A CHALLENGING ENTITY IN THE DIFFERENTIAL DIAGNOSIS OF BREAST CANCER: A RETROSPECTIVE ANALYSIS OF 17 CASES WITH GRANULOMATOUS LOBULAR MASTITIS

Objective: Granulomatous lobular mastitis (GLM) is a rare and benign disorder of the breast, of unknown etiology. Differential diagnosis by radiological and clinical evaluation remains uncertain. There is no optimal treatment for this disorder. In this study, we aimed to analyze 17 cases with GLM retrospectively with the help of clinical and radiologic studies and to give detailed information about outcomes. Materials and Methods: A retrospective chart review of 17 consecutive patients with granulomatous lobular mastitis (GLM), who were treated in Kartal Education and Research Hospital between March, 2004 and January, 2011,was carried out in our study. Results: All the cases were women of childbearing age, who had given birth and breastfed at least once. The most common causes for admission were; breast mass in 12 patients (70.6%) and pain in 12 (70.6%) cases. Five (29.4%) cases developed a fistula and four (23.5%) had abscess requiring drainage. Mammography was used for 10 (58.8%) cases, 12 (70.6%) were examined by MRI and all the patients were evaluated with ultrasound. Five (29.4%) cases were suspicious for malignancy prior to biopsies. Diagnoses of sixteen (94.1%) cases were established with tru-cut biopsy. Fourteen (82.3%) cases underwent wide local excision (WLE) following antibiotic therapy and/or drainage and 3 (17.6%) cases with diffuse disease also underwent wide local excision following therapy with antibiotics and/or drainage and steroids (prednisolone 32 mg bid). Complete remission was observed in one patient with diffuse disease who was referred to our clinic with excisional biopsy after steroid therapy (prednisolone 32 mg bid). Relapse developed in two (11.7%) cases in the end of thirty-six months of median follow-up. Both patients were treated with steroids (prednisolone 32 mg bid). Conclusion: GLM is a benign disorder and has no widely accepted treatment. Wide local excision may be performed successfully in the management of GLM alone or following a steroid therapy in those patients with diffuse involvement.