Granulomatous mastitis in a 50-year-old male:A case report and review of literature

BACKGROUND Granulomatous mastitis(GM)an inflammatory disease of the breast that usually affects women of childbearing age,occurs very rarely in males.CASE SUMMARY We present a case study of a 50-year-old male patient with GM.The patient developed a breast lump following the cleaning of a previously embedded dirtfilled nipple.While an initial improvement was noted with antibiotic therapy,a recurrence occurred a year later,showing resistance to the previously effective antibiotics.Subsequently,the lesion was excised.The histopathological examination confirmed the diagnosis of GM.CONCLUSION GM should be considered a possible diagnosis of male breast masses.

Correlation Between Granulomatous Mastitis and Autoimmune Function and the Immuneregulating Role of Traditional Chinese Medicine

Granulomatous mastitis(GM)is a benign granulomatous condition,and its pathogenesis may be related to autoimmune disorders.Cellular immunity,humoral immunity,immunoglobulins,and complement could all play a role in the disease process,showing certain clinical patterns.Corticosteroids can quickly control disease progression,and immunosuppressants can be used for complex and refractory GM cases.In traditional Chinese medicine(TCM),“healthy qi”is similar to immune system function.For GM with deficient healthy qi,TCM treatments such as internal and external herbal applications can help regulate immune function and shorten disease duration by staged and TCM treatment,regulating viscera,reinforcing healthy qi,and eliminating pathogenic factors.

Granulomatous lobular mastitis treated by a combined internal and external treatment of traditional Chinese medicine:A case report

BACKGROUND Granulomatous lobular mastitis(GLM)is a rare benign inflammatory disease of the breast and is classified under comedo mastitis in traditional Chinese medicine(TCM).The etiology of this disease is unknown,and it mainly occurs in women of childbearing age.The diagnosis depends on histopathological biopsy.At present,there is no systematic and standardized treatment plan for GLM.In the absence of evidence supporting an infectious etiology,affected patients might continue to receive multiple courses of antibiotics and unnecessary surgery.CASE SUMMARY A 37-year-old Chinese woman with a history of coronavirus disease 2019 infection presented with swelling and pain in the left breast.She also had erythema,nodules in the lower extremities,arthritis in both knees,cough,and headache.In the early stage of GLM,the mass was not significantly reduced by conservative treatment with internal application of TCM;hence,surgical treatment was carried out.The aim of postoperative treatment was to drain the pus,eliminate the necrosed tissue,and expand the muscles;fumigation and washing using TCM was applied.CONCLUSION Combined internal and external treatment with TCM,following the principle of“Prioritize internal treatment before ulceration and emphasize external treatment after ulceration”was effective in our patient with GLM.The prognosis was good.We believe that TCM offered valuable therapeutic benefits in this disease.

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.

Exploring the pathogenesis of idiopathic granulomatous mastitis based on the prolactin theory

Prolactin(PRL),as a cytokine,plays a variety of multidirectional roles in immunity and inflammation.An autoimmune condition known as idiopathic granulomatous mastitis(IGM)involves many inflammatory cells and cytokines.PRL links neuroendocrine and immune systems and plays an active role in the inflammatory and immune processes.Based on the theory of PRL and combined with the latest research review at home and abroad,this paper aims to review the mechanism of action of PRL on IGM from the aspects of various inflammatory cells,cytokines and pathways,revealing the influence of PRL theory on IGM and the mechanism of action,so as to effectively control inflammation in the long-term.

Aetiology of idiopathic granulomatous mastitis

Idiopathic granulomatous mastitis is a rare chronic inflammatory lesion of the breast that can clinically and radiographically mimic breast carcinoma. The most common clinical presentation is an unilateral, discrete breast mass, nipple retraction and even a sinus formation often associated with an inflammation of the overlying skin. The etiology of idiopathic granulomatous mastitis is still obscure. Its treatment remains controversial. The cause may be the autoimmune process, infection, a chemical reaction associated with oral contraceptive pills, or even lactation. Various factors, including hormonal imbalance, autoimmunity, unknown microbiological agents, smoking and α 1-antitrypsin deficiency have been suggested to play a role in disease aetiology. In this review, causing factors in the aetiology of idiopathic granulomatous mastitis are reviewed in detail.

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.

