Idiopathic Granulomatous Mastitis-A Mystery Yet to be Unraveled: A Case Series and Review of Literature

Abstract

Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory disease of the breast, the etiology of which, has still not been elucidated. There have been several mechanisms proposed to explain the pathogenesis. Since the first description of the disease, it has proved itself to be a great diagnostic and therapeutic challenge. It is very often misdiagnosed as cancer, resulting in myriad workup by the physician and great distress to the patient. Clear guidelines as to the management have still not been described. Here, we describe two patients who presented with IGM and have been successfully treated. The first patient was treated with a combination of steroids and antibiotics. The second patient achieved remission of the disease with antibiotics alone. We also propose an algorithm for the management of IGM.

Keywords: autoimmunity; breast cancer; breast mass; idiopathic granulomatous mastitis; inflammatory breast disease.

Figure 1. Ultrasound of the left breast showing area of abnormal echogenicity

Figure 2. Fine-needle aspiration showing breast tubules with lymphocytic infiltration (blue arrow) and granulomas (black arrow)

Figure 3. Ultrasound of the right breast showing the hypoechoic region

Figure 4. Fine-needle aspiration showing histiocytes (blue arrow) and inflammatory cells (black arrow)

Figure 5. Proposed algorithm for the management of idiopathic granulomatous mastitis