Background: We aimed to report a large series of idiopathic granulomatous lobular mastitis (IGLM) from Iran and sketch preliminary clinical practice guidelines (CPG) for approaching an inflammatory breast mass. Patients and Methods: In a retrospective records review, 43 consecutive IGLM cases were studied. Data on baseline, clinical, imaging, and pathologic characteristics were collected. Results: The mean age of the women was 33.5 years. All but 1 were married and had given birth. 16% had a cancer-like presentation. Inflammatory signs, architectural distortion, and a nodular pattern were the most common findings clinically, mammographically and ultrasonographically, respectively. 29.5% of the pathological reports indicated necrosis which was more common in younger subjects (p = 0.016); microabscesses were associated with a shorter lactation course (p = 0.006). Corticosteroids had been used as the initial treatment modality in 51%, immunosuppressive agents had not been administered, and a 16% relapse rate was recorded. We recognized the need for a multidisciplinary approach covering radiology, oncology, and surgery to best handle diagnostic and therapeutic issues and manage relevant infections as well as the major differential diagnosis, i.e. malignancy. Conclusion: We hypothesized that a shorter lactation period may cause more milk stasis and extravasation and be contributory to IGLM. CPGs are needed to incorporate the needed multidisciplinary approach and to standardize IGLM care. We present one such guideline.

Keywords:
Idiopathic granulomatous lobular mastitis, Multidisciplinary approach, Treatment strategies, Clinical practice guidelines, Iran, Milk extravasation, Breast-feeding, Relapse
1.
Sakurai K, Fujisaki S, Enomoto K, Amano S, Sugitani M: Evaluation of follow-up strategies for corticosteroid therapy of idiopathic granulomatous mastitis. Surg Today 2011;41:333-7.
2.
Takano J, Prialé P: Idiopathic chronic granulomatous mastitis: a case report. Rev Peru Med Exp Salud Publica 2010;27:635-7.
3.
Naraynsingh V, Hariharan S, Dan D, Harnarayan P, Teelucksingh S: Conservative management for idiopathic granulomatous mastitis mimicking carcinoma: case reports and literature review. Breast Dis 2010;31:57-60.
4.
Erozgen F, Ersoy YE, Akaydin M, Memmi N, Celik AS, Celebi F, Guzey D, Kaplan R: Corticosteroid treatment and timing of surgery in idiopathic granulomatous mastitis confusing with breast carcinoma. Breast Cancer Res Treat 2010;123:447-52.
5.
Heer R, Shrimankar J, Griffith CD: Granulomatous mastitis can mimic breast cancer on clinical, radiological or cytological examination: a cautionary tale. Breast 2003;12:283-6.
6.
Lacambra M, Thai TA, Lam CC, Yu AM, Pham HT, Tran PV, Law BK, Van Nguyen T, Pham DX, Tse GM: Granulomatous mastitis: the histological differentials. J Clin Pathol 2011;64:405-11.
7.
Hugon-Rodin J, Plu-Bureau G, Hugol D, Gompel A: Management of granulomatous mastitis: a series of 14 patients. Gynecol Endocrinol 2012;28:921-4.
8.
Afridi SP, Memon A, Shafiq-ur-Rahman, Memon A: Granulomatous mastitis: a case series. J Coll Physicians Surg Pak 2010;20:365-8.
9.
Kok KY, Telisinghe PU: Granulomatous mastitis: presentation, treatment and outcome in 43 patients. Surgeon 2010;8:197-201.
10.
Miller FW, Alfredsson L, Costenbader KH, Kamen DL, Nelson LM, Norris JM, De Roos AJ: Epidemiology of environmental exposures and human auto immune diseases: findings from a National Institute of Environmental Health Sciences Expert Panel Workshop. J Autoimmun 2012;39:259-71.
11.
Ozel L, Unal A, Unal E, Kara M, Erdoğdu E, Krand O, Güneş P, Karagül H, Demiral S, Izzet Titiz M: Granulomatous mastitis: is it an autoimmune disease? Diagnostic and therapeutic dilemmas. Surg Today 2012;42:729-33.
