Management of granulomatous lobular mastitis: an international multidisciplinary consensus(2021 edition)

Granulomatous lobular mastitis(GLM) is a rare and chronic benign inflammatory disease of the breast. Difficulties exist in the management of GLM for many front-line surgeons and medical specialists who care for patients with inflammatory disorders of the breast. This consensus is summarized to establish evidence-based recommendations for the management of GLM. Literature was reviewed using PubMed from January 1, 1971 to July 31, 2020. Sixty-six international experienced multidisciplinary experts from 11 countries or regions were invited to review the evidence.Levels of evidence were determined using the American College of Physicians grading system, and recommendations were discussed until consensus. Experts discussed and concluded 30 recommendations on historical definitions,etiology and predisposing factors, diagnosis criteria, treatment, clinical stages, relapse and recurrence of GLM. GLM was recommended as a widely accepted definition. In addition, this consensus introduced a new clinical stages and management algorithm for GLM to provide individual treatment strategies. In conclusion, diagnosis of GLM depends on a combination of history, clinical manifestations, imaging examinations, laboratory examinations and pathology.The approach to treatment of GLM should be applied according to the different clinical stage of GLM. This evidencebased consensus would be valuable to assist front-line surgeons and medical specialists in the optimal management of GLM.

Relationship between granulomatous lobular mastitis and methylene tetrahydrofolate reductase gene polymorphism

BACKGROUND Variations in the methylene tetrahydrofolate reductase(MTHFR)gene have been reported as risk factors for numerous conditions,including cardiovascular disease,thrombophilia,stroke,hypertension and pregnancy-related complications.Moreover,it was reported there is an association between breast cancer and mutations in MTHFR-C677T.However,whether there is an association between MTHFR gene polymorphism and granulomatous lobular mastitis or not has been rarely investigated.AIM To analyze the association between MTHFR gene polymorphism and granulomatous lobular mastitis.METHODS Fifty-one patients with granulomatous lobular mastitis admitted to The First Hospital of Kunming were selected as study samples.Their hospitalization time ranged from February 2018 to February 2019.The 51 patients were included in the experimental group,and another 51 women who underwent physical examination at The First Hospital of Kunming in the same period were included in the control group.Deoxyribonucleic acid and MTFR genetic polymorphism testing were performed in each group.The association between MTHFR gene polymorphism and granulomatous lobular mastitis was observed.RESULTS There were significant differences in genotype frequency and allele frequency of C/C and C/T between the experimental group and the control group(all P<0.05).However,there was no significant difference in frequency of T/T genotype between the two groups(P>0.05).In addition,there was no significant difference in genotype frequency and allele frequency of A/A,A/C and C/C between the two groups(P>0.05).CONCLUSION MTHFR gene C677T locus polymorphism is closely related to granulomatous lobular mastitis.

Treatment of bilateral granulomatous lobular mastitis during lactation with traditional Chinese medicine: A case report

BACKGROUND Granulomatous lobular mastitis(GLM)is a type of benign chronic inflammatory disease that poses therapeutic challenges to healthcare providers.The diagnosis of GLM relies on tissue biopsy,and incorrect treatment may lead to delayed diagnosis,considerable aesthetic damage,and even mastectomy.CASE SUMMARY We report the case of a 37-year-old Chinese woman who was lactating and had GLM in both breasts.At the time of treatment,the right breast had a mass of approximately 15 cm×11 cm,which was hard and had poor mobility.Multiple skin ulcerations and pus spills were also observed on the surface of the breast.The left breast had a mass of about 13 cm×9 cm,which was hard and had poor mobility.CONCLUSION Herein,we report a case of bilateral GLM in a lactating woman that was successfully treated with traditional Chinese medicine(TCM),without the requirement for surgery or other treatments.Therefore,TCM may have advantages in the nonsurgical treatment of GLM.

Granulomatous lobular mastitis

Granulomatous lobular mastitis is an unusual breast benign inflammatory disorder with unknown aetiology. It is generally emerged with the clinical symptoms of breast mass, abscess, inflammation and mammary duct fistula. The diagnosis is made by histopathology with a chronic non-necrotizing granulomatous inflammation in lobules of the breast tissue as the microscopic feature. Therapy of granulomatous lobular mastitis consists of surgical, medication treatment or combination of both, but now researches suggest that observational management is an acceptable treatment.

Clinical efficacy of external treatment with Zi Cao Yang He Tang combined with hormone therapy for granulomatous mastitis and its effect on cellular pyroptosis proteins

Objective:To observe the clinical effect of external application of Zi Cao Yang He Tang combined with dexamethasone ointment in the treatment of granulomatous lobular mastitis in the mass stage and the effect on cellular pyroptosis-related proteins.Methods:Forty patients with granulomatous lobular mastitis were randomly divided into 20 cases in the observation group and 20 cases in the control group.Both groups were given dexamethasone ointment for treatment,and the observation group was treated with external application of Zi Cao Yang He Tang on the basis of the control group.Breast lump vol-ume changes,breast pain and pus symptoms,pathology and histology and immunohistochemistry,cellular death-related indicators expression were compared between the two groups.Results:After treatment,the difference in mass volume of the observation group was significantly greater than that of the control group(16.7±21.5 in the control group and 32.9±27.4 in the experimental group)and the difference between the two groups was statistically significant(P<0.05);the objective remission rate of the patients in the observation group(ORR=85%)was significantly higher than that of the treatment group(ORR=50%,P<0.05).In terms of pus formation rate and pain level,the breast pain score of the observation group was significantly lower than that of the control group after two weeks or three weeks of treatment(P<0.05);the pus formation rate of the observation group was 30%,and the pus formation rate of the control group was 20%,and the difference was not statistically significant(P>0.05).The immunohistochemical expression levels of caspase-1 and GSDMD in the observation group were significantly lower than those in the control group(P<0.05);and in terms of the expression of cellular pyroptosis-related indexes,the expression of GSDMD,cas-pase-1,and NLRP3 in the observation group was significantly lower compared with that in the control group(P<0.05).Conclusion:The efficacy of external application of Zi Cao Yang He Tang combined with dexamethasone ointment in treating granulomatous lobular mastitis in the mass stage is remarkable,which can effectively reduce breast pain,reduce the size of the mass,de-crease the expression of cellular pyroptosisrelated indexes,and have a good anti-inflammatory effect.