Granulomatous Mastitis: Clinical, Histopathological, and Radiological Insights for Enhanced Management Granulomatous mastitis

Karima Mekni (1), Rahma Ayadi (2), Khaoula Belaid (3), Nadia Benjemaa (4), Zeineb Bendhief (5), Aida Ayadi (6), Chiraz ElFekih (7)
(1) Department of Obstetrics and Gynecology, Mahmoud El Matri Hospital, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia,
(2) Department of Pathology, Abderrahman Mami Hospital, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia,
(3) Department of Obstetrics and Gynecology, Mahmoud El Matri Hospital, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia,
(4) Department of Pathology, Abderrahman Mami Hospital, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia,
(5) Department of Obstetrics and Gynecology, Mahmoud El Matri Hospital, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia,
(6) Department of Pathology, Abderrahman Mami Hospital, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia,
(7) Department of Gynecology and Obstetrics, Mahmoud El Matri Hospital, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia

Abstract



Background: Granulomatous mastitis (GM) is a rare benign inflammatory breast disease that can mimic breast carcinoma and infectious mastitis. Breast abscess at initial presentation may indicate a more active inflammatory phenotype and influence management. We aimed to describe histologically confirmed GM and explore features associated with baseline breast abscess.
Methods: We conducted a retrospective single-center case series using the pathology archives of Abderrahman Mami Hospital from January 1, 2004, to February 29, 2024. Data were extracted from records and supplemented by direct patient contact when necessary. Patients were compared according to breast abscess status at initial presentation.
Results: The study population comprised 42 patients, with a mean (standard deviation [SD]) age of 50.2 (11.0) years and a mean (SD) body mass index (BMI) of 25.2 (2.6). Breast abscess was present in 12 patients (28.6%). Neutrophilic infiltrates were more frequent in the abscess group than in the nonabscess group (83.3% vs 10.0%; odds ratio [OR], 45.00; 95% confidence interval [CI], 6.53–310.26; P < .001). Microabscesses were also associated with abscess presentation (66.7% vs 16.7%; OR, 10.00; 95% CI, 2.15–46.51; P = .003). In the adjusted model, higher BMI was associated with baseline abscess presentation (adjusted OR, 1.70 per 1-unit increase in BMI; 95% CI, 1.01–2.84; P = .04).
Conclusion: In this retrospective series, breast abscess at initial presentation was associated with a more suppurative histopathological profile and a higher BMI in the adjusted exploratory model. Prospective multicenter validation is required.



References

Metanat S, Soleimani Jobaneh Y, Noori M, Sadeghi F, Mirzapour A, Mashoori N, et al. Global distribution of idiopathic granulomatous mastitis: A scoping review. Arch Breast Cancer. 2022;9(3-SI):261-71. doi: 10.32768/abc.20229SI261-271

Emiroglu M, Akcan A, Velidedeoglu M, Girgin S, Aytac O, Canturk NZ, et al. Diagnosis, approach, and clinical classification of idiopathic granulomatous mastitis: Consensus report. Breast Care (Basel). 2024;19(5):243-51. doi: 10.1159/000541482

Yuan QQ, Xiao SY, Farouk O, Du YT, Sheybani F, Tan QT, et al. Management of granulomatous lobular mastitis: An international multidisciplinary consensus (2021 edition). Mil Med Res. 2022;9(1):20. doi: 10.1186/s40779-022-00380-5

Pala EE, Ekmekci S, Kilic M, Dursun A, Colakoglu G, Karaali C, et al. Granulomatous mastitis: A clinical and diagnostic dilemma. Turk Patoloji Derg. 2022;38(1):40-5. doi: 10.5146/tjpath.2021.01554

Omranipour R, Mohammadi SF, Samimi P. Idiopathic granulomatous lobular mastitis: Report of 43 cases from Iran; introducing a preliminary clinical practice guideline. Breast Care (Basel). 2013;8(6):439-43. doi: 10.1159/000357320

Yin Y, Liu X, Meng Q, Han X, Zhang H, Lv Y. Idiopathic granulomatous mastitis: Etiology, clinical manifestation, diagnosis and treatment. J Investig Surg. 2022;35(3):709-20. doi: 10.1080/08941939.2021.1894516

Dilaveri C, Degnim A, Lee C, DeSimone D, Moldoveanu D, Ghosh K. Idiopathic granulomatous mastitis. Breast J. 2024;2024:6693720. doi: 10.1155/2024/6693720

Altintoprak F, Kivilcim T, Ozkan OV. Aetiology of idiopathic granulomatous mastitis. World J Clin Cases. 2014;2(12):852-8. doi: 10.12998/wjcc.v2.i12.852

Sheybani F, Naderi HR, Gharib M, Sarvghad MR, Mirfeizi Z. Idiopathic granulomatous mastitis: Long-discussed but yet-to-be-known. Autoimmunity. 2016;49(4):236-9. doi: 10.3109/08916934.2016.1138221

Li J, McGregor HP. Idiopathic granulomatous mastitis associated with hyperprolactinemia: A nonoperative approach. Breast J. 2017;23(6):742-4. doi: 10.1111/tbj.12914

