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 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