Granulomatous mastitis.

Abstract

INTRODUCTION: Granulomatous mastitis (GM) is a rare disease which predominantly occurs in premenopausal women shortly after their last childbirth. ETIOLOGY: Its etiology is unclear, however, the disease has been shown to be correlated with breast-feeding and the use of oral contraceptives. An autoimmune component has also been discussed. PRESENTATION: It presents with the clinical symptoms of galactorrhea, inflammation, breast mass, tumorous indurations and ulcerations of the skin. In mammography and sonography nodular opacities and hypoechoic nodules are found. Very often clinical and radiological findings mimic breast cancer. HISTOLOGICAL DIAGNOSIS: The diagnosis is made by histopathology. Histological features in GM include signs of a chronic granulomatous inflammation with giant cells, leucocytes, epitheloid cells and macrophages as well as abscesses. TREATMENT: Therapy of GM consists of complete surgical excision combined with oral steroid therapy, eventually in combination with anti-inflammatory drugs or colchicine. Use of methotrexate has also been successful. In case of formation of abscesses antibiotic therapy should be applied before steroid therapy. Immune-suppressive therapy should be performed until complete remission as rates of recurrence can be up to 50%.