Idiopathic granulomatous mastitis (IGM)

  • Idiopathic granulomatous mastitis (IGM):
    • Is a rare, benign, chronic inflammatory condition of the breast occurring mostly in non-white women of childbearing age
  • In the United States:
    • It’s more commonly seen in the Hispanic population
  • Idiopathic granulomatous mastitis often presents with:
    • A unilateral, hard, discrete tender mass
  • Nonetheless, it may also present with:
    • Multiple indurated inflammatory masses
    • A non-tender mass
    • With pain as a solitary symptom
  • In many cases, a central mass is accompanied by:
    • Multiple simultaneous areas of peripheral infection with abscesses
    • Erythema and ulceration of the overlying skin, and / or fistula formation
  • Pathologic features of IGM include:
    • Non-caseating granulomatous inflammation with necrosis and giant cell formation on a background of neutrophils all surrounding a breast lobule
  • Given the overlap between clinical and radiographic features of IGM and other disease processes:
    • Histopathologic evaluation has emerged as the gold standard for diagnosis of IGM
  • There is no formal consensus regarding the appropriate treatment for patients diagnosed with IGM:
    • The available treatment options include:
      • Expectant management
      • Steroid therapy
      • Immunomodulators such as:
        • Methotrexate and azathioprine
      • Limited or wide surgical excision
      • Antibiotic treatment in the setting of superimposed infection
  • References:
    • Mohammed S., Statz A, Lacross JS, Lassinger BK, Contreras A, Gutierrez C, et al. Granulomatous mastitis: a 10-year experience from a large inner city county hospital. J Surg Res. 2013;184(1):299-303.
    • Pandey TS, Mackinnon JC, Bressler L, Millar A, Marcus EE, Ganschow PS. Idiopathoic granulomatous mastitis – a prospective study of 49 women and treatment outcomes with steroid therapy. Breast J. 2014;20(3):258-266.
    • Oran ES, Gurdal SO, Yankol Y, Öznur M, Calay Z, Tunacı M, et al. Management of idiopathic granulomatous mastitis diagnosed by core biopsy: a retrospective multicenter study. Breast J. 2013;19(4):411-418.
    • Akbulut S, Yilmaz D, Bakir S. Methotrexate in the management of idiopathic granulomatous mastitis: review of 108 published cases and report of four cases. Breast J. 2011;17(6):661-668.

#Arrangoiz #BreastSurgeon #BreastCancer #CancerSurgeon #IGM #IdiopathicGranulomatousMastitis #Miami #Mexico

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