Idiopathic Granulomatous Mastitis (IGM)

  • Idiopathic granulomatous mastitis (IGM):
    • Also known as:
      • Non-puerperal mastitis or granulomatous lobular mastitis.
    • Is a rare, benign, chronic inflammatory disorder of the breast:
      • First described by Kessler and Wolloch 1972:
        • Often mimicking breast cancer or an abscess in clinical and radiologic presentation.
      • Is characterized by:
        • Sterile non-caseating lobulocentric granulomatous inflammation:
          • It usually has a:
            • Recurrent or prolonged natural disease course that eventually leads to lesion burnout.
      • IGM usually affects:
        • Parous premenopausal women
        • With a history of lactation
        • Frequently is clinically associated with hyperprolactinemia
    • Diagnostic work-up includes:
        • Mammogram and ultrasound
        • Often a course of antibiotics at initial presentation:
          • When an infectious etiology is suspected.

IGM 1

    • Needle core biopsy and / or surgical biopsy of the abscess wall:
      • Reveals noncaseating granulomas centered around breast lobules with negative microbiology (sterile).
    • Surgical drainage and biopsy with or without antibiotics has been performed in the past:
      • Current thought suggests:
        • Diagnostic core biopsy
        • Corticosteroid treatment
        • Reserving surgical drainage for refractory cases
  • IGM may recur after resolution in up to:
    • 15% to 30% of cases.
  • Recent studies have evaluated the role of surgical excision after corticosteroid therapy:
    • Finding those completing 0.5 mg/kg/d of methylprednisolone followed by wide surgical excision:
      • Did not experience recurrence:
        • While 30% of those treated with steroids alone recurred (p<0.001).
  • Some have recently tried more aggressive surgical management up front:
    • Suggesting this may result in quicker resolution and a lower recurrence rate though this in additional studies.
IGM 1
– Drawings of external anterior oblique view (a) and sagittal view at the nipple axis (b) illustrate typical clinical manifestations of IGM in the left breast. – A peripheral inflamed terminal ductal lobular unit (TDLU) with focal masslike properties is shown in b. The overlying focal skin erythema shown in a is seen less commonly, in about one-third of patients. – However, it would be seen adjacent to the palpable finding and occupying not more than one-third of the breast skin. – A concurrent abscess with a draining cutaneous sinus tract is relatively common. – Clinically palpable axillary lymph nodes, extensive inflammatory skin changes, and nipple retraction are uncommon with IGM.
  • References
    1. Handa P, Leibman AJ, Sun D, et al. Granulomatous mastitis: changing clinical and imaging features with image-guided biopsy correlation. Eur Radiol. 2014;24:2404-2411.
    2. Karanlik H, Ozgur I, Simsek S, et al. Can steroids plus surgery become a first-line treatment of idiopathic granulomatous mastitis? Breast Care (Basel). 2014;9:338-342.
    3. Kessler E, Wolloch Y. Granulomatous mastitis: a lesion clinically simulating carcinoma. Am J Clin Pathol. 1972;58:642-646.
    4. Mizrakli T, Velidedeoglu M, Yemisen M, et al. Corticosteroid treatment in the management of idiopathic granulomatous mastitis to avoid unnecessary surgery. Surg Today. 2015;45:457-465.
    5. Mohammed S, Statz A, Lacross JS, et al. Granulomatous mastitis: a 10 year experience from a large inner city county hospital. J Surg Res. 2013;184:299-303.
    6. Yabanoğlu H, Çolakoğlu T, Belli S, et al. A comparative study of conservative versus surgical treatment protocols for 77 patients with idiopathic granulomatous mastitis. Breast J.

 

👉Rodrigo Arrangoiz MS, MD, FACS cirujano oncology y cirujano de mamá de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:

  • Es experto en el manejo del cáncer de mama.

👉Es miembro de la American Society of Breast Surgeons:

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

#Arrangoiz

#Surgeon

#Cirujano

#SurgicalOncologist

#CirujanoOncologo

#BreastSurgeon

#CirujanodeMama

#CancerSurgeon

#CirujanodeCancer

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