Granulomatous lobular mastitis secondary to Mycobacterium fortuitum

Granulomatous lobular mastitis is a rare inflammatory disease of the breast of unknown etiology. Most present as breast masses in women of child-bearing age. A 29-year-old female presented with a swollen, firm and tender right breast, initially misdiagnosed as mastitis. Core needle biopsy revealed findings consistent with granulomatous lobular mastitis, and cultures were all negative for an infectious etiology. She was started on steroid therapy to which she initially responded well. A few weeks later she deteriorated and was found to have multiple breast abscesses. She underwent operative drainage and cultures grew Mycobacterium fortuitum. Granulomatous lobular mastitis is a rare inflammatory disease of the breast. The definitive diagnose entails a biopsy. Other causes of chronic or granulomatous mastitis should be ruled out, including atypical or rare bacteria such as Mycobacterium fortuitum. This is the first reported case of granulomatous mastitis secondary to Mycobacterium fortuitum. With pathologic confirmation of granulomatous mastitis, an infectious etiology must be ruled out. Atypical bacteria such as Mycobacterium fortuitum may not readily grow on cultures, as with our case. Medical management is appropriate, with surgical excision reserved for refractory cases or for drainage of abscesses.

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 Mastitis: Incidence and Experience in a Mexican Institute

The significance of this work is that chronic granulomatous disease can mimic two common breast diseases;breast cancer and breast abscess;so it is mandatory that the diagnosis is made in order to avoid mistaken carcinoma diagnosis. On the other hand, the current treatment of this particular disease still remains controversial. Objectives: The aim of this study is to expose and describe the chronicity and the impact in a patient’s quality of life with Granulomatous Mastitis diagnosis. We describe the evolution of the disease and the treatment of the disease in a Mexican Institution. Material and methods: In a descriptive retrospective study we identified 9 patients with idiopathic granulomatous mastitis (IMG), all of them were diagnosed with histopathological findings. Results: In a period of time between January 2005 and December 2017, we included a total of 9 female patients. All of them have had histopathological findings consistent with granulomatous mastitis. The age range was 25 - 83 years old (mean 50.8 yrs). In 4 patients (44.4%) had the right side affected, three patients (33.3%) had the left side affected and 2 patients (22.2%) had a bilateral presentation. In 3 patients (33.3%) we observed more than one affected quadrant and 4 patients (44.4%) had a diffuse presentation on image. The most common symptom was breast pain in 9 patients (100%) and the most common sign was the presence of a nodule, 8 patients (88.8%). We observed erythema in 7 cases (77.7%) followed by abscess, edema and pus secretion in 6 patients (66.6%). The most frequent treatment was the use of a combination of NAIDs and antibiotic in 8 patients (88.8%). Six patients were incised with scalp and drained. Six patients underwent mastectomy.

Granulomatous Mastitis with Erythema Nodosum That Responded to Low-Dose Steroid: Case Report and Literature Review of Nine Patients

A 31-year-old woman was referred with a painful mass in the left breast that was initially treated with antibiotics. Three weeks later, the mass had increased and polyarthritis and erythema nodosum had developed in both legs. A core needle biopsy led to a diagnosis of granulomatous mastitis with arthritis and erythema nodosum. Low-dose prednisolone (10 mg) rapidly improved the arthritis and the erythema nodosum. Granulomatous mastitis is a very rare, chronic inflammatory disease and only nine patients with granulomatous mastitis with erythema nodosum have been described. We reviewed the literature to determine the clinicopathological features and treatment of granulomatous mastitis. Appropriate diagnosis and steroid therapy should result in excellent outcomes.

Granulomatous Mastitis, Radio-Histological Correlation

Granulomatous mastitis, also called granulomatous lobular mastitis, is a benign pathology of the mammary gland characterized by chronic inflammation of the gland tissue, which becomes erythematous, manifesting itself as a palpable and painful mass on physical examination, sometimes it can be accompanied by abscesses. The following case is a 45-year-old Guatemalan female, with a history of increased volume in the left breast, compromising the upper quadrants. A mammogram was performed, followed by breast ultrasound;the diagnosis was confirmed by histology. The treatment offered was surgery with image controls every six months.

Meta-analysis of clinical efficacy of combined traditional Chinese and western medicine in the treatment of granulomatous mastitis

Objective:To systematically evaluate the clinical effect (including effective rate and recurrence rate) of the combination of traditional Chinese and Western medicine in the treatment of granulomatous mastitis (GM).Methods: Computer searches CNKI, Wanfang database, VIP, PubMed, web of science and EMBASE, Chinese biomedical database, and selects randomized controlled trial (RCT) of treating granulomatous mastitis with the combination of traditional Chinese and Western medicine. The retrieval time is from July 2019 to July 2019. Then, we used Revman 5.3 software to meta analyze the data.Results: Nine RCTs were included, six of which were effective observation, two of which were recurrence rate observation, one of which was effective observation and reexamination rate observation. A total of 664 patients were included, including 456 in the experimental group and 208 in the control group. After analysis, it was found that the effective rate of GM in the experimental group was 92.3%, which was significantly higher than that in the control group (Western medicine alone) by 75.5% (or = 4.09, 95% CI (2.28, 7.36), P < 00001), the recurrence rate of GM in the experimental group (treated with integrated traditional Chinese and Western Medicine) was 21.6%, which was significantly lower than that in the control group (treated with western medicine alone) by 55.7% (or = 0.19, 95% CI (0.10, 0.37), P < 0.0001).Conclusion: The combination of traditional Chinese and Western medicine in the treatment of granulomatous mastitis can not only improve the effective rate of clinical treatment, but also reduce the recurrence rate of granulomatous mastitis.

