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Clinical Medical Reviews and Case Reports





DOI: 10.23937/2378-3656/1410019



Idiopathic Granulomatous Mastitis - A Great Mimic

Akash Virupakshaiah1, Praneeth Pasam2, Prachi Kala3, Shilpa Lakkundi4 and Mayilvaganan Sabaretnam5*


1Resident, Department of Endocrine and Breast Surgery, Vydehi Institute of Medical Sciences & Research Center, India
2Post Graduate Resident, Department of Endocrine and Breast Surgery, Vydehi Institute of Medical Sciences & Research Center, India
3Professor, Department of Radiology, Vydehi Institute of Medical Sciences & Research Center, India
4Assistant Professor, Department of Pathology, Vydehi Institute of Medical Sciences & Research Center, India
5Assistant Professor and Consultant, Department of Endocrine and Breast Surgery, Vydehi Institute of Medical Sciences & Research Center, India


*Corresponding author: Mayilvaganan Sabaretnam, Assistant Professor and Consultant, Department of Endocrine and Breast Surgery, Vydehi Institute of Medical Sciences & Research Center, Whitefield, Bangalore, Karnataka, India, Tel: 919655851510, E-mail: drretnam@gmail.com
Clin Med Rev Case Rep, CMRCR-2-019, (Volume 2, Issue 2), Case Report; ISSN: 2378-3656
Received: September 15, 2014 | Accepted: February 26, 2015 | Published: February 28, 2015
Citation: Virupakshaiah A, Pasam P, Kala P, Lakkundi S, Sabaretnam M (2015) Idiopathic Granulomatous Mastitis - A Great Mimic. Clin Med Rev Case Rep 2:019. 10.23937/2378-3656/1410019
Copyright: © 2015 Virupakshaiah A. This is an open-access article distributed underthe terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.



Introduction

Idiopathic Granulomatous Mastitis (IGM) is an uncommon breast disease often mistaken for breast infection, abscess or Carcinoma. Here are two cases of IGM diagnosed after prolonged ineffective treatment of presumed infectious mastitis with abscess and carcinoma. The diagnosis was confirmed by biopsy and the patients were further evaluated to exclude other causes that would present with granulomatous formation. Many cases of IGM respond to immunosuppressant with steroids, methotrexate or extensive surgery. A diagnosing physician must have a high index of suspicion when presumed infectious mastitis and breast abscess do not respond to usual treatment [1,2].


Case Presentation: One

A 43 year old aged woman presented with history of pain and lump her left breast which she noticed since two months. The patient consulted many clinicians, general surgeons &pulmonologists. Differential diagnoses included breast abscess, carcinoma and tuberculosis were made. She was treated for breast abscess which gave her no relief. Later, she underwent edge, wedge and trucut biopsies which revealed characteristic granulomas. MRI of the breasts is shown below (Figure 1).


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Figure 1: T1-weighted, T2-weighted Short Tau Inversion-Recovery (STIR) and Post gadolinium enhanced MR sequences at two axial levels show multiple peripherally enhancing lesions with irregular margins and central necrosis involving almost the entire right breast glandular tissue and skin thickening with nipple retraction View Figure 1





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Figure 2: Clinical photograph with arrow at the biopsy site View Figure 2





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Case Presentation: Two

A 28 year old lady, referred to the outpatient clinic with history of lump in the left breast since one year which was associated with pain and also had biopsy done to rule out malignancy (Figure 2). Histopathological examination of the biopsy showed features suggestive of Granulomatous mastitis (Figure 3,4).


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Figure 3: Photomicrograph demonstrating the Granuloma View Figure 3





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Figure 4: Photomicrograph demonstrating the Giant Cell View Figure 4





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Both the patients were started on steroids. Both of them found relief from symptoms and the lump disappeared completely with the healing of the biopsy site ulcer.


Conclusion

Idiopathic Granulomatous mastitis can mimic both benign as well the malignant conditions of the breast and also is a myth for both the patient and the treating physician with the characteristic remissions and relapses.


References
  1. Ruiter AM, Vegting IL, Nanayakkara PW (2010) Idiopathic granulomatous mastitis: a great imitator? BMJ Case Rep 2010.

  2. Altintoprak F, Karakece E, Kivilcim T, Dikicier E, Cakmak G, et al. (2013) Idiopathic granulomatous mastitis: an autoimmune disease? Scientific World Journal 2013: 148727.

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