Chronic Granulomatous Mastitis (CGM)

It is a rare, chronic and benign inflammatory disease of the breast, where the management is challenging and difficult due to unknown etiology and diagnosis.

Presentation

  • Varied presentation of breast infection  and painful breast lump
  • Painful, firm and vague breast mass
  • Sinus infection
  • Palpable and hardening breast mass may present like signs of breast carcinoma
  • Presentation of lesions usually around nipple (periareolar) or diffuse
  • Recurrent breast abscess

 

Causes / Etiology

  • Unknown
  • May be related to Autoimmune,  undetected microorganism, use of oral contraceptives (OCPs), smoking, DM, Hyperprolactinemia, viruses, parasitic infection
  • Diagnosis of exclusion after rule out malignancy, and other granulomatous disease suchs as TB, Sarcoidosis

 

Investigation

  • Breast Ultrasound: Discrete or irregular mass, ill-defined margins, parenchymal heterogenous appearance, Abscess formation, occasionally with enlarged axillary lymph nodes.
  • Mammography: assymetrical density, skin thickening
  • Core Biopsy / Surgical Excision Biopsy of mass is mandatory to establish diagnosis and rule out malignancy
  • Serology or bacterial test

 

Histopathology examination of CGM

  • Presence of epitheloid histiocytes, lymphocytes, plasma cells, leukocytes, multinucleated giant cells without caseous necrosis.

 

Treatment / Management

  • No standarised treatment strategy established
  • Drainage of abscess, wide local excision,
  • Antibiotics
  • Use of steroids : *Oral Prednisolone (0.5mg -1mg/kg) for 2 weeks with gradual tapering dose
  • Average time of resolution of symptoms after drainage is 3-5months.
  • Proper treatment is shown by regression of skin lesions and parenchymal induration after 2 weeks of therapy
  • Complete residual lesion may take up to 6-12 months.
  • Recurrence is common (20-50%)
  • In severe long term cases, sometimes, mastectomy may be necessary

*Prednisolone – Oral corticosteroid therapy

  • Its an anti-inflammatory, vasocontrictive, antiprolieferative, immunosuppressive effects
  • It suppresses your immune systems in conditions where your immune systems mistakenly attacks its own tissues and aggravate the disease.
  • Short term side-effects (few months) :  Changes in behavior, weight gain, Irritation of stomach lining, raised BP, change in blood sugar level, weakness of bones.
  • Long term side-effects  (months to years) : osteoporosis or fractures, cataracts, worsening diabetes

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