Bilateral involvement in patients with granulomatous mastitis: Surgical treatment and case report

Introduction: Granulomatous mastitis (GM) is a rare benign histopathologic lesion, associated with tissue inflammation, architectural distortions and heterogeneous parenchymal inflammation upon radiological evaluation. The treatment of GM is controversial, and currently, there is no consensus about the most appropriate therapy. Case Presentation: We presented a unique, atypical GM case with a prolonged disease course that ultimately led to a bilateral mastectomy. A conservative therapeutic approach and limited or wide surgical excisions have failed to prevent unfavorable outcomes in both the initial presentation and recurrent disease. Conclusions: There’re no clear data in the literature delineating persistent recurrences of GM after conservative treatment and multiple surgeries. Obtaining a disease-free surgical margin might be an important prognostic factor for a lasting relapse-free clinical resolution.

An entity mimicking inflammatory breast carcinoma: Granulomatous mastitis

Granulomatous mastitis (GM) is a chronic inflammatory breast disease. This pathology was first described by Kersler and Wolloch in 1972 [1]. It is an uncommon cause of a breast mass [2-5]. Awareness of this entity is crucial, because it can clinically and radiologically mimic breast carcinoma, fibroadenoma or fibrocystic changes [3]. It has several appearances radiologically also;biopsy still remains the only way for final diagnoses. Here we present a woman with a breast mass. Our aim is to show ultrasound, mammography and magnetic resonance imaging findings of GM by reviewing the literature.

A qualitative research of idiopathic granulomatous mastitis patients

Objective To thoroughly investigate the genuine emotional experience of patients with idiopathic granulomatous mastitis(IGM)pre-and post-treatment.Methods A purposive sampling method was adopted to select 13 patients with idiopathic granulomatous mastitis(IGM)as study objects during Feb to Dec 2016 who were all from the Department of Breast Surgery,the first affiliated hospital of Xiamen University.In addition,hermeneutic phenomenological method was performed in different ways including face-to-face interview,semi-structured interview,indepth interview,live recording and subject analysis of these collected data in hermeneutics rota⁃tion principle.Results The genuine emotional experience of patients with idiopathic granuloma⁃tous mastitis(IGM)pre-and post-treatment could be summarized into six subjects,through the thoroughly analysis of interview data,including change of sleep state,fatigue,lack of knowledge of disease,difficult to adapt to treatment state,worries and fears,and positive views of prosthesis implantation.Conclusion Lifestyle change among patient was prevalent pre-idiopathic granulo⁃matous mastitis,and patient always suffered from negative emotions and lack of disease knowl⁃edge once developed it.Therefore,it would demand medical staff to be committed to health edu⁃cation,communication with patients,and discovery problems in the first time.Moreover,posi⁃tive pertinent measures were appealed to improve confidence to overcome the suffering,and to ease or eliminate the negative emotion for recovery promotion.

乳腺MRI导管异常信号作为伴随征象的鉴别诊断意义

目的探讨乳腺MRI导管异常信号作为伴随征象的鉴别诊断意义。方法选取经病理证实的乳腺纤维腺瘤及(或)腺病、肉芽肿性小叶性乳腺炎(granulomatous lobular mastitis,GLM)、乳腺癌(breast cancer,BC)共172例患者,将172例患者按三类疾病分为三组;乳腺纤维腺瘤及(或)腺病组、GLM组、BC组,对预扫描导管高信号及导管样强化在三组数据的阳性率进行卡方检验,判断差异是否有统计学意义。多元logistic回归分析导管样异常信号对鉴别三类病变的价值。结果预扫描导管高信号三组阳性率差异无统计学意义(P>0.05),导管样强化三组阳性率差异有统计学意义(P<0.05)。多元logistic回归分析:以纤维腺瘤及(或)腺病组为对照,导管样强化增加GLM诊断的可能性差异有统计学意义(OR=10.011,95%CI 3.492-28.703,P<0.001)。以BC组为对照,导管样强化增加GLM诊断的可能性差异有统计学意义(OR=4.435,95%CI 1.772-11.096,P=0.001)。结论导管样强化对GLM诊断具有一定价值。

