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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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Fat necrosis

Foreign body reaction

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)

Sarcoidosis

● 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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