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Granulomatous mastitis
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Granulomatous mastitis

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Contributors: Johnny Zhao BA, Mitalee P. Christman MD, Carmen Castilla MD, Alisa Femia MD, Miriam Keltz Pomeranz MD
Other Resources UpToDate PubMed

Synopsis

Chronic granulomatous mastitis (CGM), also commonly referred to as idiopathic granulomatous mastitis or granulomatous lobular mastitis, is a rare benign inflammatory condition of the breast. The etiology of the condition is poorly understood. CGM may be easily confused with breast carcinoma.

Patients with CGM are usually women in their childbearing years and present with a palpable breast lump, indurated plaque, or fluctuant nodule that is typically painful. With progressing disease, fistulas may occur, leading to purulent drainage.

CGM is a diagnosis of exclusion. It is crucial to rule out breast carcinoma with mammography, ultrasound, and core needle biopsy. Core needle biopsy should also be sent for culture to rule out infectious etiologies. In addition, other causes of granulomatous disease, such as sarcoidosis or rheumatologic disease, may be considered.

To date, there is no established treatment algorithm. From case series and case reports, antibiotics, corticosteroids, and/or immunosuppressants may be helpful for some patients. The natural course of the disease is not well-described: some patients spontaneously regress, others improve with therapy, and some relapse or have resistant disease despite treatment.

See also mastitis.

Codes

ICD10CM:
N63.0 – Unspecified lump in unspecified breast

SNOMEDCT:
237444008 –  Granulomatous mastitis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Since the diagnosis of CGM is one of exclusion, other causes of granulomatous inflammation must be ruled out:
Hidradenitis suppurativa (HS) is another dermatological condition characterized by abscesses located on the breast. However, HS is characterized by inflammatory papules and comedones and frequently involves other intertriginous areas such as the axillae and groin. HS is a disorder of the pilosebaceous unit, whereas CGM involves the deeper underlying breast tissue. CGM is also usually unilateral.

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Last Updated: 04/23/2019
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Granulomatous mastitis
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Granulomatous mastitis : Nipple discharge, Breast mass, Inverted nipple, Peau d'orange skin of breast
Copyright © 2019 VisualDx®. All rights reserved.