Granulomatous Mastitis - An Insight

Introduction

Granulomatous mastitis was first described by Kessler and Wolloch in 1972. The breast tissue is highly circulated with rich blood vessels and fatty tissue cushioning it. Granulomatous mastitis usually occurs in a middle-aged female population. It is a well-defined benign lesion on the outer surface of breast tissue. The worst part of this disease is its nagging nature making the healing process very slow. It usually takes six months to one and a half years to heal. There is a high chance of developing this condition into a cancerous state.

What Is Granulomatous Mastitis?

Granulomatous of the breast is a pathological condition where the patient complains of a lump in the breast. This is commonly seen in Hispanic, Asian, and Arabian people. It is usually seen after two years of lactation. It could be due to a breast infection. This condition is not associated with common breastfeeding disorders. But it can also be seen in young females as well. Women can develop this condition between the age group of 20 to 40 years. It can also be seen in pregnancy conditions. It is usually seen as a large lump growing outside the breast tissue. Clinically, the lesion is seen as a large, rigid, or indurated lesion. Such a gross appearance of the lesion can mimic the malignant state of cancer.

What Causes Granulomatous Mastitis?

The exact cause of this condition is not known. It is also seen with numerous lobules. Therefore, it is also known as idiopathic granulomatous lobular mastitis. The possible factors that can play a significant role in developing this disease are as follows:

• Viral, fungal, foreign body, sarcoidosis, or tuberculosis infection.

• Microbial infections.

• Trauma.

• Chemicals.

• Diabetes (a group of illnesses that impair the way the body uses blood sugar).

• Smoking.

• Autoimmune reactions.

• Hormonal changes.

• Use of excessive contraceptive pills.

• The production of increased prolactin hormone causes the development of a pituitary gland tumor called a prolactinoma. Hyperprolactinemia can cause granulomatous mastitis.

Who Is More at a Risk of Developing Granulomatous Mastitis?

Granulomatous mastitis is inflammation of the breast followed by lesions. This is commonly observed in females.

• Women between the ages of twenty and forty can develop this condition.

• Women who are pregnant or lactating.

• A recent delivery can also cause the condition.

• It is seen as more rampant among African American women and Hispanics.

What Are the Signs of Granulomatous Mastitis?

Some of the commonly encountered signs and symptoms are as follows.

• Enlarged breasts. The inflammation occurs without necrosis.

• It is mainly found unilateral.

• Inflammation of the lymph nodes.

• Tender and large lump.

• Locally aggressive.

• Pain and distress in breasts.

• It is recurrent.

• Multiple lumps develop after the primary lesion within six to twelve months. This can be ulcerative and drain discharge.

• Milky discharge of the nipples irrespective of pregnancy state (galactorrhea).

• Firm and palpable mass of the breast.

• Inward retraction of nipples.

• Plasma cells are elevated.

• Extensive fibrosis is present.

• In some cases, abscesses and fistula can occur.

How Different Is Chronic Granulomatous From Acute Granulomatous Condition of the Breast?

Granulomatous mastitis has recently become one of the most rampant clinical cases. Many case studies have led to a better treatment plan for the condition. The following features characterize chronic granulomatous inflammation of the breast.

• Impairment of white blood cells or immune cells to kill infectious agents is seen (for example, bacteria and fungi).

• The patient develops inflammatory reactions like lung conditions, skin disease, and bowel distress. These are known as autoimmune or autoinflammatory conditions.

What Are the Other Differential Diagnosis Which Mimics Granulomatous Mastitis?

Some conditions mimic granulomatous mastitis, such as:

• Breast cancer.

• Fibroadenoma of the breast.

• Tuberculosis.

• Breast abscess.

• Skin ulcerations.

• Periductal mastitis (a disorder characterized by inflammation of the subareolar ducts; the origin is unclear).

How Is Granulomatous Mastitis Treated?

There are no proven treatments for this condition. Therefore, the following medical management is used against this condition.

• Corticosteroid Injection: This helps in reducing lesion size and inflammation. It has also proven to be effective against recurrent lesions. Medications like oral Prednisone or Methotrexate can be used.

• Surgical Management: This is done in extensive lesions. The defective area is surgically removed. This is more of a complicated procedure. The rate of recurrence post-surgery is estimated to be around 13 percent.

• Conservative Management: If the abscess contains a bacterial colony of Corynebacterium species or some other microbes, initial treatment of antibiotic therapy is done to suppress the lesion. The abscesses can be aspirated and dressed for quick healing.

• Combination Therapy: This is done by combining drugs such as oral steroids and oral antibiotics. However, studies have shown a high recurrence rate after this method.

What Are the Tests Conducted to Rule Out Granulomatous Mastitis From Other Malignancies?

Microscopic study of tissue can be conducted to rule out other malignancies.

• Biopsy: This is a standard gold test to study cellular function and its structural composition. The tissue is seen with multinucleated giant cells, epithelioid histiocytes, lymphocytes, and plasma cells. The Corynebacterium kroppenstedtii is the causative agent behind cystic neutrophilic granulomatous mastitis.

• Blood Tests: The C-reactive protein (CRP) is evaluated, identifying the inflammatory reaction. The CRP, ESR, and serum prolactin levels are slightly elevated.

• Tuberculin Test: This is done to rule out tuberculosis.

• Mammogram: A radiographic image of the breast can help identify the lesion's depth and spread. The lesions can be marked by their irregular shape. However, this method cannot determine the spite of the condition.

• Ultrasound: The cells are seen with multiple masses.

• Magnetic Resonance Imaging (MRI): This test shows ill-defined masses depending on the severity of inflammation. This helps in ruling out any malignancies if present.

Conclusion

The long healing period of granulomatous mastitis can frustrate females. This can affect their social, sexual, and daily activities. The patients can go into a depressed state looking at the sizable imperfect lesion on the feminine organ. This can create intolerance, impatience, and a lack of self-confidence in patients. Granulomatous mastitis has also been reported among males but in few cases. Early screening and treatment can heal or suppress the condition to an extent.