Granulomatous mastitis (GM) is an uncommon chronic inflammatory disease of the breast that can mimic breast carcinoma or infection. The treatment options include expectant management, complete resection, and corticosteroid therapy, although no standard treatment has been established. Recently, several case reports have suggested that methotrexate is another effective treatment for GM. Here, we describe the first Korean case of recurrent GM successfully treated with low-dose weekly methotrexate and review the relevant literature.
Breast ; Granulomatous Mastitis ; Hydrazines ; Methotrexate

Granulomatous mastitis (GM) is an uncommon chronic inflammatory disease of the breast that can mimic breast carcinoma or infection. The treatment options include expectant management, complete resection, and corticosteroid therapy, although no standard treatment has been established. Recently, several case reports have suggested that methotrexate is another effective treatment for GM. Here, we describe the first Korean case of recurrent GM successfully treated with low-dose weekly methotrexate and review the relevant literature.
Breast ; Granulomatous Mastitis ; Hydrazines ; Methotrexate

Diagnosis, Differential ; Female ; Granulomatous Mastitis/drug therapy* ; Humans ; Mammography

PURPOSE: To present the author's experience with various treatment methods of granulomatous lobular mastitis (GLM) and to determine effective treatment methods of GLM. METHODS: Fifty patients who were diagnosed with GLM were classified into five groups based on the initial treatment methods they underwent, which included observation (n = 8), antibiotics (n = 3), steroid (n = 13), drainage (n = 14), and surgical excision (n = 12). The treatment processes in each group were examined and their clinical characteristics, treatment processes, and results were analyzed respectively. RESULTS: Success rates with each initial treatment were observation, 87.5%; antibiotics, 33.3%; steroids, 30.8%; drainage, 28.6%; and surgical excision, 91.7%. In most cases of observation, the lesions were small and the symptoms were mild. A total of 23 patients underwent surgical excision during treatment. Surgical excision showed particularly fast recovery, high success rate (90.3%) and low recurrence rate (8.7%). CONCLUSION: The clinical course of GLM is complex and the outcome of each treatment type are variable. Surgery may play an important role when a lesion is determined to be mass-forming or appears localized as an abscess pocket during breast examination or imaging study.
Abscess ; Anti-Bacterial Agents ; Breast ; Drainage ; Female ; Granulomatous Mastitis ; Humans ; Mastitis ; Recurrence ; Steroids

PURPOSE: To describe the radiologic findings of granulomatous mastitis of the breast. MATERIALS AND METHODS: This study included 19 patients (age range: 22 to 56 years; mean 37 years) with 22 lesions that were pathologically confirmed as having granulomatous mastitis. All the patients underwent a breast ultrasonography and 13 patients underwent a mammography. RESULTS: The results of the mammography revealed focal asymmetry (n=9), multiple ill-defined isodense nodules (n=2), ill-defined nodular density on a craniocaudal view (n=1), and unremarkable finding (n=1). The sonographic findings included continuous or discontinuous multiple tubular and nodular low echoic lesions (n=7), ill-defined heterogeneously low echoic lesion (n=5), irregular-shaped, ill-defined low echoic mass (n=4), fluid collection with internal floating materials suggesting the presence of an abscess (n=4), ill-defined heterogeneously low echoic lesion and abscess (n=1), and multiple ill-defined nodules (n=1). CONCLUSION: In the case of granulomatous mastitis, the mammography results indicate a lack of specificity between normal findings and focal asymmetry. The sonographic findings indicate that ill-defined heterogeneously low echoic lesions or irregularly shaped, ill-defined low echoic masses are difficult to differentiate from breast cancer. The sonographic findings of abscesses indicate a difficulty in differentiating them from cases of pyogenic mastitis. However, multiple tubular and nodular low echoic lesions, especially with a continuous appearance, should point to granulomatous mastitis, and is helpful in its differential diagnosis and treatment.
Abscess ; Breast Diseases ; Breast Neoplasms ; Diagnosis, Differential ; Female ; Granuloma ; Granulomatous Mastitis ; Humans ; Mammography ; Mastitis ; Sensitivity and Specificity ; Ultrasonography, Mammary

PURPOSE: Idiopathic granulomatous mastitis is a rare benign inflammatory breast disease of an unknown etiology and the optimal treatment remains controversial. The aim of this study is to evaluate the efficacy of surgically complete excision in patients with idiopathic granulomatous mastitis. METHODS: Between March 2005 and November 2008, we treated 14 cases that were diagnosed with idiopathic granulomatous mastitis. Prospectively, we treated the cases with complete surgical excision with or without steroid therapy in all patients. RESULTS: The mean age of the patients was 36 years (range 30 to 53 years). All cases performed were complete excision with or without steroid therapy. The median follow up period was 26 months (range 5 to 50 months) and all cases had no recurrence. 13 patients out of the 14 were satisfied with the cosmesis of the treated breast. CONCLUSION: We conclude that the treatment of choice for idiopathic granulomatous mastitis is surgically complete excision.
Breast ; Breast Diseases ; Follow-Up Studies ; Granulomatous Mastitis ; Humans ; Prospective Studies ; Recurrence

