A. Arif1, S. Kazmi2, H. Riaz3, S. Zeeshan2 1Aga Khan University, Deans Office, Karachi, Sindh, Pakistan 2Aga Khan University Medical College, Section Of Breast Surgery, Department Of Surgery, Karachi, Sindh, Pakistan 3Aga Khan University Medical College, Department Of Medicine, Karachi, Sindh, Pakistan
Introduction: Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory condition of the breast that usually affects women of childbearing age. Common presentations include breast lumps, tenderness, ulceration and abscess formation. The condition is often misdiagnosed as breast cancer and despite the advent of standardized treatment guidelines, disease management remains varied in our setting leading to unsatisfactory outcomes.
Methods: A retrospective observational study was conducted at a tertiary care center in Karachi, Pakistan. Cases were retrieved from the pathology database from January 2017 to April 2022. Patients age ≥ 18 years with histologically proven IGM were included. Patient demographics, clinical presentation, management approach and response to treatment were recorded and they were followed up for 6 months after completion of treatment.
Results: A total of 48 cases were included. All of them were females with a mean age of 35 years. Family history of breast cancer was reported in 2.1% of patients. 75% of patients had a suspicion of cancer at presentation. The most common presentations included lump (40%), pain (35%), and abscess like presentation (22%). The majority of cases (71%) had granulomatous inflammation on histopathological examination. Half of the patients (50.5%) presented with advanced stage disease (stages 3 and 4), as per the clinical staging established in the international guidelines for granulomatous mastitis. The most common site of involvement was the upper outer quadrant with no side preponderance. 45.8% of patients were treated medically whereas 41.7% underwent surgical intervention as well, with quadrantectomy being the most common procedure. Medical treatment included NSAIDs (81.2%), oral corticosteroids (43.8%) and immunosuppressants (25%). A lower risk of recurrence was noted in patients treated with steroids and immunosuppressants and those that had responded to treatment with NSAIDs. No significant correlation was identified with the duration of treatment. Patients having an abscess-like presentation were more likely to have recurrence.
Conclusion: Our patients had varied clinical presentations, with a slightly higher than 40% risk of recurrence. Our study showed that granulomatous inflammation is the most common histopathological characteristic seen in IGM. Abscess formation at presentation (stage 3 and 4) was found to be the most common risk factor for recurrence in our patient population. Treatment with NSAIDs and immunosuppresants was found to be effective in reducing the risk of recurrence.