J Breast Cancer.  2012 Mar;15(1):111-118. 10.4048/jbc.2012.15.1.111.

Differential Diagnosis in Idiopathic Granulomatous Mastitis and Tuberculous Mastitis

Affiliations
  • 1Department of Surgery, Ajou University School of Medicine, Suwon, Korea. ideakims@gmail.com
  • 2Department of Pathology, Ajou University School of Medicine, Suwon, Korea.
  • 3Department of Radiology, Ajou University School of Medicine, Suwon, Korea.
  • 4Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea.
  • 5Department of Nuclear Medicine, Ajou University School of Medicine, Suwon, Korea.
  • 6Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea.
  • 7Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea.

Abstract

PURPOSE
Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory disease of unknown etiology. The diagnosis of IGM requires that other granulomatous lesions in the breast be excluded. Tuberculous mastitis (TM) is also an uncommon disease that is often difficult to differentiate from IGM. The purpose of this study is to develop a new algorithm for the differential diagnosis and treatment of IGM and TM.
METHODS
Medical records of 68 patients (58 with IGM and 10 with TM) between July 1999 and February 2009 were retrospectively reviewed.
RESULTS
The mean age of the patients was 33.5 (IGM) and 40 (TM) years (p=0.018). The median follow-up was 84 months. Of the total 10 patients with TM, 5 patients had a history of pulmonary tuberculosis. The most common symptoms of the diseases were breast lump and pain. However, axillary lymphadenopathy was more seen in TM (50%) compared to IGM (20.6%) (p=0.048). TM showed more cancer-mimicking findings on radiologic study (p=0.028). In IGM, 48 patients (82.7%) underwent surgical wide excision and 21 patients (36.2%) were managed with corticosteroid therapy and antibiotics. All of the TM patients received anti-tuberculosis medications and 9 patients (90%) underwent wide excision. The mean treatment duration was 2.8 months in IGM and 8.4 months in TM. Recurrence developed in 5 patients (8.6%) in IGM and 1 patient (10%) in TM.
CONCLUSION
This study shows different characteristics between IGM and TM. The IGM patients were younger and had more mastalgia symptoms than the TM patients. Axillary lymphadenopathy was seen more often in TM patients. Half of the TM patients had pulmonary tuberculosis or tuberculosis lymphadenitis. Surgical wide excision might be both therapeutic and useful for providing an exact diagnosis.

Keyword

Breast; Granulomatous mastitis; Tuberculous mastitis

MeSH Terms

Anti-Bacterial Agents
Breast
Diagnosis, Differential
Female
Follow-Up Studies
Granulomatous Mastitis
Humans
Immunoglobulin M
Lymphadenitis
Lymphatic Diseases
Mastitis
Mastodynia
Medical Records
Recurrence
Retrospective Studies
Tuberculosis
Tuberculosis, Pulmonary
Anti-Bacterial Agents
Immunoglobulin M

Figure

  • Figure 1 Ultrasonography of idiopathic granulomatous mastitis and tuberculous mastitis. (A) Idiopathic granulomatous mastitis: ill-defined hypoechoic mass with echogenic debridement. (B) Idiopathic granulomatous mastitis: finger-like projection. (C, D) Tuberculous mastitis: heterogeneous, hypoechoic masses with internal calcification.

  • Figure 2 Pathological characteristics of a patient with idiopathic granulomatous mastitis and tuberculous mastitis. (A) Idiopathic granulomatous mastitis: lobulocentric granulomas (H&E stain, ×200). Inlet: epithelioid granulomas and multinucleated giant cells were gathered around a glandular structure (H&E stain, ×400). (B) Tuberculous mastitis: biopsy specimen showing granulomatous inflammation with microabscess in the center (H&E stain,×200). Inlet: histopathological examination of the specimen revealed granulomas with caseous necrosis (H&E stain, ×400). (C) Tuberculous mastitis: acid-fast bacilli (Ziehl-Neelsen stain, ×1,000).

  • Figure 3 Treatment algorithm for the management of idiopathic granulomatous mastitis and tuberculous mastitis. I&D=incision and drainage; IGM=idiopathic granulomatous mastitis; TM=tuberculous mastitis.


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