Editorial Department of Practical Pharmacy & Clinical Remedies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Numerous underlying causes can lead to inflammatory breast disorders. A wide range of non-specific symptoms may be presenting symptoms, which could cause a delay in diagnosis and thus improper therapy. Studies on artificial intelligence (AI) are rapidly developing and offer a wide range of possible uses in breast imaging. Artificial intelligence-based computer-assisted diagnosis (AI-CAD) holds promise in the field of mammography. It demonstrated diagnostic performances that are equivalent to or even better than those achieved by stand-alone methods. The current work aimed to identify whether AI can improve the performance of mammography in diagnosing inflammatory breast diseases and excluding the underlying malignancy in cases resistant to treatment that may reduce the need for interventional procedures such as biopsy. Methods Our study was a retrograde one done on 34 patients with pathologically proven inflammatory breast lesions. Results Suppurative breast lesions gave high false positive results. This was also the case with granulomatous mastitis; while simple inflammatory lesions gave true negative results on AI interrogation. Conclusions Artificial intelligence can be of great value in diagnosing simple inflammatory breast lesions thus following up on such lesions can usually be sufficient without asking for unneeded biopsies. On the other hand, our study showed that AI had high false positive results in suppurative lesions and granulomatous mastitis. Consequently, ultrasonography can be more reliable in their diagnosis.

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.

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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 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 To compare and analyze the clinical efficacy, recurrence rate, and breast appearance evaluation of simple surgery and surgery combined with glucocorticoids in the treatment of mass type granulomatous mastitis. Methods This study retrospectively analyzed 106 patients with nodular granulomatous mastitis who visited the Department of Breast Surgery at Yichang Central People's Hospital from January 2017 to January 2022 as the study subjects. According to the different treatment methods during the visit, patients were divided into Group A with simple surgical treatment （n = 67） and Group B with surgery combined with glucocorticoid treatment （n = 39）. The general information and clinical indicators of the two groups of patients were observed and compared. Obtain patient clinical efficacy, time to clinical cure （TTCR), recurrence rate within one year, and breast appearance evaluation through follow⁃up. Results The prognosis of the follow⁃up patients after treatment showed that Group B patients had better clinical cure rate and one⁃year recurrence rate than the simple surgery group （P < 0.05）. More⁃over， the difference in breast appearance evaluation between the two groups was statistically significant, with Group B patients having a significantly higher rate of excellent appearance （88.06%） than Group A （92.31%）. According to statistics, only 5.13% of patients in Group B experienced gastrointestinal reactions within one year after taking hormone therapy. Conclusions The combination of surgery and glucocorticoids in the treatment of mass type GM can effectively improve the overall clinical treatment effect of patients， reduce the short⁃term recurrence rate, and have a significant effect on ensuring the integrity of breast appearance. At the same time, low⁃dose oral steroid drugs have fewer adverse reactions and high safety. [ABSTRACT FROM AUTHOR]

Idiopathic granulomatous mastitis (IGM) is an infrequent inflammatory breast disease that typically presents with unilateral and sometimes bilateral breast masses, leading to pain, erythema, and nipple discharge. IGM may be accompanied by extramammary symptoms, including episcleritis and arthralgia suggesting and underlying autoimmune process. To evaluate the frequency of characteristics manifestations including rheumatologic in females with IGM referred to Imam Ali Hospital (Karaj, Iran). This study was performed on 178 females referred to the breast surgery department of Imam Ali Hospital and diagnosed with IGM based on core needle biopsy and histopathological examination. The various manifestations including rheumatic presented for those patients were recorded. The mean age of the patients was 35.17 ± 5.88 years and body mass index was 26.38 ± 2.45. 91 % of the patients were nulliparous and only 3 used oral contraceptive pills. The breast-feeding duration of parous patients was 28.91 ± 14.97 months. Associated minor thalassemia was present in 2.25 %, bronchial asthma, diabetes, psoriasis and hypothyroidism were present in 2 patients each. 7 (3.92 %) of cases had history of previous breast surgery. Twenty-five (14 %) patients with IGM had associated manifestations including arthralgia (10.11 %), arthritis (2.25 %) and erythema nodosum (2.81 %). Only one patient had peripheral and another optic neuritis. 158 (88.76 %) patients had no notable past medical history. IGM was bilateral in 21 (11.8 %) patients. The coexistence of erythema nodosum and arthritis with IGM is not uncommon. They are mostly unilaterally present in nulliparous Iranian females. Optic and peripheral neuropathies are rarely associated. [ABSTRACT FROM AUTHOR]

