Idiopathic Granulomatous Mastitis; Various Clinical Presentations and Challenges in the Management

Background: The term idiopathic granulomatous mastitis (IGM) or granulomatous lobular mastitis generally refers to any condition that causes a granulomatous inflammatory reaction within the breast or conditions for which the etiological factors cannot be identified.The study aims to describe the various clinical presentations of the disease and various management options.Methods: This retrospective cross-sectional study included 97 patients who were diagnosed with the disease in the period from 2016 -2021.Female patients complaining from IGM who accepted to be enrolled in the current study were included.Results: The mean age of patients was 33.85 years.Most patients were healthy with no clinical history of chronic diseases or autoimmune diseases, although thyroid diseases were the commonest associated medical diseases.The mean clinical course of the disease was around 11.06 months, and most of them presented with a painful breast lump, followed by a painless lump, skin redness, and edema as common forms of presentation.The mean size of the lump was 22.7 mm.The upper outer quadrant was the commonest affected site among single cases, although the majority were multiple with different sites.Ultrasound was done for all patients, mammography for 2.1%, and MRI for 1%.Tissue sampling was done using FNAC in 19.6 %, tru cut biopsy in 59.8%, and excisional biopsy in 70.1% of them.The vast majority of patients received medical therapy with a mean duration of therapy of 7.13 months.All patients received different types of antibiotics, steroids were administered in 42.3 % of patients, and immune therapy in 6.2% of them.Some forms of surgical interventions were done for 96.9% of patients, lumpectomy and drainage of the abscess were the commonest forms of surgical interventions, and in 68% of patients, multiple interventions were required.Quinolone group and β-lactam antibiotics were the 2 most commonly administered antibiotics.The response to the management was good in 72.16% of patients, followed by poor response in 22.66%, and 2.06% of patients had a worsening course of the disease even after the management.After the management of the patients with IGM in our study, 69.07% of patients showed no relapse, while the remaining 30.93% showed relapse after the Conclusion: IGM is a clinically challenging disease.The most important initial step is appropriate diagnosis and exclusion of cancer by biopsy.Selection of treatment must be individualized.Complete surgical resection helps much in patient management and results in reducing the site effects of medical treatment, particularly steroids.