Diagnosis and Treatment of Granulomatous Mastitis: A study of 12 cases

ABSTRACT

PURPOSE: Granulomatous mastitis is a benign inflammatory disease of the breast and its etiology is not clearly defined. In 1972, Kessler and Wolloch described the microscopic features of granulomatous mastitis, but frequently it mimics a carcinoma in a clinical setting. This study was performed to determine the modalities that are important for the diagnosis and the treatment of granulomatous mastitis. METHODS: We studied 12 patients who were diagnosed as having granulomatous mastitis based on pathology. Age, parity, time from last delivery, number of operations, past history of breast feeding and oral contra ceptives, radiologic findings, and cytologic results were retrospectively evaluated. In two recent cases, a polymerase chain reaction (PCR) for mycobacterium tuberculosis was performed to exclude tuberculous mastitis. RESULTS: Among the 12 patients, 8 were in the thirties, 2 in the twenties, 1 in the forties and 1 in the fifties. Of the 12 patients, 9 patients had breast fed and 2 patients had used oral contraceptive pills previously. No patients were suffered from pulmonary tuberculosis. The mean number of deliveries was two. The time from last delivery were varied from 3 weeks to 24 years but most were within 6 years. The location of the lesions were the upper outer quadrant in 6, upper inner quadrant in 3, inner area in 1, lower outer quadrant in 1 and lower inner quadrant in 1 patient. The mean size of the lesions was 3.52 cm. Preoperative mammography was not helpful in finding granulomatous mastitis. Ultra sonographically multiple clustered, contiguous tubular hypochoic lesions suggested the possibility of the disease. Furthermore, fine needle aspiration cytology showed epithelial histiocytes or giant cells and could be used to diagnose granulomatous mastitis. Cultures of microorganisms were sterile, and AFB stainings were all negative. Tuberculous mastitis was excluded by PCR in 2 cases. Surgical resection of the affected tissue was performed in 8 patients and steroid therapy was performed in the remaining 4 who had been surgically treated in other clinics before. All excision cases, except one, were cured. Among the patientsfor whom steroid therapy was used, 1 patient was cured, 1 had a recurrence and the remaining 2 are now under treatment. CONCLUSION: Although rare, granulomatous mastitis could be diagnosed with the aid of ultrasonography and cytology. Surgical excision of the affected tissue and long-term steroid therapy could be used to treat the disease.