الفهرس 
INFLAMMATORY DISEASES OF THE BREASTOnly 14 pages are availabe for public view
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Abstract
Idiopathic granulomatous mastitis is a rare benign
breast disease. The prevalence of Granulomatous Mastitis is
generally reported at less than 1% worldwide among women
presenting with breast problems however, reports vary
greatly by country and ethnic group and a study of
granulomatous mastitis (GM) in the United States
demonstrated a prevalence of less than 1% among women
who underwent biopsy for breast diseases. In the UK, it was
found in 0.98% of patients presenting at the breast unit.
IGLM is a rare chronic non-specific inflammatory
disease of the breast that mimics cancer both clinically and
mammographically. Originally described by Kessler and
Wolloch in 1972.
The etiology of idiopathic granulomatous mastitis is
still obscure.The cause may be the autoimmune process,
infection, a chemical reaction associated with oral
contraceptive pills, or even lactation. Various factors,
including hormonal imbalance, autoimmunity, unknown
microbiological agents, smoking and α 1-antitrypsin
deficiency have been suggested to play a role in disease
aetiology.It has been considered as rare, chronic, nonspecific
granulomatous process, affecting the breast in relatively
young patients, especially parous women as a tender,
unilateral, firm, discrete extra-areolar breast lump in a
lobular distribution, often associated with inflammation of
the overlying skin.
Patients are almost always afebrile and might present
with multiple areas of simultaneous peripheral infection with
abscesses and or inflammation of the skin overlying the
region and ulceration or sinus formation.
The granulomas in granulomatous mastitis have been
described as noncaseating granulomas,consisting of
epithelioid histiocytes and multinucleated giant cells that are
surrounded by lymphocytes and plasma cells. Frequently, the
granulomas became confluent with central suppuration and
liquefaction necrosis.
Granulomatous mastitis can mimic breast carcinoma
clinically and mammographically, thus making an accurate
preoperative diagnosis difficult. However, the sonographic
appearance of multiple clustered, often contiguous tubular
hypoechoic lesions that are sometimes associated with a
large hypoechoic mass should suggest the possibility of
granulomatous mastitis.Clinical and radiological findings are insufficient for
diagnosis of IGLM as they are not disease specific and so the
diagnosis of IGM requires a multidisciplinary approach,
incorporating clinical, radiological, microbiological and
pathological findings. Lesions identified clinically and
radiologically could easily be misdiagnosed as carcinoma.
Therefore, histopathological evaluation plays a very
important role in differentiating these lesions from other
granulomatous conditions, inflammatory changes, and
carcinoma. A definitive diagnosis of IGLM can be made by
FNAC, core biopsy or incisional and excisional biopsy.
Although IGM as a disease has been known for nearly
four decades, there is no consensus regarding the first-line
treatment modality. Several treatment options have been
described (antibiotics with repeated drainage, wide surgical
excision or mastectomy, oral steroids, immunosuppression
with methotrexate, and close follow-up), and successful
results have been reported for each of these options.
Currently, the most frequently employed treatment options
are surgical treatment and systemic steroid treatment.
Wide surgical excision is more beneficial than limited
excision in patients with localized disease as limited excision
alone is associated with a strong tendency for persistence or
recurrence.A course of oral steroids, nonsteroidal anti‐ inflammatory drugs, or colchicine can be used in order
to shrink the breast mass, allowing more conservative
surgery. On the other hand, the initiation of steroids is often
limited by concerns related to the presence of an infectious
etiology.The role of incision&drainage is controversial
because it may lead to increased scarring and nonhealing of
incision tracks, which subsequently leads to formation of
sinus tracks.