Q. Kindly advise the management of mammary duct ectasia with chronic granulomatous mastitis.

Answered by
Dr. Noushif M
and medically reviewed by iCliniq medical review team.
Published on Dec 28, 2018

Hello doctor,

I am 33 years old female. Before four years, I had a baby girl but she never did breastfeeding on my left breast. Now before one month, I have noticed I have breast lump which is never painful for me. I had reduced my weight to 8 to 10 kg from last 10 months. That is the only symptom that matches here. The doctor suggested mammogram followed by biopsy but the result was active chronic mastitis with giant cell reaction. So, the doctor prescribed antibiotics but after 20 days lump is of the same size. The next visit she suggested was an excisional biopsy of the lump. So, finally, I did an excisional biopsy or removed lump with surgery and then now biopsy report says mammary duct ectasia with chronic granulomatous mastitis. There is no evidence of malignancy in the examined material. Now my doctor is confused about what kind of treatment has to be started here as disease says for chances of repeated again but what kind of treatment will be effective here. Can you please advice here, if possible?

Dr. Noushif M

General Surgery Medical Gastroenterology Surgical Gastroenterology
#

Hi,

Welcome to icliniq.com.

First of all, you can relax well as there is nothing to worry with this report (attachment removed to protect patient identity). The breast lump excision biopsy (the removed lump) has no evidence of cancerous tissue. It has evidence of inflammation and infection. Now few changes are noted in the biopsy are also seen in tuberculosis. But there is no strong evidence to suggest tuberculosis. This might have made your treating doctor confused. My suggestions would be you can get the slides reviewed by another pathologist, just for a second opinion. If it is non-specific, you can be just on follow up.

Hi doctor,

Thank you very much. We had already reviewed with two laboratories. I have attached my reports. Do you suggest to consult any TB or chest specialist? I am bit confused.

Dr. Noushif M

General Surgery Medical Gastroenterology Surgical Gastroenterology
#

Hi,

Welcome back to icliniq.com.

This scenario is confusing most of the times. Nothing wrong in the options suggested. Granulomatous mastitis is a benign inflammation and can result from multiple causes. TB is considered very commonly associated with it in your country. Your report shows mastitis, but typical features of TB are lacking. There are two options now. Wait and watch with regular follow up. If any new symptoms appear or fresh changes are seen on follow up, consider TB medicines. Else leave alone. Start TB medicines and complete the course. Which one to choose depends on your choice as well as treating doctors decision. You can reach a consensus after a mutual discussion. Stick on to a single plan. Nothing wrong as the source has already been removed well by surgery.

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