Sparganosis of the breast is an uncommon disease. Cytological granulomatous inflammation is a common feature of sparganosis. The presence of larval fragments is necessary for a definitive diagnosis of sparganosis in a cytological specimen. However, calcareous corpuscles entrapped in necrotic debris can be very diagnostic for sparganosis in endemic areas. We experienced three cases of mammary sparganosis diagnosed by fine needle aspiration cytology before surgical excision. Two cases showed numerous calcareous corpuscles associated with necrotic debris thought to be degenerated parasitic bodies. The remaining case revealed a few degenerative calcareous corpuscles and parasitic bodies. The presence of calcareous corpuscles and/or degenerative parasitic bodies can be an aid in the differential diagnosis between sparganosis and other forms of granulomatous mastitis, particularly in endemic areas of sparganosis.
Biopsy, Fine-Needle ; Breast ; Diagnosis, Differential ; Granulomatous Mastitis ; Inflammation ; Larva ; Sparganosis

Granulomatous Mastitis (GM) is a rare chronic inflammatory lesion of the breast that clinically simulate carcinoma. The purpose of this report is to review the clinicopathological features of this clinical entity in a series of 5 cases that were diagnosed at our institute. Mammography, ultrasonography, and fine needle aspiration were performed in all cases. The treatment of choice for granulomatous mastitis is unclear. Of the 5 cases, one case underwent steroid therapy, two cases underwent anti-tuberculosis medication, and the others underwent only excision. There were no complications for the 5 cases during the follow-up periods. Therefore, the diagnosis and treatment of granulomatous mastitis should be determined on a case by case basis, by the clinician considering the various case results that have been reported on.
Biopsy, Fine-Needle ; Breast ; Diagnosis ; Follow-Up Studies ; Granulomatous Mastitis* ; Mammography ; Ultrasonography

PURPOSE: Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory disease of unknown etiology. The diagnosis of IGM requires that other granulomatous lesions in the breast be excluded. Tuberculous mastitis (TM) is also an uncommon disease that is often difficult to differentiate from IGM. The purpose of this study is to develop a new algorithm for the differential diagnosis and treatment of IGM and TM. METHODS: Medical records of 68 patients (58 with IGM and 10 with TM) between July 1999 and February 2009 were retrospectively reviewed. RESULTS: The mean age of the patients was 33.5 (IGM) and 40 (TM) years (p=0.018). The median follow-up was 84 months. Of the total 10 patients with TM, 5 patients had a history of pulmonary tuberculosis. The most common symptoms of the diseases were breast lump and pain. However, axillary lymphadenopathy was more seen in TM (50%) compared to IGM (20.6%) (p=0.048). TM showed more cancer-mimicking findings on radiologic study (p=0.028). In IGM, 48 patients (82.7%) underwent surgical wide excision and 21 patients (36.2%) were managed with corticosteroid therapy and antibiotics. All of the TM patients received anti-tuberculosis medications and 9 patients (90%) underwent wide excision. The mean treatment duration was 2.8 months in IGM and 8.4 months in TM. Recurrence developed in 5 patients (8.6%) in IGM and 1 patient (10%) in TM. CONCLUSION: This study shows different characteristics between IGM and TM. The IGM patients were younger and had more mastalgia symptoms than the TM patients. Axillary lymphadenopathy was seen more often in TM patients. Half of the TM patients had pulmonary tuberculosis or tuberculosis lymphadenitis. Surgical wide excision might be both therapeutic and useful for providing an exact diagnosis.
Anti-Bacterial Agents ; Breast ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Granulomatous Mastitis ; Humans ; Immunoglobulin M ; Lymphadenitis ; Lymphatic Diseases ; Mastitis ; Mastodynia ; Medical Records ; Recurrence ; Retrospective Studies ; Tuberculosis ; Tuberculosis, Pulmonary

PURPOSE: Idiopathic granulomatous mastitis (IGM) is a rare disease characterized by noncaseating granulomatous inflammation of unknown origin. Because its clinical features are similar to those of other type of mastitis or breast cancer, accurate diagnosis and adequate treatment are essential to ensuring a short symptom duration and improving the quality of life. METHODS: The clinical, radiologic, pathophysiologic, and treatment data for 43 patients diagnosed with IGM at the Breast Cancer Center of Gachon University Gil Medical Center between 2005 and 2016 were retrospectively reviewed. RESULTS: Forty-one patients (95.34%) were of childbearing age, seven (16.27%) had a history of lactation, and five (11.62%) had a history of oral contraceptive use. In terms of radiologic findings, 30 patients (69.77%) were diagnosed with Breast Imaging-Reporting and Data System category ≥4A lesions. Corticosteroid therapy was administered to 36 patients (83.72%); overall, 18 patients (41.86%) did not require surgery and 25 patients (58.13%) underwent partial or total mastectomy. Twelve patients (27.90%) developed recurrence. CONCLUSION: IGM is a benign disease that can be misdiagnosed as breast cancer because of its similar clinical and radiologic findings. Proper diagnosis and treatment can be difficult, but delays may lead to prolonged pain and cosmetic and socioeconomic problems. Efforts should be aimed at establishing the cause of IGM and developing efficient protocols for its diagnosis and treatment.
Breast ; Breast Neoplasms ; Diagnosis* ; Female ; Granulomatous Mastitis* ; Humans ; Immunoglobulin M ; Inflammation ; Information Systems ; Lactation ; Mastectomy, Simple ; Mastitis ; Quality of Life ; Rare Diseases ; Recurrence ; Retrospective Studies* ; Steroids