Background: The etiology of idiopathic granulomatous mastitis (IGM) is unknown, and it is commonly misdiagnosed clinically and/or radiologically as breast cancer. The role of fine-needle aspiration cytology (FNAC) in its diagnosis is still a matter of debate. The aim of the current study is to assess the value of FNAC in the diagnosis of IGM, and to search for the presence of bacteria in IGM with cystic vacuoles, which was described recently by a few authors. Materials and Methods: Retrospective study of cytologic smears and histologic tissue sections of 65 Egyptian IGM cases was done along with microbiologic testing. A comparison of the frequency of IGM in Egypt to that of other populations was also made. Results: IGM has typical FNA features which can easily exclude malignancy. Histologically, cystic vacuoles were encountered in 35 out of 65 cases (53.9%), with only 6 (17.14%) of these cases showing Gram-positive bacilli (GPB). The frequency of IGM in Egypt is comparable to those in other Middle Eastern countries but much higher than in Western countries. Conclusion: IGM is a common breast disease in Egypt. FNAC in IGM has a high diagnostic accuracy. This study supports the few recent studies that have detected GPB in IGM with cystic vacuoles. Thus, bacteriologic examination in such cases may affect the treatment strategy.

Kessler E, Wolloch Y: Granulomatous mastitis: a lesion clinically simulating carcinoma. Am J Clin Pathol 1972;58:642-646.
Ahmed I, Nazir R, Chaudhary MY, et al: Triple assessment of breast lump. J Coll Physicians Surg Pak 2007;17:535-538.
Akhator A: Benign breast masses in Nigeria. Niger J Surg Sci 2007;17:105-108.
Taylor GB, Paviour SD, Musaad S, et al: A clinicopathological review of 34 cases of inflammatory breast disease showing an association between corynebacteria infection and granulomatous mastitis. Pathology 2003;35:109-119.
Al-Khaffaf B, Knox F, Bundred NJ: Idiopathic granulomatous mastitis: a 25-year experience. J Am Coll Sur 2008;206:269-273.
Hovanessian Larsen LJ, Peyvandi B, Klipfel N, Grant E, lyengar G: Granulomatous lobular mastitis: imaging, diagnosis, and treatment. AJR Am J Roentgenol 2009;193:574-581.
Seo HR, Na KY, Yim HE, Kim Th, Kang DK, Oh KK, et al: Differential diagnosis in idiopathic granulomatous mastitis and tuberculous mastitis. J Breast Cancer 2012;15:111-118.
Memis A, Bilgen I, Ustun EE, Ozdemir N, Erhan Y, Kapkac M: Granulomatous mastitis: imaging findings with histopathologic correlation. Clin Radiol 2002;57:1001-1006.
Lin C-H, Hsu C-W, Tsao T-Y, Chou J: Idiopathic granulomatous mastitis associated with risperidone-induced hyperprolactinemia. Diagn Pathol 2012;7:2.
Kanazawa S, Naae T, Fukuda K, Katsu I, Mukai N, Sugihara Y, Otani H, Higami Y, Tsunoda T: Granulomatous lobular mastitis: difficulty of diagnosis. Int J Clin Oncol 2000;5:57-61.
Tse GM, Poon CS, Ramachandram K, Ma TK, Pang LM, Law BK, Chu WC, Tang AP, Cheung HS: Granulomatous mastitis: a clinicopathological review of 26 cases. Pathology 2004;36:254-257.
Rosenman M, Clayton KL, Cummings OW, Danielson CFM, Freeman AM, Garrison PJ, Harris JD, Meece C, Spinola S, Wilson S, Monroe JA, Roberson MS, Mac Cannell T, Perz J: Idiopathic granulomatous mastitis in Hispanic women - Indiana, 2006-2008. MMWR Morb Mortal Wkly Rep 2009;58:1317-1321.
Lacambra M, Thai TA, Lam CCF, Yu A, Pham HT, Tran PV, Law BK, Nguyen TV, Pham DX, Tse GM: Granulomatous mastitis: the histological differentials. J Clin Pathol 2011;64:405-411.
Boufettal H, Essodegui F, Noun M, Hermas S, Samouh N: Idiopathic granulomatous mastitis: a report of twenty cases. Diagn Interv Imaging 2012;93:586-596.
Cheng L, Reddy V, Solmos G, Watkins L, Cimbaluk D, Bitterman P, Ghai R, Gattuso P: Mastitis, a radiographic, clinical and histopathologic review. Breast J 2015;21:403-409.
Gurleyik G, Aktekin A, Aker F, Karagulle H, Saglam A: Medical and surgical treatment of idiopathic granulomatous lobular mastitis: a benign inflammatory disease mimicking invasive carcinoma. Breast Cancer 2012;15:119-123.
