Review of Mammographic and Sonographic Features of an Uncommon Inflammatory Breast Disease - Granulomatous Lobular Mastitis Granulomatous Lobular Mastitis

Vinita Thakur (1), Rupa Renganathan (2), Prema Subramaniam (3), P Prathiba Rajalakshmi (4)
(1) Kovai Medical Center and Hospitals, Tamil Nadu, India, India,
(2) Department of Diagnostic and Interventional Radiology, Kovai Medical Centre and Hospitals, Tamil Nadu, India, India,
(3) Division of Breast and Women’s imaging, Kovai Medical Centre and Hospitals, Tamil Nadu, India, India,
(4) Department of Diagnostic and Interventional Radiology, Kovai Medical Centre and Hospitals, Tamil Nadu, India, India

Abstract

Background: Granulomatous lobular mastitis (GLM) is a rare inflammatory disease of the breast. Its clinical features and imaging findings often mimic malignancy. The aim of this study is to review the mammographic and ultrasound features of granulomatous lobular mastitis to help differentiate it from other diagnoses.


Methods: In our study, imaging data of 51 patients were reviewed retrospectively, who were diagnosed with granulomatous lobular mastitis by core needle biopsy and culture analysis. 


Results: The mammographic findings of granulomatous lobular mastitis observed in our study group were focal or global asymmetry (52.6%), oval or round lesions with obscured margins (15.7%), irregular mass with indistinct margins (15.7%) and associated skin thickening (26.3%) with no specific pointers to differentiate from malignancy.The most common morphological abnormality on ultrasound was single or multiple collections with or without tracts (72.5%). Other morphological abnormalities were non-mass areas with tracts (25.5%), dilated ducts with debris (13.7%) and mass (3.9%). The common associated abnormalities were perilesional increased echogenicity (86.3%), increased peripheral vascularity (88.2%), intercommunicating tracts (76.5%) and axillary adenopathy (68.6%) and these ultrasound features were pointers to differentiate granulomatous mastitis from malignancy.


Conclusion: Granulomatous lobular mastitis has non-specific clinical and imaging features. Imaging, especially ultrasound as in our study, is found to be indispensable in diagnosing GLM and excluding other causes such as infective mastitis and malignancy.  

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References

Kessler E, Wolloch Y. Granulomatous mastitis: a lesion clinically simulating carcinoma. Am J Clin Pathol [Internet]. 1972;58(6):642–6. doi: 10.1093/ajcp/58.6.642.

Korkut E, Akcay MN, Karadeniz E, Subasi ID, Gursan N. Granulomatous Mastitis: A Ten-Year Experience at a University Hospital. Eurasian J Med. 2015 Oct;47(3):165-73. doi: 10.5152/eurasianjmed.2015.118.

Going JJ, Anderson TJ, Wilkinson S, Chetty U. Granulomatous lobular mastitis. J Clin Pathol. 1987 May;40(5):535-40. doi: 10.1136/jcp.40.5.535.

Al-Khawari HA, Al-Manfouhi HA, Madda JP, Kovacs A, Sheikh M, Roberts O. Radiologic features of granulomatous mastitis. Breast J. 2011 Nov-Dec;17(6):645-50. doi: 10.1111/j.1524-4741.2011.01154.x.

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

Altintoprak F, Karakece E, Kivilcim T, Dikicier E, Cakmak G, Celebi F, et al. Idiopathic granulomatous mastitis: an autoimmune disease? ScientificWorldJournal. 2013 Sep 4;2013:148727. doi: 10.1155/2013/148727.1

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 Apr;82(4):e165-75. doi: 10.1016/j.ejrad.2012.11.010.

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

Yildiz S, Aralasmak A, Kadioglu H, Toprak H, Yetis H, Gucin Z, et al. Radiologic findings of idiopathic granulomatous mastitis. Medical Ultrasonography, 2015.17(1), 39-44. doi: 10.11152/mu.2013.2066.171.rfm

Oztekin PS, Durhan G, Nercis Kosar P, Erel S, Hucumenoglu S. Imaging Findings in Patients with Granulomatous Mastitis. Iran J Radiol. 2016 May 31;13(3):e33900. doi: 10.5812/iranjradiol.33900.

Memis A, Bilgen I, Ustun EE, Ozdemir N, Erhan Y, Kapkac M. Granulomatous mastitis: imaging findings with histopathologic correlation. Clin Radiol. 2002 Nov;57(11):1001-6. doi: 10.1053/crad.2002.1056.

