Profile of patients with idiopathic granulomatous mastitis presenting to a university teaching hospital in UAE: A case series

Objective: To highlight the profi le of fi ve patients diagnosed as having idiopathic granulomatous mastitis by histopathological examination. Materials and Methods: This presentation is a case series of patients, diagnosed as idiopathic granulomatous mastitis by histopathological examination of excised specimens. The total number of cases included in the report was fi ve females over a 4-year period from 2005 to 2009. Results: The mean age of the patients was 29.6 years and the duration of symptoms varied from 3 weeks to 4 months. All the patients presented with a palpable mass in the breast, and two patients had associated pain and one had a bloody nipple discharge. The average size of the excised mass was 3.8 × 3.1 cm. Four out of the fi ve patients diagnosed to have breast abscess or segmental mastitis had taken a course of antibiotics. One patient had a persistent wound sinus which subsided with ATT and the rest of the patients had no post-operative complications. Conclusion: Idiopathic granulomatous mastitis is a relatively rare disease which mimics the common breast disorders in the reproductive age group including malignancy.


INTRODUCTION
Idiopathic granulomatous mastitis (IGM) is a benign breast disease fi rst described by Kesseler and Wolloch in 1972. [1]Failure to recognize it can result in a diagnosis of cancer and the unnecessary performance of mastectomies. [2][6] The duration from the onset of symptoms to biopsy ranged from 3 weeks to 4 months, in the fi rst reported cluster series of nine cases of IGM in Hispanic women during 2006-2008.Association of IGM with a history of recent pregnancy, breast feeding, and oral contraceptive pills has been reported. [7,8]he present case series highlights the profi le of fi ve patients diagnosed as granulomatous mastitis by histopathological examination in a university teaching hospital in the UAE.A clinical diagnosis of galactocele, fi brocystic, and segmental mastitis, respectively, was made in each of three patients, and breast abscess in the remaining two patients.Four out of the fi ve patients diagnosed to have breast abscess or segmental mastitis had taken a course of antibiotics.One patient underwent ultrasound-guided wide bore aspiration with percutaneous biopsy of the abscess wall under local anesthesia.Two patients underwent I and D and biopsy of the abscess wall and the other two underwent excision biopsy of the mass under general anesthesia.Histopathological examination confi rmed the diagnosis [Figures 2 and 3].One patient had a persistent wound sinus which subsided with ATT and the others had no post-operative complications.

DISCUSSION
The fi ve cases of granulomatous mastitis that reported to our hospital over a 4-year period were described in this report.The disease is common in women in the child-bearing age group, [3] which is similar to our case series where the mean age is 29.6 years and the youngest being 24 years of age.The disease is common in nonwhite females which is similar to the fi ndings in our series where all cases are nonwhite females.6] The duration from the onset of symptoms to biopsy noted in our series ranges from as short as 3 weeks as long as 4 months which is similar to the fi rst reported cluster series of nine cases of IGM in Hispanic women, during 2006-2008.Association of IGM with recent pregnancy, breast feeding and oral contraceptive pills has been reported, [7,8] but in our series none of the patient's were pregnant, breast feeding or used oral contraceptive pills.
The treatment of choice for IGM has not yet been established.Complications of IGM seem to be related to the disease process and the surgical procedure and include skin ulceration, abscess formation, fi stula, wound infection and recurrence. [9,10]In our series two patients underwent I and D and biopsy of the abscess wall and the other two excision biopsy of the mass under general anesthesia as has been reported in literature.One patient had a persistent wound sinus which subsided with ATT and the rest of the patients had no post-operative complications.All patients had received a course of antibiotics and analgesics post-operatively.
The diagnosis of IGM was confirmed in all five cases based on histopathological fi ndings during biopsies done to rule out malignancy.

CONCLUSIONS
Idiopathic granulomatous mastitis is a relatively rare disease which mimics the common breast disorders in the reproductive age group including malignancy.This causes anxiety and distress to the patient and needs histopathological examination to confi rm the diagnosis.
Journal of Medicine and Public Health | Jul-Sep 2013 | Vol 3 | Issue 3 a smoker.The size of the excised masses ranged from 4.5 × 3.5 cm to 2.5 × 2.0 cm, with an average size of 3.8 × 3.1 cm.