Surgical Globetrotting
Chronic Granulomatous Mastitis: Diagnostic and Therapeutic Considerations
Aziz Firzah Azlina, M.S.,
1
Zakaria Ariza, M.B.B.S.,
1
Talib Arni, M. Path.,
2
Abdullah Noor Hisham, M.S.
1
1
Department of Breast and Endocrine Surgery, Putrajaya Hospital, Precinct 7, 62250 Putrajaya, Malaysia
2
Department of Pathology, Kuala Lumpur Hospital, Jalan Pahang, 50586 Kuala Lumpur, Malaysia
Abstract. To review the clinical presentation, histopathological features,
and optimal treatment of chronic granulomatous mastitis, the authors con-
ducted a retrospective study of 25 women admitted to a teaching hospital in
Malaysia between January 1998 and December 2000 who met the required
histologic criteria. The primary outcome measures were morbidity and re-
currence of the disease. Thirteen patients presented with a breast mass
clinically mimicking breast cancer, and 12 patients had breast induration
and abscess formation. In addition, 8 of these patients had recurrent breast
disease. Clinical and imaging diagnosis has often been difficult and incon-
clusive, so histopathology remains the optimal diagnostic tool. Of interest,
50% of patients experience recurrences, and long-term follow-up is there-
fore necessary. The authors concluded that, because chronic granuloma-
tous mastitis is a rare benign breast condition that may be misdiagnosed as
breast carcinoma, complete resection should be accomplished whenever
possible. Steroid therapy may be an adjuvant for optimal treatment.
Awareness among surgeons and pathologists should also be emphasized to
avoid unnecessary misdiagnosis and treatment.
Chronic granulomatous mastitis (CGM) is a rare benign breast
condition first described by Kessler and Wolloch in 1972 [1]. They
reported five women with breast masses characterized by florid
granulomatous mastitis, which was not associated with trauma, spe-
cific infections, or exogenous materials. To date, there are only ap-
proximately 120 reported cases in the international literature [2].
Although it is a benign entity, CGM clinically mimics breast cancer
in terms of physical and radiological findings, often leading to di-
sastrous consequences. At present, the definitive diagnosis can only
be established and confirmed by histopathology. The aim of this
study was to review the clinical presentation of CGM and its histo-
pathological features, and to outline the diagnostic and therapeutic
considerations in the management of this potentially recurrent
nonmalignant breast disease.
Patients and Methods
A retrospective study included 25 women who met the required
histological criteria of CGM and who were treated between Janu-
ary 1998 and December 2000. This study was performed in a teach-
ing hospital; the patients were either referred from the Outpatient
Department of the hospital or from peripheral government health
clinics with outpatient services. The diagnosis was confirmed either
by core needle biopsy or fine-needle aspiration cytology for the sus-
picious breast lesions and also from biopsy specimens taken from
the abscess wall during drainage. Clinical data of the presentation,
histopathology, and management were analyzed by review of medi-
cal records. Patients who had history of cosmetic treatment by in-
jection of silicone, liquid paraffin, or beeswax into the breast pa-
renchyma (olegranulomatous mastitis) were excluded from this
study.
Follow-up information was obtained from clinical reviews at
monthly intervals (range, 2 to 11 months). The types of symptoms,
severity, and duration were documented. The data collected were
then studied and the various parameters were compared retrospec-
tively.
Results
Complete follow-up information for all patients diagnosed with
CGM with regard to the clinical presentation, histology report, and
management was obtained for all 25 patients. The patients ranged
in age from 21 to 47 years, with the exception of one patient who
was 74 years old. The median age was 36.5 years. There were 19
Malay and 6 Indian ethnic patients in our series. The parity of these
patients ranged from nil to six, with a mean parity of three. At the
time of presentation, one patient was 28 weeks pregnant and five
patients were lactating. None of these patients were on any medi-
cation or hormonal treatment.
All patients except one presented with a history of a painful pal-
pable lesion in the affected breast. These lesions were unilateral
and occurred with no tendency to any particular quadrant of the
respective breast. The size of the mass ranged from 1 to 10 cm with
a mean of 5.5 cm. There was also no tendency for any side of the
breast to be more involved (left 64%, right 36%). The mean dura-
tion of symptoms was 2.0 months. At the time of presentation, 12
women (52.0%) had a clinical impression of breast abscess. The
other 13 women in this study (48.0%) had a clinical impression of a
malignant breast lump. More than half the women in our series had
already been treated with a course of antibiotics with or without
Correspondence to: Abdullah Noor Hisham, M.S., e-mail: anhisham@
pd.jaring.my
WOR LD
Journal of
SURGERY
© 2003 by the Socie´te´
Internationale de Chirurgie
World J. Surg. 27, 515–518, 2003
DOI: 10.1007/s00268-003-6806-1