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.

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