Granulomatous Mastitis and Lipogranuloma of the Breast

The writer does not accept an immunologic basis as the cause of gran ulomatous mastitis clinically simulating carcinoma, as previously published in the Journal. In 3 similar cases seen recently patients had been using oral contraceptives. Areas of metoplasia of ductular or acinar epithelium have been observed. These cells block the ducts. Ductular epithelium becomes distended and eventually denuded so that luminal contents come in contact with stroma. This evokes a chronic granulomatous reaction on a chemical rather than an immunological basis which the author calls "lipogranuloma." This term differentiates the lesion from tubuculous or fungal granuloma. The effects of oral contraceptives are thought to be related. Reply by Doctor Kessler, author of the original article, follows. He distinguishes the lesions d escribed by him from lipogranuloma. His patients had not been using oral contraceptives.