12.
Hovanessian Larsen LJ, Peyvandi B, Klipfel N, Grant E, Iyengar G: Granulomatous lobular mastitis: imaging, diagnosis, and treatment. AJR Am J Roentgenol 2009;193:574-81.
13.
Peña-Santos G, Ruiz-Moreno JL: Idiopathic granulomatous mastitis treated with steroids and methotrexate. Ginecol Obstet Mex 2011;79:373-6.
14.
Cabrera G, Medina R: (Idiopathic granulomatous mastitis; a benign lesion with malignant clinical-radiological characteristics). Radiologia 2013;55: 90-2.
15.
Tse GM, Tan PH, Pang AL, Tang AP, Cheung HS: Calcification in breast lesions: pathologists' perspective. J Clin Pathol 2008;61:145-51.
16.
Dursun M, Yilmaz S, Yahyayev A, Salmaslioglu A, Yavuz E, Igci A, Acunas G, Tunacı M: Multi-modality imaging features of idiopathic granulomatous mastitis: outcome of 12 years of experience. Radiol Med 2012;117:529-38.
17.
Boufettal H, Essodegui F, Noun M, Hermas S, Samouh N: Idiopathic granulomatous mastitis: a report of twenty cases. Diagn Interv Imaging 2012;93:586-96.
18.
Going JJ, Anderson TJ, Wilkinson S, Chetty U: Granulomatous lobular mastitis. J Clin Pathol 1987;40:535-40.
19.
Stary CM, Lee YS, Balfour J: Idiopathic granulomatous mastitis associated with corynebacterium sp. infection. Hawaii Med J 2011;70:99-101.
20.
Renshaw AA, Derhagopian RP, Gould EW: Cystic neutrophilic granulomatous mastitis: an under-appreciated pattern strongly associated with grampositive bacilli. Am J Clin Pathol 2011;136:424-7.
21.
Pereira FA, Mudgil AV, Macias ES, Karsif K: Idiopathic granulomatous lobular mastitis. Int J Dermatol 2012;51:142-51.
22.
Imoto S, Kitaya T, Kodama T, Hasebe T, Mukai K: Idiopathic granulomatous mastitis: case report and review of the literature. Jpn J Clin Oncol 1997;27:274-7.
23.
DeHertogh DA, Rossof AH, Harris AA, Economou SG: Prednisone management of granulomatous mastitis. N Engl J Med 1980;303:799-800.
24.
Akbulut S, Yilmaz D, Bakir S: Methotrexate in the management of idiopathic granulomatous mastitis: review of 108 published cases and report of four cases. Breast J 2011;17:661-8.
25.
Seo HR, Na KY, Yim HE, Kim TH, Kang DK, Oh KK, Kang SY, An YS, Chun M, Kim W, Park RW, Jung YS, Kim KS: Differential diagnosis in idiopathic granulomatous mastitis and tuberculous mastitis. J Breast Cancer 2012;15:111-8.
26.
Kok KY, Telisinghe PU: Granulomatous mastitis: presentation, treatment and outcome in 43 patients. Surgeon 2010;8:197-201.
27.
Diesing D, Axt-Fliedner R, Hornung D, Weiss JM, Diedrich K, Friedrich M: Granulomatous mastitis. Arch Gynecol Obstet 2004;269:233-6.
28.
Vinayagam R, Cox J, Webb L: Granulomatous mastitis: a spectrum of disease. Breast Care (Basel) 2009;4:251-4.
29.
Baslaim MM, Khayat HA, Al-Amoudi SA: Idiopathic granulomatous mastitis: a heterogeneous disease with variable clinical presentation. World J Surg 2007;31:1677-81.
30.
Akbulut S, Arikanoglu Z, Senol A, Sogutcu N, Basbug M, Yeniaras E, Yagmur Y: Is methotrexate an acceptable treatment in the management of idiopathic granulomatous mastitis? Arch Gynecol Obstet 2011;284:1189-95.
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2013
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