WhyGM! – a prospective case-control study evaluating the etiology of idiopathic granulomatous mastitis
DOI:
https://doi.org/10.18203/2320-6012.ijrms20260235Keywords:
Autoimmunity, Infections, Hyperprolactinemia, Granulomatous mastitisAbstract
Background: Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory condition affecting mostly young women usually within 5 years of childbirth and lactation. The etio-pathogenesis of this disease is not well understood leading to mismanagement causing progressive inflammation and multiple recurrences.
Methods: It was a case-control study design with cases comprising patients with histopathological diagnosis of IGM and matched controls comprising women with benign breast disease other than IGM. All patients were interviewed with a structured questionnaire to determine potential risk factors. Serum sample was analysed for anti-nuclear antibody (ANA), prolactin, globulin and tissue from biopsy specimen was analysed in cases for microbial growth. Specific Autoantibody, Immunoglobulin assay was done in case of ANA positivity or elevated globulin levels
Results: There was a significantly longer period of lactation (p=0.0002) and previous history of nipple discharge (p=0.038) among the cases. There was no evidence of uncommon infections caused by bacteria, mycobacteria or fungi. Markers for systemic autoimmunity such as serum ANA, Immunoglobulin levels (p=0.9531) and prolactin levels (p=0.1086) did not show a significant increase in case
Conclusions: IGM was associated with a significantly longer period of lactation and nipple discharge. There was no significant correlation with systemic autoimmunity, hyperprolactinemia or infections. The aetiology of IGM remains elusive with potential for further research into localized autoimmune phenomenon.
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References
Kessler E, Wolloch Y. Granulomatous mastitis: a lesion clinically simulating carcinoma. Am J Clin Pathol. 1972;58(6):642-6. DOI: https://doi.org/10.1093/ajcp/58.6.642
Altintoprak F, Kivilcim T, Ozkan OV. Aetiology of idiopathic granulomatous mastitis. World J Clin Cases WJCC. 2014;2(12):852-8. DOI: https://doi.org/10.12998/wjcc.v2.i12.852
Sheybani F, Naderi HR, Gharib M, Sarvghad M, Mirfeizi Z. Idiopathic granulomatous mastitis: Long-discussed but yet-to-be-known. Autoimmunity. 2016;49(4):236-9. DOI: https://doi.org/10.3109/08916934.2016.1138221
Fruchter R, Castilla C, Ng E, Pomeranz MK, Femia AN. Erythema nodosum in association with idiopathic granulomatous mastitis: a case series and review of the literature. J Eur Acad Dermatol Venereol. 2017;31(9):e391-3. DOI: https://doi.org/10.1111/jdv.14194
Skandarajah A, Marley L. Idiopathic granulomatous mastitis: a medical or surgical disease of the breast? ANZ J Surg. 2015;85(12):979-82. DOI: https://doi.org/10.1111/ans.12929
Salehi M, Salehi M, Kalbasi N, Hakamifard A, Salehi H, Salehi MM, et al. Corticosteroid and Azithromycin in Idiopathic Granulomatous Mastitis. Adv Biomed Res. 2017;6:8. DOI: https://doi.org/10.4103/2277-9175.199259
DeHertogh DA, Rossof AH, Harris AA, Economou SG. Prednisone management of granulomatous mastitis. N Engl J Med. 1980;303(14):799-800. DOI: https://doi.org/10.1056/NEJM198010023031406
Ozel L, Unal A, Unal E, Kara M, Erdoğdu E, Krand O, et al. Granulomatous mastitis: is it an autoimmune disease? Diagnostic and therapeutic dilemmas. Surg Today. 2012;42(8):729-33. DOI: https://doi.org/10.1007/s00595-011-0046-z
Altintoprak F, Karakece E, Kivilcim T, Dikicier E, Cakmak G, Celebi F, et al. Idiopathic Granulomatous Mastitis: An Autoimmune Disease? de Bree E, De Luca M, editors. Sci World J. 2013;2013:148727. DOI: https://doi.org/10.1155/2013/148727
Taylor GB, Paviour SD, Musaad S, Jones WO, Holland DJ. A clinicopathological review of 34 cases of inflammatory breast disease showing an association between corynebacteria infection and granulomatous mastitis. Pathology (Phila). 2003;35(2):109-19. DOI: https://doi.org/10.1080/0031302031000082197