Martínez-Parra D, Nevado-Santos M, Meléndez-Guerrero B, García-Solano J, Hierro-Guilmain CC, Pérez-Guillermo M: Utility of fine-needle aspiration in the diagnosis of granulomatous lesions of the breast. Diagn Cytopathol 1997;17:108-114.
Tse GMK, Poon CSP, Law BKB, Pang LM, Chu WCW, Ma TKF: Fine needle aspiration cytology of granulomatous mastitis. J Clin Pathol 2003;56:519-521.
Gangopadhyay M, De A, Chakrabarti I, Ray S, Giri A, Das R: Idiopathic granulomatous mastitis-utility of fine needle aspiration cytology (FNAC) in preventing unnecessary surgery. J Turk Ger Gynecol Assoc 2010;11:127-130.
Gupta RK: Fine needle aspiration cytology of granulomatous mastitis. Acta Cytol 2010;54:138-141.
Aghajanzadeh M, Hassanzadeh R, et al: Granulomatous mastitis: presentations, diagnosis, treatment and outcome in 206 patients from the north of Iran. Breast 2015;24:456-460.
Lin CH, Hsu CW, Tsao TY, Chou J: Idiopathic granulomatous mastitis associated with risperidone-induced hyperprolactinemia. Diagn Pathol 2012;7:2.
Lacambra M, Thai TA, Lam CC, et al: Granulomatous mastitis: the histological differentials. J Clin Pathol 2011;64:405-411.
Panzacchi R, Gallo C, Fois F, et al: Primary sarcoidosis of the breast: case description and review of the literature. Pathologica 2010;102:104-107.
Vaamonde R, Cabrera JM, Vaamonde-Martin RJ, Jimena I, Marcos Martin J: Silicone granulomatous lymphadenopathy and siliconomas of the breast. Histol Histopathol 1997;12:1003-1011.
Renshaw AA, Derhagopian RP, Gould EW: Cystic neutrophilic granulomatous mastitis. Am J Clin Pathol 2011;136:424-427.
D'Alfonso TM, Moo TA, Arleo EK, Cheng E, Antonio LB, Hoda SA: Cystic neutrophilic granulomatous mastitis: further characterization of a distinctive histopathologic entity not always demonstrably atributable to Corynebacterium infection. Am Surg Pathol 2015;39:1440-1447.
Girgin S, Uslukaya Ö, Yılmaz EE, Fırat U, Gümüş H, Kapan M, Gümüş M: Granulomatous mastitis: a retrospective review of 49 patients. Dicle Tıp Dergisi 2015;42:22-27.
Eser M, Kaptanoglu L, Kement M, Eyvaz K, Gokceiman M, Kurt N, Demiray M, Gecer MO: A challenging entity in the differential diagnosis of breast cancer: a retrospective analysis of 17 cases with granulomatous lobular mastitis. J Breast Health 2013,9:69-75.
Nayeri F, Hariat M, Dalili H, Raji F, Kavimi A: Breast feeding status and effective factors in 21-27 months Iranian infants. Open J Pediatr 2015;5:156-163.
Kessler El, Katzav JA: Lobular granulomatous mastitis. Surg Pathol 1990;3:115-120.
Brydon L, Edwards S, Jia H, et al: Psychological stress activates interleukin-1 beta gene expression in human mononuclear cells. Brain Behav Immun 2005;19:540-546.
Steptoe A, Hamer M, Chida Y: The effects of acute psychological stress on circulating inflammatory factors in humans: a review and meta-analysis. Brain Behav Immum 2007;21:901-912.
Kumarasinghe MP: Cytology of granulomatous mastitis. Acta Cytol 1997;41:727-730.
Kochhar AK, Jindal U, Singh K: Spectrum of cytological findings in fine needle aspiration cytology of breast lumps with histopathology correlation: experience in a tertiary care rural hospital in India. Asian Pac J Cancer Prev 2013;14:7257-7260.
D'Alfonso TM, Ginter PS, Shin SJ: A review of inflammatory processes of the breast with a focus on diagnosis in core biopsy samples. J Pathol Transl Med 2015;49:279-287.
Kakkar S, Kapila K, Singh MK, Verma K: Tuberculosis of the breast: a cytomorphologic study. Acta Cytol 2000;44:292-296.
Chandanwale SS, Buch AC, Gore CR, Ramanpreet KC, Jadhav P: Five needle aspiration cytology in breast tuberculosis: diagnostic difficulties - study of eleven cases. Indian J Tuberc 2012;59:162-167.
Masood S: Cytopathology of the Breast: ASCP Theory and Practice of Cytopathology. Chicago, American Society of Clinical Pathologists Press, 1996, vol 5.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.