DIAGNOSTIC DILEMMA AND TREATMENT CHALLENGES IN IDIOPATHIC GRANULOMATOUS MASTITIS

Abstract

Objective: To outline diagnostic difficulties and problems in the treatment of Idiopathic Granulomatous Mastitis

Study Design: Prospective observational study.

Place and Duration of Study: Breast clinic, Combined Military Hospital Rawalpindi, from Aug 2019 to Jul 2020.

Methodology: Patients with tender mass with or without signs of inflammation, mass with abscess, sinus formation, and with recurrent abscesses were included. Those cases were labelled as IGM whose histopathology showed granulomatous mastitis with no evidence of malignancy and tissue cultures were negative. Patients with mild to moderate symptoms were treated with reassurance, analgesia and multivitamins. Abscesses were treated with incision & drainage and empirical antibiotics for 1-2 weeks. All these patients were followed at 1, 3, 6 and 12 months.

Results: A total of 35 patients fulfilled the criteria for Idiopathic Granulomatous Mastitis and were included in the study. Two patients had lactational abscess, 3 had bilateral disease and 1 patient was with diabetes 0% patients were having mass with abscess; spontaneous resolution was observed in majority of them with a few requiring incision and drainage. Of 31.4% presented with tender mass only; majority of them resolved with observation, except mass excision in two patients, 19.7% presented with discharging sinuses with underlying mass; among them 71% responded to conservative treatment while 29% were treated with anti-tuberculous therapy for recurrent sinuses. 8.5% presented with spontaneously ruptured abscesses with sinuses; they were managed conservatively.

Conclusion: We concluded that Idiopathic Granulomatous Mastitisis a benign self-limiting disease which can be effectively managed with conservative treatment.