Paviour S, Musaad S, Roberts S, Taylor G, Taylor S, Shore K, et al. Corynebacterium species isolated from patients with mastitis. Clin Infect Dis Off Publ Infect Dis Soc Am. 2002;35(11):1434-40. DOI: https://doi.org/10.1086/344463
Yu HJ, Deng H, Ma J, Huang SJ, Yang JM, Huang YF, et al. Clinical metagenomic analysis of bacterial communities in breast abscesses of granulomatous mastitis. Int J Infect Dis IJID Off Publ Int Soc Infect Dis. 2016;53:30-3. DOI: https://doi.org/10.1016/j.ijid.2016.10.015
Thimmappa D, Mallikarjuna MN, Vijayakumar A. Breast Tuberculosis. Indian J Surg. 2015;77(3):1378-84. DOI: https://doi.org/10.1007/s12262-015-1272-1
Kapila K, Verma K. Diagnosis of parasites in fine needle breast aspirates. Acta Cytol. 1996;40(4):653-6. DOI: https://doi.org/10.1159/000333934
Sangwan S, Singh SP. Filariasis of the breast. Med J Armed Forces India. 2015;71(1):S240-1. DOI: https://doi.org/10.1016/j.mjafi.2014.05.002
Houn HY, Granger JK. Granulomatous mastitis secondary to histoplasmosis: report of a case diagnosed by fine-needle aspiration biopsy. Diagn Cytopathol. 1991;7(3):282-5. DOI: https://doi.org/10.1002/dc.2840070314
Osborne BM. Granulomatous mastitis caused by histoplasma and mimicking inflammatory breast carcinoma. Hum Pathol. 1989;20(1):47-52. DOI: https://doi.org/10.1016/0046-8177(89)90201-3
Omranipour R, Mohammadi SF, Samimi P. Idiopathic granulomatous lobular mastitis-report of 43 cases from iran; introducing a preliminary clinical practice guideline. Breast Care Basel Switz. 2013;8(6):439-43. DOI: https://doi.org/10.1159/000357320
Erhan Y, Veral A, Kara E, Ozdemir N, Kapkac M, Ozdedeli E, et al. A clinicopthologic study of a rare clinical entity mimicking breast carcinoma: idiopathic granulomatous mastitis. Breast Edinb Scotl. 2000;9(1):52-6. DOI: https://doi.org/10.1054/brst.1999.0072
Baslaim MM, Khayat HA, Al-Amoudi SA. Idiopathic granulomatous mastitis: a heterogeneous disease with variable clinical presentation. World J Surg. 2007;31(8):1677-81. DOI: https://doi.org/10.1007/s00268-007-9116-1
Kawashima K, Yamamoto S, Narui K, Fujiwara Y, Adachi S, Sasamoto M, et al. Granulomatous mastitis in a male breast: A case report and review of literature. Clin Case Rep. 2023;11(3):e7048. DOI: https://doi.org/10.1002/ccr3.7048
Akcan A, Akyıldız H, Deneme MA, Akgun H, Arıtas Y. Granulomatous Lobular Mastitis: A Complex Diagnostic and Therapeutic Problem. World J Surg. 2006;30(8):1536. DOI: https://doi.org/10.1007/s00268-005-0476-0
Thornton JW, Argenta LC, McClatchey KD, Marks MW. Studies on the endogenous flora of the human breast. Ann Plast Surg. 1988;20(1):39-42. DOI: https://doi.org/10.1097/00000637-198801000-00008
Liu R, Luo Z, Dai C, Wei Y, Yan S, Kuang X, et al. Corynebacterium parakroppenstedtii secretes a novel glycolipid to promote the development of granulomatous lobular mastitis. Signal Transduct Target Ther. 2024;9:292. DOI: https://doi.org/10.1038/s41392-024-01984-0
Wang X, He X, Liu J, Zhang H, Wan H, Luo J, et al. Immune pathogenesis of idiopathic granulomatous mastitis: from etiology toward therapeutic approaches. Front Immunol. 2024;15:1295759. DOI: https://doi.org/10.3389/fimmu.2024.1295759
Koksal H. The Clinical Utility of Autoantibodies in Patients with Idiopathic Granulomatous Mastitis. J Investig Surg Off J Acad Surg Res. 2022;35(2):325-9. DOI: https://doi.org/10.1080/08941939.2020.1861666
Yuan QQ, Xiao SX, Farouk O, Du YT, Sheybani F, Tan QT, et al. Management of granulomatous lobular mastitis: an international multidisciplinary consensus (2021 edition). Mil Med Res. 2022;9:20.
Ramadan R, Koryem IM, Fayed H. Idiopathic granulomatous mastitis: Risk factors and management. Breast Dis. 2022;41(1):413-20. DOI: https://doi.org/10.3233/BD-220047
Zeng R chao, Li Q, Lin K lu, Zhang W, Gao E li, Huang G li, et al. Predicting the factors of lateral lymph node metastasis in papillary microcarcinoma of the thyroid in eastern China. Clin Transl Oncol Off Publ Fed Span Oncol Soc Natl Cancer Inst Mex. 2012;14(11):842-7. DOI: https://doi.org/10.1007/s12094-012-0875-2