Aghajanzadeh M, Hassanzadeh R, Alizadeh Sefat S, Alavi A, Hemmati H, Esmaeili Delshad MS, et al,. Granulomatous mastitis: Presentations, diagnosis, treatment and outcome in 206 patients from the north of Iran. Breast. 2015 Aug;24(4):456-60. doi: 10.1016/j.breast.2015.04.003.

Yilmaz E, Lebe B, Usal C, Balci P. Mammographic and sonographic findings in the diagnosis of idiopathic granulomatous mastitis. Eur Radiol. 2001;11(11):2236-40. doi: 10.1007/s003300100965.

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

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 Aug;173(2):317-20. doi: 10.2214/ajr.173.2.10430126.

Lee JH, Oh KK, Kim EK, Kwack KS, Jung WH, Lee HK. Radiologic and clinical features of idiopathic granulomatous lobular mastitis mimicking advanced breast cancer. Yonsei Med J. 2006 Feb 28;47(1):78-84. doi: 10.3349/ymj.2006.47.1.78.

Manogna P, Dev B, Joseph LD, Ramakrishnan R. Idiopathic granulomatous mastitis—our experience. Egypt J Radiol Nucl Med [Internet]. 2020;51(1). doi: 10.1186/s43055-019-0126-4.

Hovanessian Larsen LJ, Peyvandi B, Klipfel N, Grant E, Iyengar G. Granulomatous lobular mastitis: imaging, diagnosis, and treatment. AJR Am J Roentgenol. 2009 Aug;193(2):574-81. doi: 10.2214/AJR.08.1528.

Dursun M, Yilmaz S, Yahyayev A, Salmaslioglu A, Yavuz E, Igci A, et al. Multimodality imaging features of idiopathic granulomatous mastitis: outcome of 12 years of experience. Radiol Med. 2012 Jun;117(4):529-38. doi: 10.1007/s11547-011-0733-2.

Kataria N, Parker EU, Kilgore MR, Scheel JR. Idiopathic granulomatous mastitis of the breast: Radiologic–pathologic correlation. Journal of Breast Imaging [Internet]. 2021;3(1):87–92. doi: 10.1093/jbi/wbaa107.

Hovanessian Larsen LJ, Peyvandi B, Klipfel N, Grant E, Iyengar G. Granulomatous lobular mastitis: imaging, diagnosis, and treatment. AJR Am J Roentgenol. 2009 Aug;193(2):574-81. doi: 10.2214/AJR.08.1528.

Yabanoğlu H, Çolakoğlu T, Belli S, Aytac HO, Bolat FA, Pourbagher A, et al. A Comparative Study of Conservative versus Surgical Treatment Protocols for 77 Patients with Idiopathic Granulomatous Mastitis. Breast J. 2015 Jul-Aug;21(4):363-9. doi: 10.1111/tbj.12415.

Yau FM, Macadam SA, Kuusk U, Nimmo M, Van Laeken N. The surgical management of granulomatous mastitis. Ann Plast Surg. 2010 Jan;64(1):9-16. doi: 10.1097/SAP.0b013e3181a20cae.

Chai FY. Granulomatous Mastitis - More data is needed. Breast [Internet]. 2016;26:148. doi: 10.1016/j.breast.2015.12.006

Pluguez-Turull CW, Nanyes JE, Quintero CJ, Alizai H, Mais DD, Kist KA, et al,. Idiopathic Granulomatous Mastitis: Manifestations at Multimodality Imaging and Pitfalls. Radiographics. 2018 Mar-Apr;38(2):330-356. doi: 10.1148/rg.2018170095.

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 Apr 26;9(1):20. doi: 10.1186/s40779-022-00380-5.

Authors

Vinita Thakur
Rupa Renganathan
drrrupa@gmail.com (Primary Contact)
Prema Subramaniam
P Prathiba Rajalakshmi
1.
Thakur V, Renganathan R, Subramaniam P, Rajalakshmi PP. Review of Mammographic and Sonographic Features of an Uncommon Inflammatory Breast Disease - Granulomatous Lobular Mastitis: Granulomatous Lobular Mastitis. Arch Breast Cancer [Internet]. 2023 Jan. 12 [cited 2024 Feb. 28];10(1):57-65. Available from: https://www.archbreastcancer.com/index.php/abc/article/view/645

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