Al-Khaffaf B, Knox F, Bundred NJ. Idiopathic granulomatous mastitis: A 25-year experience. J Am Coll Surg. 2008;206(2):269-73. doi: 10.1016/j.jamcollsurg.2007.07.041

Akcan A, Akyıldız H, Deneme MA, Akgun H, Arıtas Y. Granulomatous lobular mastitis: A complex diagnostic and therapeutic problem. World J Surg. 2006;30(8):1403-9. doi: 10.1007/s00268-005-0476-0

Azizi A, Prasath V, Canner J, Gharib M, Sadat Fattahi A, Naser Forghani M, et al. Idiopathic granulomatous mastitis: Management and predictors of recurrence in 474 patients. Breast J. 2020;26(7):1358-62. doi: 10.1111/tbj.13822

Wei C, Wang X, Zeng J, Zhang G. Body mass index and risk of inflammatory breast disease: A Mendelian randomization study. Nutr Hosp. 2024;41(1):96-111. doi: 10.20960/nh.04746

Yilmaz TU, Gurel B, Guler SA, Baran MA, Ersan B, Duman S, et al. Scoring idiopathic granulomatous mastitis: An effective system for predicting recurrence?. Eur J Breast Health. 2018;14(2):112-6. doi: 10.5152/ejbh.2018.3709

Zeng Y, Zhang D, Fu N, Zhao W, Huang Q, Cui J, et al. Risk factors for granulomatous mastitis and establishment and validation of a clinical prediction model. Risk Manag Healthc Policy. 2023;16:2209-22. doi: 10.2147/RMHP.S431228

Wang S, Liu R, Yan S, Zhao P. Idiopathic granulomatous mastitis: Immune-pathogen imbalance in a treatment-resistant benign inflammatory disease. Int J Womens Health. 2025;17:3607-31. doi: 10.2147/IJWH.S536970

Gautier N, Lalonde L, Tran-Thanh D, El Khoury M, David J, Labelle M, et al. Chronic granulomatous mastitis: Imaging, pathology and management. Eur J Radiol. 2013;82(4):e165-e175. doi: 10.1016/j.ejrad.2012.11.010

Han BK, Choe YH, Park JM, Moon WK, Ko YH, Yang JH, et al. Granulomatous mastitis: Mammographic and sonographic appearances. AJR Am J Roentgenol. 1999;173(2):317-20. doi: 10.2214/ajr.173.2.10430126

Fazzio RT, Shah SS, Sandhu NP, Glazebrook KN. Idiopathic granulomatous mastitis: Imaging update and review. Insights Imaging. 2016;7(4):531-9. doi: 10.1007/s13244-016-0499-0

Thakur V, Renganathan R, Subramaniam P, Rajalakshmi PP. Review of mammographic and sonographic features of an uncommon inflammatory breast disease: Granulomatous lobular mastitis. Arch Breast Cancer. 2023;10(1):57-65. doi: 10.32768/abc.202310157-65

Benson JR, Dumitru D. Idiopathic granulomatous mastitis: Presentation, investigation and management. Future Oncol. 2016;12(11):1381-94. doi: 10.2217/fon-2015-0038

Radhi J, Otero C, Reid S. Significant eosinophilic infiltrate of the breast. Internet J Pathol. 2008;9(2):1-5. doi: 10.5580/d45

Hur SM, Cho DH, Lee SK, Choi MY, Bae SY, Koo MY, et al. Experience of treatment of patients with granulomatous lobular mastitis. J Korean Surg Soc. 2013;85(1):1-6. doi: 10.4174/jkss.2013.85.1.1

Akbulut S, Yilmaz D, Bakir S. Methotrexate in the management of idiopathic granulomatous mastitis: Review of 108 published cases and report of four cases. Breast J. 2011;17(6):661-8. doi: 10.1111/j.1524-4741.2011.01162.x

Lai ECH, Chan WC, Ma TKF, Tang APY, Poon CSP, Leong HT. The role of conservative treatment in idiopathic granulomatous mastitis. Breast J. 2005;11(6):454-6. doi: 10.1111/j.1075-122x.2005.00127.x

Xiao M, Li S, Tong S. Clinical analysis of treatment with granulomatous lobular mastitis by ultrasonography-guided abscess puncture aspiration or drainage combined with local application of triamcinolone acetonide for 46 cases. Chin Arch Gen Surg Electron Ed. 2019;13(1):30-3. doi: 10.3877/cma.j.issn.1674-0793.2019.01.005

Authors

Karima Mekni
karima.mekni@fmt.utm.tn (Primary Contact)
Rahma Ayadi
Khaoula Belaid
Nadia Benjemaa
Zeineb Bendhief
Aida Ayadi
Chiraz ElFekih
1.
Mekni K, Ayadi R, Belaid K, Benjemaa N, Bendhief Z, Ayadi A, ElFekih C. Granulomatous Mastitis: Clinical, Histopathological, and Radiological Insights for Enhanced Management: Granulomatous mastitis. Arch Breast Cancer [Internet]. 2026 Oct. 23 [cited 2026 Oct. 23];13(4):486-94. Available from: https://www.archbreastcancer.com/index.php/abc/article/view/1291

Article Details