Tokushukai Medical Group

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Breast Surgery Disease:Granulomatous Mastitis

The disease present with symptom which is like inflammatory breast cancer.

The disease is a benign granuloma-forming lesions which is produced in non-areola area (a bit apart from nipple) and is developed with tumor mass or flare. This is unlikely affected with both side, and present similar symptoms like inflammatory breast cancer which breast swells like edema or mammary abscess. It is said that this disease are common among childbearing age who is not breast-feeding, especially among female within 5 years from childbirth.

Change of endocrine environment or infection of virus may get engaged?

The cause of the disease is still unknown. It is assumed that endocrine environment changes like autoimmune disease, pregnancy/delivery/breast-feeding, birth control pill, smoking, hyperprolactinemia, or milk stagnation mastitis, engagement of unknown virus/bacterial infection, and is considered that granuloma is formed by the deviation to the interstitial quality of secretions by disorders of the mammary gland epithelium and inflammation reaction against them are raising further a disorder of mammary epithelium. There is a case where nodular erythema (disease which red colored nodal cell is produced with pain on knee) is complicated.

Differentiation with other diseases which produce granuloma is necessary.

There is less distinguished observation in image diagnosis at echography so that it is difficult to differentiate with breast cancer by image only. Histological examination (biopsy with a needle) is useful. There is a report saying that the confirmed diagnosis can be done with multiple examinations. Histologically, characteristic of the disease is that the infiltration to epithelioid cell with primary lobules of mammary gland, inflammatory cell like neutrophil, and there is no caseous necrosis in the center of granuloma tissue consists with multinucleated giant cell so that inflammation of blood vessel or mammary ductal ectasia cannot be seen. Also, it is necessary to deny existence of acid fast bacillus/fungus.

Furthermore, it becomes necessary to differentiate breast disease forming granuloma, tuberculosis, non-tuberculous mycobacterial infection, fungus disease, panniculitis, sarcoidosis, Bechet’s disease, Churg-Strauss syndrome, Wegner granuloma, plasma cell mastitis, Weber-Christian disease, external injury, exogenous material, mammary ductal ectasia, or ruptured cyst. Identifying fungus is most unlikely happen in bacteriological examination. And it has an impression that the egestion of pus is less on the contrary of the image when punctured.

The approach to therapy is not yet established although there are many cases which are cured or become less severe.

Dosage of antibiotic is almost useless. A case is reported where follow-up or repeated needling has got less severe, but it is difficult to improve with incomplete drainage, and there is a report saying disease is cured by Seton method used for anal fistula. Although it is considered that the dosage of adrenal cortical steroid is a primary option as medical agent, typical dosage amount or dosage period has not been established. There is a report saying combination with immunoinhibitory effect is useful.

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