Idiopathic granulomatous mastitis: a clinical case and a review of the literature

Abstract

Idiopathic granulomatous mastitis (IGM) is a rare benign chronic inflammatory disease of the breast with an unknown etiology, characterized by the presence of sterile non-caseous granulomas and the formation of microabscesses in the lobules of the breast. The exact prevalence of this disease is still unknown. This is mainly due to the relatively small number of the reported cases, as well as the diagnostic difficulties. The aim of the study: to highlight the clinical experience of managing a patient with IGM, to explain the role of pathomorphological examination in diagnostic search, to discuss differential diagnosis and treatment modalities according to the review of English-language literature sources. When the patient visited the clinic, the chief complaint was pain in the right breast. On examination, a painless mass with indistinct border and stone-like density up to 2.5 cm was revealed at the union of the inner quadrants of the right breast. The patient underwent a number of tests: ultrasound, MSCT, mammography, MRI, which were indicative of breast cancer. The final diagnosis was made after the double histopathologically verified examination with differential diagnosis. Considering the young age of the patient, the successful experience of conservative management of patients covered in the world literature, the possible cosmetic effects after surgery, it was decided to treat with cytostatics and glucocorticoids. A 3.5- and 7.0-month follow-up of treatment results by a mammologist showed neither visible pathological changes in the breasts nor palpatory nodular or tumor mass. The state after idiopathic granulomatous mastitis was reconvalescence. The paper also discusses other methods of treatment: surgery, drug therapy such as corticosteroids (topical, oral), immunosuppressants (methotrexate, azathioprine) or a conventional follow-up of patients with mild symptoms. However, considering severe pain and significant aesthetic defects as a result of inadequate therapy, the follow-up is not dominant in the patient management. A delay in the diagnosis can lead to treatment errors, causing chronic changes and increasing the inflammatory size in the breast, influence the severity of the disease and subsequent therapy. Conclusions. The clinical case of the patient with IGM, diagnostic search and effective conservative treatment tactics have been described. The significance and indispensability of pathohistological examination in the diagnostic search have been explained. The most effective treatment regimens for IGM patients have been discussed.