肉芽肿性乳腺炎病灶组织差异表达蛋白质筛选及关键分子验证

目的分析肉芽肿性小叶性乳腺炎(GLM)病灶组织中的差异表达蛋白质,筛选GLM的生物标志物,再根据结果对关键分子进行验证。方法采用TMT标记定量蛋白质组学方法,对GLM患者(3例)病灶与正常乳腺组织中蛋白质组进行鉴定和定量,筛选出发生显著变化的差异表达蛋白质,导入Proteome Discoverer软件中,搜索Uniprot数据库,完成生物信息学分析。采用细胞因子抗体芯片技术对筛选出的关键分子进行定量和验证。结果GLM病灶组织与正常乳腺组织筛选出差异表达蛋白质1405个,其中1106个表达上调,299个表达下调。GO富集分析显示,这些差异表达蛋白质主要参与细胞过程、代谢过程、蛋白质代谢、生物学调节等。KEGG通路分析发现,差异表达蛋白质参与补体活化、免疫调节、炎症反应等。细胞因子定量分析验证了GLM病灶组织中IL-1β、MCP2、IL-6表达升高。结论GLM病灶和正常乳腺组织中存在差异表达的蛋白质参与炎症、免疫等多种信号通路,可能是GLM发生发展的关键分子。特定蛋白质是值得进一步研究的生物标志物。

仙方活命饮治疗囊性中性粒细胞性肉芽肿性乳腺炎热毒证的临床疗效及机制探讨

目的观察仙方活命饮对囊性中性粒细胞性肉芽肿性乳腺炎(CNGM)热毒证患者的临床疗效及潜在作用机制。方法将72例CNGM热毒证患者随机分为对照组与试验组,每组各36例;试验组予仙方活命饮口服治疗,对照组予左氧氟沙星口服治疗,两组疗程均为14 d。观察比较疾病活动指数、疾病活动度、肿块大小、疼痛数字分级评分法(NRS)评分、炎症指标的变化。免疫荧光法检测乳腺组织内中性粒细胞胞外诱捕网(NETs)标志物瓜氨酸化组蛋白H3(CitH3)、髄过氧化物酶(MPO)含量的变化。结果①试验过程中,对照组脱落2例,试验组剔除1例、脱落2例,最终完成试验者67例,其中对照组34例、试验组33例。完成14d药物治疗后进一步接受手术治疗者共40例,其中对照组22例、试验组18例,每组随机选取5例纳入NETs形成相关指标机制分析。②局部症状活动指数,治疗前后组内比较,对照组疼痛活动指数降低(P<0.05),脓肿活动指数升高(P<0.05);试验组肿块、疼痛、红热活动指数均降低(P<0.05)。组间治疗后比较,试验组肿块、疼痛、红热活动指数低于对照组(P<0.05)。③全身症状活动指数,治疗前后组内比较,对照组发热活动指数降低(P<0.05),试验组发热、其他相关炎症症状活动指数降低(P<0.05)。组间治疗后比较,两组各项全身症状活动指数比较,差异无统计学意义(P>0.05)。④疾病活动指数,治疗前后组内比较,对照组全身症状活动指数、疾病活动指数下降(P<0.05),试验组局部、全身症状活动指数及疾病活动指数均下降(P<0.05)。组间治疗后比较,试验组局部症状活动指数、疾病活动指数低于对照组(P<0.05)。⑤治疗后,两组高活动度例数减少、低活动度及中活动度例数增多,其中试验组高活动度比例从78.8%下降到36.4%;两组疾病活动度分布情况比较,试验组优于对照组(P<0.05)。⑥治疗后,试验组肿块变小(P<0.05),对照组肿块大小无明显变化(P>0.05);两组疼痛NRS评分均降低(P<0.05),且试验组低于对照组(P<0.05)。⑦治疗前后组内比较,试验组红细胞沉降率水平降低(P<0.05),对照组白细胞、中性粒细胞水平降低(P<0.05);组间治疗后比较,两组各项炎症指标比较,差异无统计学意义(P>0.05)。⑧治疗后,两组CitH3的光密度(IOD)、面密度(AD)值均下降(P<0.05),且试验组低于对照组(P<0.05);试验组MPO的IOD、AD值下降(P<0.05),且试验组低于对照组(P<0.05)。结论仙方活命饮能改善CNGM热毒证患者乳房局部炎症症状,降低疾病活动度,在局部症状改善方面疗效优于左氧氟沙星,在全身症状改善方面疗效与左氧氟沙星相当;其可能通过清除乳腺炎症组织中过量产生的NETs发挥疗效。