Idiopathic Granulomatous Mastitis

Description:

Idiopathic Granulomatous Mastitis (IGM) is an uncommon benign chronic inflammatory condition of the breast, occurring most commonly in women of childbearing age with a higher incidence in certain geographical areas. The aetiology is uncertain and diagnosis is difficult; it is usually made by exclusion. The clinical and radiological features often overlap with those of other benign diseases of the breast in women, but also with those of breast cancer, which is why early diagnosis is necessary to allow timely intervention when required.  Its evolution is unpredictable and there is currently no consensus on the optimal treatment for these patients.The aim of this book is to provide readers with an overview of the data available to date on this unknown and controversial disease. General surgeons, breast surgeons, general practitioners, internal medicine specialists, pathologists, radiologists, rheumatologists, immunologists and dermatologists will certainly benefit from this practical guide.

Foreword

Idiopathic Granulomatous Mastitis (IGM) is a difficult condition both for patients and their physicians. Usually in medicine a doctor makes a diagnosis and having prescribed treatment, the condition improves. This is not the situation in IGM. First making the diagnosis of IGM is not always easy. Malignancy is often the initial diagnosis, and the full range of pathological changes described in IGM is not always all present in all patients. The clinical presentation of IGM also overlaps with the clinical features of tuberculosis so excluding TB by sending biopsies for culture is important in such patients before making the diagnosis of IGM. Second, once a diagnosis is made there is no established treatment. Third, there is no established aetiology. Fourth, the clinical course of IGM is variable.

With so much unknown and so much controversy in the literature about IGM, this book is exactly what clinicians and patients have needed for some time. The authors discuss all the information available on IGM covering the clinical features, aetiology, and treatment. It is comprehensive, well balanced and it has a comprehensive list of references at the end of each chapter.

I enjoyed reading this book and liked the way it is laid out into small easy digestible chapters dealing with all the major issues in relation to IGM. The chapter on the role of infection in this condition was a particular favourite of mine. The section on aetiology includes new data on the role of different subsets of inflammatory cells and discusses whether IGM has an underlying autoimmune component.

I have treated many women with this condition. I used to use steroids to treat IGM but now rarely use these. The authors note that most cases resolve with a conservative approach making sure any abscesses are appropriately treated by aspiration or by small incision drainage. I have seen more patients who have had problems after surgery than I have seen helped by surgery. The section on treatment in this book is comprehensive and makes the very important point that there is no one best treatment for all patients with this condition.

It is a great privilege and pleasure to recommend this book to all involved in managing this very difficult condition. The authors have done a fantastic job of summarizing all that is known and have made it easy to read and digest. Prepare to be much more knowledgeable about IGM at the end of this book than you are now.

Table of contents :