Objectives: Granulomatous mastitis is a rare benign inflammatory disease of the breast commonly seen in women at childbearing age. The aim of this study is to describe clinical and paraclinical characteristics of GM patients, to demonstrate the management and follow-up experience of our center, and review the literature on the topic. Methods: 30 GM cases were identified among the 3248 patients who applied to the breast health center of the Liv Bona Dea hospital between January 2018 and August 2023. Cases were identified as granulomatous mastitis histopathologically from the biopsy specimens. Patient data was evaluated from the database, and missing information was retrieved by calling the patients. Results: Among the 3248 patients who were admitted to our breast health center, 30 patients (0.9%) had a diagnosis of GM and were identified as applicable to our study. All the patients were female, with a median age of 33, ranging from 27 to 66. Of the 30 patients, 11 were overweight and 7 were obese at the time of diagnosis (mean BMI: 26.7). While the majority (n=23, 76%) of the patients presented with a breast lump, only 1 (3%) of the patient’s only symptom was breast lump. 8 (27%) of the cases had comorbidities, including Hashimoto Thyroiditis (n=1), Hypertension (n=6), Diabetes Mellitus type 1 (=1), Diabetes Mellitus type 2 (n=4), Major Depression (n=1). Of the lesions, 16 (53%) showed high suspicion with a Bi-Rads score ≥ 4, and 14 (47%) showed low suspicion with a Bi-Rads score ≤ 4. 18 (60%) of patients received only medical treatment, 11 (37%) patients received both surgery (excision) and medical treatment, and only 1 (3%) received surgery (excision) alone. Conclusion: Even though idiopathic GM is the most common GM type, results from the paper of Ercan Kokrut et al. suggest that Tuberculosis should not be skipped, especially in developing countries, with reported 20% as a cause of GM. A multidisciplinary team is crucial in the diagnosis and treatment of GM to be able to distinguish it from breast cancer To conclude, Granulomatous mastitis is a tricky condition that can cause high anxiety in physicians as high as in patients. Idiopathic GM is the most common type, but evaluation of other reasons, such as tuberculosis mastitis, must be on the checklist. More research regarding the outcome of different treatment modalities will give a straightforward approach for physicians. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives: Idiopathic granulomatous mastitis (IGM) is a rare, benign, chronic inflammatory breast disease of unknown etiology. There is no standardized treatment because its etiology is still unclear. In this multicenter study, we presented the demographic, treatment, and follow-up characteristics of IGM cases monitored by rheumatology clinics. Material and Methods: This retrospective study was conducted in 13 different rheumatology centers. A total of 108 patients with IGM were included in the study. Demographic and clinical data were retrospectively obtained from patient files. Results: The most commonly administered drugs were, in order of frequency, corticosteroid (CS) (91.7%), methotrexate (MTX) (74.1%), antibiotics (63%), non-steroidal anti-inflammatory drugs (41.7%), azathioprine (AZA) (13.9%), colchicine (5.6%), and tumor necrosis factor (TNF) inhibitors (0.9%). The most commonly used form of immunosuppressive (IS) treatment was the MTX and CS combination 78 (72.2%). The ratio of patients receiving CS alone was 19 (17.6%). The ratio of patients who were operated on only and did not use IS drugs was 6.5%. The ratio of patients who received no treatment was 2.8%. Among the drugs used, MTX and CS alone use were independent risk factors for relapse; (p=0.027, p=0.011, respectively). The relapse rate was higher in patients receiving CS alone. Conclusion: IS drugs including CS, MTX, AZA, and TNF inhibitors seem to be efficient for treating IGM. CS alone use is associated with relapse, and the use of other IS drugs such as MTX is particularly effective in reducing relapse in IGM. [ABSTRACT FROM AUTHOR]

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.

