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Breast-nonmalignant
Inflammatory / infectious
Granulomatous mastitis (idiopathic)
Reviewer: Hind Nassar, M.D. in January 2009 (see Authors page)
Revised: 27 September 2012
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Diagnosis of exclusion of other granulomatous conditions
Terminology
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● Also called granulomatous lobular mastitis
Epidemiology
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● Rare; young women with inflammatory breast processes (Ann NY Acad Sci 2007;1108:603)
● Median age 36 years, not related to smoking (J Am Coll Surg 2008;206:269)
Etiology
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● Some cases may be due to Corynebacterium (Pathology 2003;35:109, J Clin Microbiol 2007;45:1666)
Clinical features
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● Clinical presentation may resemble breast cancer (Breast J 2009 Dec 16 [Epub ahead of print])
Prognostic factors
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●
Case reports
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● 20 year old woman with large ulcer (The Internet Journal of Surgery 2007;13(2))
● 35 year old woman with tender breast mass (Jpn J Clin Oncol 1997;27:274)
● 36 year old woman with mass (Int Semin Surg Oncol 2007;4:21)
● Recent cluster of cases in Hispanic women in Indiana, USA (MMWR Morb Mortal Wkly Rep 2009;58:1317)
Treatment
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● No consensus; observation, glucocorticoids (Surg Today 2009;39:695), surgery (Am Surg 2007;73:798)
● May recur or be locally aggressive and require multiple surgeries (Ann Plast Surg 2010;64:9)
Clinical images
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Appearance of second lump post-biopsy Firm mass with multiple sinuses
Gross description (Macroscopy)
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● Firm, hard faintly nodular mass
Micro description (Histopathology)
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● Granulomatous inflammation centered on lobules with lymphocytes, plasma cells, epithelioid histiocytes, multinucleated giant cells
● May be neutrophils; necrosis in 11%
Micro images
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Various images
Granulomatous inflammation centered on breast lobules
Inflammatory reaction in lobules Nonnecrotizing granulomas with giant cells
with giant cells (AFIP)
Multinucleated giant cells
Virtual Slides
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Videos
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Cytology description
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● Abundant epithelioid histiocytes and neutrophils, variable granulomas, usually no necrosis (J Clin Path 2003;56:519)
Cytology images
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●
Positive stains
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●
Negative stains
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● GMS and PAS for fungi or mycobacteria
Electron microscopy descriptions
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●
Electron microscopy images
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Molecular / cytogenetics description
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Molecular / cytogenetics images
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Differential Diagnosis
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● Granulomatous angiopanniculitis: involves subcutis and extends into breast, Hum Path 1989;20:1084)
● Infections: including mycobacteria (Cases J 2008 Oct 25;1:273), fungi, cat scratch disease (Archives 1989;113:473), Brucella (Acta Cytol 2009;53:667)
● Wegener's granulomatosis
Additional references
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● Archives 1994;118:822, Pathology 2004;36:254, Stanford University
End of Breast-nonmalignant > Inflammatory / infectious > Granulomatous mastitis (idiopathic)
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