IDIOPATHIC GRANULOMATOUS MASTITIS: CASE REPORT

Female pacient, 44 years old, G3P3, last delivery 18 years earlier, history of long-term breastfeeding, non-smoker, family history of breast cancer in a 45-years-old cousin. The patient presented persistent pain and volume increase in the left breast. Physical examination showed a hardened area with undefined margins, a diameter of 9 cm, occupying the upper-lateral quadrant of the left breast and a palpable axillary lymph node without unusual appearance. Mammography revealed an asymmetric area in the upper-lateral quadrant of left breast (BIRADS IVA). Ultrasonography revealed an irregular tumor, with undefined margins (BIRADS IVA) measuring 2,4cm × 1,7cm. MRI of left breast showed an irregular tumor of 3,3 cm × 2,4 cm, with an extensive area of hypercaptation adjacent to the nodule with 7 cm of extension and category IVC. The core needle biopsy confirmed the diagnosis of idiopathic granulomatous mastitis. An extensive resection of the lesion and local flap rotation for aesthetic repair of the breast were performed with successful evolution. The granulomatous mastitis is a rare, benign, chronic inflammatory disease, whose etiology is unknown. It occurs usually in young women with a history of recent lactation and it is associated with smoking and use of hormonal contraceptive. It can be presented as an enlarging mass (57%), pain (33%), local inflammation, lymph node enlargement and fistulas (15%). The diagnosis of idiopathic granulomatous mastitis can only be established after excluding secondary infections. The differential diagnosis with breast cancer is imperative and determined only by the histopathology as they have similar radiological findings. On histology, granulomatous mastitis is characterized by noncaseating granulomas around breast lobes and often in association with microabscess and inflammatory process rich in histiocytes. The most commonly used therapy is the surgical excision of the granuloma. Steroids have been shown to help in shrinking the lesion, reducing recurrence and post operatory complications. Immunosuppressive drugs can achieve better control of inflammatory processes and prevention of future complications, persistence, fistulas, abscesses, skin ulceration and recurrence (from 16 to 50%). The case described aims to remember the main characteristics of the disease, the mandatory need for differential diagnosis with inflammatory carcinoma and to review the presentation, diagnosis and correct treatment of the disease.