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. [ABSTRACT FROM AUTHOR]

Background: Idiopathic granulomatous mastitis (IGM) is a rare inflammatory breast disease, in which there is no clear established treatment algorithm. Several physicians keep away from using immunosuppressive (IS) treatments in routine clinical practice. Aims: This study aimed to evaluate the rates of drug-free remission of the patients with IGM in a period of 3-year follow-up. Methods: This retrospective study conducted with 55 biopsy-proven IGM patients, who were followed up between February, 2011, and November, 2021, in rheumatology outpatient clinic of Gulhane Training and Research Hospital. The demographic and clinical characteristics of the patients were obtained from patients' files. The 3-year follow-up data were assessed for long-term outcome analyses. Results: There were 55 female patients with a mean age of 36.8 ± 6.3 years. Fifty-four (98.1%) patients were in drug-free remission at the end of 3 years. The median duration of drug-free remission in patients receiving methotrexate (MTX), only corticosteroid (CS), and azathioprine was 19.7, 32.9, and 14.7 months, respectively. The drug-free remission duration for the patient who received cyclosporine A as IS was 28.3 months. The median duration of IS treatment was 15.8 months, and the median duration of treatment with CS and other IS combination was 6.7 months. Recurrence was observed in 4 (80%) patients without IS therapy after surgery, of whom MTX was used in 3 (75%) patients and achieved remission. Conclusions: IS agents provide high rate of prolonged drug-free remission and should be considered a part of routine medical care of the patients with IGM. [ABSTRACT FROM AUTHOR]

Background: Idiopathic granulomatous mastitis (IGM) is an uncommon inflammatory disorder, which tends to occur in childbearing women. Although IGM has a benign nature, it can mimic a vast spectrum of diseases and may lead to an erroneous diagnosis of carcinoma. Also, the patients usually experience a prolonged course of the disease, which is distressing. But, the clinicopathological of IGM is nonspecific and not clear enough. Objectives: This study aims at evaluating the clinicopathological aspects of IGM. Methods: This cross-sectional retrospective study was performed in Shohada-e-Tajrish Hospital, Tehran, Iran on patients between 20 to 50 years old, preliminary diagnosed with IGM from 2010 to 2019. Then, the demographic, clinical, ultrasound, and histopathologic features of patients enrolled were evaluated. Results: A total number of 60 women aged 20 to 50 years old and initially diagnosed with IGM were enrolled in this study. Their mean age was 34.5 ± 6.73. Among all participants, 38.3% of patients had a family history of breast cancer. The most common location of the lesion was the upper outer quadrant (UOQ) with the predominance of the left side (36.6%). They were more likely to present with pain, erythema, swelling, and warmth (51.6%) of the breast followed by palpable mass (38.3%). With ultrasound assessment, the results were matched with a tubular hypoechoic mass in 43.3% of the patients, while the remainder showed a tumor-like lesion (21.6%) and abscess formation (15%). Histologically, non-caseating granulomas associated with mixed inflammatory cells (70%) and cystic space formations surrounded by neutrophil aggregations (15%) composed the dominant features. Conclusions: Despite the rarity of the disease, IGM is a diagnostic challenge as it can masquerade various breast conditions. A definite diagnosis needs collaboration of clinical, radiological, and histopathological findings. [ABSTRACT FROM AUTHOR]

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.

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

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.

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.

