Learning objectives
-Review the radiological findings of Idiopathic Granulomatous Mastitis (IGM) in mammography,
ultrasound and Magnetic Resonance Imaging (MRI).
-To discuss and illustrate the main differential diagnosis pitfalls.
Background
Idiopathic granulomatous mastitis,
also known as nonpuerperal mastitis or granulomatous lobular mastitis,
is a benign,
rare and chronic inflammatory disease of the breast of unknown etiology.
It usually has a recurrent or prolonged natural disease course.
Although it is a benign condition,
it is important because it clinically and radiographically mimics breast cancer,
especially inflammatory type (1).
The etiology of IGM is unknown but some factors have been stated,
including reaction to chemical materials,
infectious disease,
autoimmune diseases and immunologic response for milk leakage from...
Findings and procedure details
At imaging,
granulomatous mastitis can manifest with a variety of nonspecific findings,
which often mimic the appearances of malignancy.
A standard diagnostic protocol has not yet been established.
The first step for diagnosis is usually the mammography.
If diagnosis is unclear,
ultrasound and MRI are performed ( Fig. 1 ,
Fig. 2 ,
Fig. 3 ,
Fig. 4 Fig. 5 ).
In patients younger than 40 years who present with a palpable abnormality,
mammography is often omitted and the initial evaluation is performed with ultrasound...
Conclusion
Idiopathic granulomatous mastitis is an infrequent non caseating granulomatous inflammatory disease,
which typically affects women within 6 years of pregnancy.
The most frequent clinical signs are unilateral breast mass,
pain,
skin erythema,
edema and warmth.
There are no radiologic pathognomonic findings specific to this entity due to the wide spectrum of mammography,
ultrasound and MR imagings of IGM.
At mammography,
the most common findings are focal asymmetric density,
diffuse asymmetric opacity or an irregular focal mass.
Ultrasound usually shows hypo-echoic or heterogeneous mass or masses...
References
(1)Mahmodlou R ,
Dadkhah N ,Abbasi F,et al.
Idiopathic granulomatous mastitis: dilemmas in diagnosis and treatment.
Electron physician2017;25(9):5375-5379.
(2)Pluguez-Turull CW,
Nanyes JE,
Quintero CJ,
et al.
Idiopathic Granulomatous Mastitis: Manifestations at Multimodality Imaging and Pitfalls.
Radiographics,2018;38(2):330-356.
(3) Aghajanzadeh M,
Hassanzadeh R,
Alizadeh Sefat S,
et al.
Granulomatous mastitis: presentations,
diagnosis,
treatment and outcome in 206 patients from the north of Iran.
Breast 2015;24(4):456–460.
(4) Gautier N,
Lalonde L,
Tran-Thanh D,
et al.
Chronic granulomatous mastitis: imaging,
pathology and management.
Eur J Radiol 2013;82(4):e165–e175.
(5) Baslaim...