Foreword
Acknowledgement
Contents
Contributors
Overview on Idiopathic Granulomatous Mastitis
1 Introduction
2 Definition
3 Historical Perspective
References
Epidemiology
1 Gender
2 Age
3 History of Parity and Breastfeeding
4 Ethnicity
5 Place of Residence of the Patients
6 Education
7 Seasonal Fluctuation
References
Etiology and Pathogenesis
1 α1-Antitrypsin Deficiency
2 Oral Contraceptives
3 Hyperprolactinemia
4 Gestation, Birth, and Breastfeeding
5 Autoimmunity and Immune Dysregulation
References
The Role of Genetic Factors
1 Genetic Polymorphism Studies
2 Gene Expression Studies
3 Human Microbiome Studies
4 The Future
References
Clinical Manifestations and Classification
1 Local Manifestations
2 Extramammarian Manifestations
3 Classification
References
Microbiology and Biological Markers
1 Introduction
2 Pathophysiology and Pathogenesis
3 Infection and IGM
4 Antibiotic Treatment in IGM
5 Markers in Diagnosis and Investigations
5.1 C-Reactive Protein and Interleukin-6
5.2 Neutrophil-to-Lymphocyte Ratio (NLR) and IGM
5.3 sTREM-1 (Soluble Triggering Receptor Expressed on Myeloid Cells) and IGM
5.4 Interleukin-33 in IGM
6 Summary
References
Imaging Studies in Idiopathic Granulomatous Mastitis
1 Mammography
2 Ultrasonography
2.1 Doppler Ultrasonography
2.2 Sonoelastography
3 Interventional Procedures
4 Breast Magnetic Resonance Imaging
4.1 Diffusion Breast Magnetic Resonance Imaging
5 Positron Emission Tomography and Computed Tomography Scans (PET/CT)
References
Imaging Appearances and Differential Diagnosis of Idiopathic Granulomatous Mastitis
1 Introduction
2 Radiological Appearances
3 Mammography
4 Ultrasound
5 Magnetic Resonance Imaging
6 Computed Tomography
7 Other Conditions that Can Mimic IGM
7.1 Infective Mastitis
7.2 Periductal Mastitis
7.3 Tuberculous Mastitis
7.4 Sarcoidosis
7.5 Malignancy
7.6 Diabetic Mastopathy
7.7 Mastitis in Other Autoimmune Conditions
8 Conclusion
References
Pathology of Idiopathic Granulomatous Mastitis
1 Fine-Needle Aspiration Cytology
2 Gross Pathology
3 Histopathology
4 Ancillary Diagnostic Studies
References
Pathological Differential Diagnoses for Granulomatous Mastitis
1 Granulomatous Mastitis
2 Idiopathic Granulomatous Mastitis
3 Differential Diagnoses for Granulomatous Mastitis
3.1 Breast Infarct
3.1.1 Macroscopic Description
3.1.2 Microscopic Description
3.2 Xanthogranulomatous Mastitis (Fat Necrosis)
3.2.1 Macroscopic Description
3.2.2 Microscopic Description
3.3 Plasma Cell Mastitis
3.3.1 Macroscopic Description
3.3.2 Microscopic Description
3.4 Periductal Mastitis
3.4.1 Macroscopic Description
3.4.2 Microscopic Description
3.5 Cystic Neutrophilic Granulomatous Mastitis
3.5.1 Macroscopic Description
3.5.2 Microscopic Description
3.6 Sarcoidosis
3.6.1 Macroscopic Description
3.6.2 Microscopic Description
3.7 Mammary Tuberculosis
3.7.1 Macroscopic Description
3.7.2 Microscopic Description
3.8 Granulomatous Reaction in Carcinoma
3.8.1 Macroscopic Description
3.8.2 Microscopic Description
3.9 Inflammatory Pseudotumour/Inflammatory Myofibroblastic Tumor
3.9.1 Macroscopic Description
3.9.2 Microscopic Description
3.10 Wegener Granulomatosis in Breast
3.10.1 Macroscopic Description
3.10.2 Microscopic Description
3.11 Lupus Mastitis
3.11.1 Macroscopic Description
3.11.2 Microscopic Description
3.12 Paraffinoma (Sclerosing Lipogranuloma)
3.12.1 Macroscopic Description
3.12.2 Microscopic Description
3.13 Silicone Granuloma
3.13.1 Macroscopic Description
3.13.2 Microscopic Description
3.14 Eosinophilic Mastitis
3.14.1 Macroscopic Description
3.14.2 Microscopic Description
3.15 Diabetic Mastopathy
3.15.1 Macroscopic Description
3.15.2 Microscopic Description
3.16 Mammary Amyloidosis
3.16.1 Macroscopic Description
3.16.2 Microscopic Description
3.17 IgG4-Related Sclerosing Mastitis
3.17.1 Macroscopic Description
3.17.2 Microscopic Description
3.18 Histoplasmosis
3.18.1 Macroscopic Description
3.18.2 Microscopic Description
3.19 Blastomycosis
3.19.1 Macroscopic Description
3.19.2 Microscopic Description
3.20 Cryptococcosis
3.20.1 Macroscopic Description
3.20.2 Microscopic Description
3.21 Aspergillosis
3.21.1 Macroscopic Description
3.21.2 Microscopic Description
3.22 Coccidiodomycosis
3.22.1 Macroscopic Description
3.22.2 Microscopic Description
3.23 Filariasis
3.23.1 Macroscopic Description
3.23.2 Microscopic Description
References
Medical Treatment and Prognosis
1 Treatment Approaches
1.1 Conservative Approaches
1.1.1 Wait and Watch
1.1.2 Antibiotics Only
1.1.3 Nonsteroidal Anti-Inflammatory Drugs
1.1.4 Immunosuppressive Treatment
Corticosteroids
Systemic Corticosteroid Therapy
Local Corticosteroid Therapy
Topical Corticosteroid Therapy
Intralesional Corticosteroid Therapy
Methotrexate
Azathioprine
Mycophenolate Mofetil
1.1.5 Traditional Treatment
1.1.6 Others
Colchicine
Etanercept
Minocycline
Platelet-Rich Plasma
Conclusion
Treatment of IGM Patients with Erythema Nodosum
Treatment of IGM Patients with Pregnancy
2 Prognosis
References
Surgical Treatment
1 Surgical Procedures
1.1 Drainage
1.2 Excision
1.3 Breast-Conserving Surgery
1.4 Mastectomy
References