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. P<0.05 was considered significant. Results: There was no significant difference between the demographic variables of age and body mass index with the treatment outcome in the examined patients (P>0.05). 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: Rare disease Background: Sarcoidosis is a benign systemic granulomatous disorder of unknown etiology that affects multiple organs. Patients diagnosed with sarcoidosis usually present with nonspecific symptoms: fatigue, fever, weight loss, and respiratory symptoms such as cough and dyspnea; 50% of the patients are asymptomatic at the time of diagnosis. In 90% of patients, sarcoidosis targets hilar and mediastinal lymph nodes. In rare cases, it presents solely in the breast with no other symptoms. The diagnosis is established based on compatible clinical and radiological findings and supported by histological evidence in 1 or more organs of non-caseating epithelioid cell granulomas in the absence of organisms or particles. Case Report: We herein present a unique case of a 27-year-old woman who presented with pain and swelling in her left breast. On examination, the left breast revealed multiple, firm-hard, and tender masses. Breast ultrasound showed large loculated focally dilated ducts with significant periductal vascularity and inflammation. Fineneedle aspiration (FNA) showed an inflammatory process with granulomatous formation. An ultrasound-guided core biopsy, which was histologically consistent with granulomatous mastitis, and elevated angiotensinconverting enzyme (ACE) levels confirmed a diagnosis of sarcoidosis. The patient was started on IV steroids followed by oral prednisolone and azathioprine. During treatment, the mass size decreased and the pain substantially improved. Conclusions: It is important to consider sarcoidosis in a patient who presents with only pain and swelling in the breast to ensure early diagnosis and initiate treatment, improving the patient's overall prognosis. [ABSTRACT FROM AUTHOR]

Granulomatous mastitis is a rare benign inflammatory disease of the breast of uncertain origin characterized from the histopathological point of view by a non-caseificant granulomatous inflammation with no evidence of underlying infection whose diagnosis is by exclusion due to the fact that its clinical and radiological characteristics are similar to those of infectious pathologies or breast carcinoma. Core needle biopsy continues to be the definitive diagnostic method. Differential diagnosis should include ductal ectasia with periductal mastitis, fat necrosis, foreign body reaction, toxoplasmosis, brucellosis, amyloidosis, Paget's disease, diabetic mastopathy, granulomatous reaction and tuberculous mastitis. The purpose of this review is to describe the radiological findings of granulomatous mastitis base depending on its chronicity to make an accurate diagnosis and guide the clinician to establish an adequate therapeutic scheme. [ABSTRACT FROM AUTHOR]

Objective To analyze the efficacy and safety of intralesional triamcinolone acetonide in the treatment of mass granulomatous mastitis (GLM). Methods Retrospective analysis was made on 67 patients with GLM who were treated in Xijing Hospital from July 2021 to May 2022 and met the inclusion criteria. Among them, 31 patients were treated with local injection of triamcinolone acetonide, while 36 ones were treated with oral methylprednisolone. All the included patients underwent surgical treatment after their condition met the surgical criteria, and the follow-up period lasted for up to six months after surgery. The two groups were compared in improvement of symptoms and signs, treatment time, clinical effectiveness and safety, and recurrence rate. Results The effective rate of triamcinolone acetonide group and methylprednisolone group was 100%, but the clinical cure rate was significantly higher in triamcinolone acetonide group than in methylprednisolone group in stratified analysis (P<0.05). The improvement time of symptoms and signs in triamcinolone acetonide group was significantly shorter than that in methylprednisolone group (P<0.05). The incidence of side effects in triamcinolone acetonide group was also significantly reduced compared to methylprednisolone group (P<0.05). Follow-up for half a year showed no recurrence in both groups. Conclusion Compared with the traditional oral methylprednisolone group, local injection of triamcinolone acetonide in the treatment of mass granulomatous mastitis can rapidly relieve clinical symptoms and signs, shorten treatment time, and has higher efficiency and fewer side effects. Local injection of hormone combined with surgery is effective in treating mass granulomatous mastitis with low recurrence rate. [ABSTRACT FROM AUTHOR]

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