title: Differential diagnosis in idiopathic granulomatous mastitis and tuberculous mastitis.
abstract: OBJECTIVE
  Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory disease of unknown etiology. The diagnosis of IGM requires that other granulomatous lesions in the breast be excluded. Tuberculous mastitis (TM) is also an uncommon disease that is often difficult to differentiate from IGM. The purpose of this study is to develop a new algorithm for the differential diagnosis and treatment of IGM and TM.
  
  
  METHODS
  Medical records of 68 patients (58 with IGM and 10 with TM) between July 1999 and February 2009 were retrospectively reviewed.
  
  
  RESULTS
  The mean age of the patients was 33.5 (IGM) and 40 (TM) years (p=0.018). The median follow-up was 84 months. Of the total 10 patients with TM, 5 patients had a history of pulmonary tuberculosis. The most common symptoms of the diseases were breast lump and pain. However, axillary lymphadenopathy was more seen in TM (50%) compared to IGM (20.6%) (p=0.048). TM showed more cancer-mimicking findings on radiologic study (p=0.028). In IGM, 48 patients (82.7%) underwent surgical wide excision and 21 patients (36.2%) were managed with corticosteroid therapy and antibiotics. All of the TM patients received anti-tuberculosis medications and 9 patients (90%) underwent wide excision. The mean treatment duration was 2.8 months in IGM and 8.4 months in TM. Recurrence developed in 5 patients (8.6%) in IGM and 1 patient (10%) in TM.
  
  
  CONCLUSIONS
  This study shows different characteristics between IGM and TM. The IGM patients were younger and had more mastalgia symptoms than the TM patients. Axillary lymphadenopathy was seen more often in TM patients. Half of the TM patients had pulmonary tuberculosis or tuberculosis lymphadenitis. Surgical wide excision might be both therapeutic and useful for providing an exact diagnosis.
authors.affiliation: Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Hee Ri Na
authors.initials: HR
authors.lastname: Seo
authors.forename: Kuk Young
authors.initials: KY
authors.lastname: Na
authors.forename: Hyun Ee
authors.initials: HE
authors.lastname: Yim
authors.forename: Tae Hee
authors.initials: TH
authors.lastname: Kim
authors.forename: Doo Kyoung
authors.initials: DK
authors.lastname: Kang
authors.forename: Ki Keun
authors.initials: KK
authors.lastname: Oh
authors.forename: Seok Yun
authors.initials: SY
authors.lastname: Kang
authors.forename: Young-Sil
authors.initials: YS
authors.lastname: An
authors.forename: Mison
authors.initials: M
authors.lastname: Chun
authors.forename: Woojae
authors.initials: W
authors.lastname: Kim
authors.forename: Rae Woong
authors.initials: RW
authors.lastname: Park
authors.forename: Yong Sik
authors.initials: YS
authors.lastname: Jung
authors.forename: Ku Sang
authors.initials: KS
authors.lastname: Kim