Management of idiopathic granulomatous mastitis: dilemmas in diagnosis and treatment

BACKGROUND: Idiopathic granulomatous mastitis (IGM) is a rare inflammatory disease. Because of it’s uncommon etiology and rareness, diagnosis and treatment is still a challenge. Owing to wide spectrum of IGM it is difficult to standardize and optimize the treatment. The aim of this study was to report and describe the clinical signs, radiological findings, management, clinical course and the recurrence rate of the patients which were treated due to IGM. METHODS: In this retrospective review of patients diagnosed with IGM histopathologically between January 2006 and December 2011, medical reports, ultrasonography (US) and mammograhy (MMG) findings, follow-up information and recurrence were obtained from records. RESULTS: Painful, firm and ill defined mass was the symptom of all patients. While parenchymal heterogeneity, abscess and mass were the findings of US, increased asymmetric density was the main finding of MMG. Wide local excision was performed in 15 (62.5%) patients, incisional biopsy with abscess drainage was performed in 9 (37.5%) patients. Median follow-up was 34.8 (range 10–66) months. CONCLUSIONS: While the physical examination give rise to thought of breast carcinoma, the appearance of parenchymal heterogeneity and abscess formation on US especially with enlarged axillary lymph nodes support the presence of an inflammatory process. But these findings do not exclude carcinoma. Hereby, histopathologic confirmation is mandatory to ensure that a malignancy is not missed.