Granulomatous mastitis: Presentations, diagnosis, treatment and outcome in 206 patients from the north of Iran.
OBJECTIVE
The aim of this study is to review the clinical presentations, diagnostic methods, treatment options and outcome of patients with Granulomatous Mastitis (GM).


METHODS
In a retrospective study, we indentified 206 women who met the required histological criteria of (GM).


RESULTS
Thirty eight (18%) of these women had taken antibiotics before their diagnosis of GM. The most common symptoms in remaining 168 symptomatic women were breast mass. The most common ultrasonographic and mammographic finding was large irregular hypo echoic masses and an irregular mass, respectively. As a diagnostic tool, fine needle aspiration (FNA) was performed in 33 (19.5%) and core needle biopsy with or without ultrasound was done in 92 (55%) of patients while successful rate was 13 (39%) and 87 (94.5%), respectively. The remaining 43 (25.5%) of women underwent surgical excisions. Only 6 (3%) patients improved with antibiotics and 200 (97%) of women who did not respond to antibiotics, were treated with steroid and among them 144 (72%) improved. Treatment with combination of methotrexate and steroid was done in 56 (28%) patients and was effective in 40 (71%) of them. Sixteen (8%) patients were treated with a combination of steroid and bromocriptine which was effective in 5 (31%) patients. A wide surgical excision was performed in 11 (5.5%) patients who were nonresponsive to steroid and methotrexate and bromocriptine therapy.


CONCLUSIONS
Our findings indicate that clinical and imaging findings of (GM) have overlapped with malignancy. The best diagnostic method is core needle biopsy. Corticosteroids are in the first line of treatment with a good therapeutic response.
Department of Surgery, Guilan University of Medical Sciences, Rasht, Iran.
Manouchehr
M
Aghajanzadeh
Student Research Committee, Guilan University of Medical Sciences, Rasht, Iran. Electronic address: rasool.hassanzadeh@gmail.com.
Rasool
R
Hassanzadeh
Department of Surgery, Guilan University of Medical Sciences, Rasht, Iran.
Soheila
S
Alizadeh Sefat
Respiratory Diseases Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran.
Ali
A
Alavi
Department of Surgery, Guilan University of Medical Sciences, Rasht, Iran.
Hossein
H
Hemmati
Department of Surgery, Guilan University of Medical Sciences, Rasht, Iran.
Mohammad Sadegh
MS
Esmaeili Delshad
Respiratory Diseases Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran.
Cyrus
C
Emir Alavi
Respiratory Diseases Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran.
Siamak
S
Rimaz
Department of Pathology, Guilan University of Medical Sciences, Rasht, Iran.
Siamak
S
Geranmayeh
Department of Pathology, Guilan University of Medical Sciences, Rasht, Iran.
Mohammad
M
Najafi Ashtiani
Department of Pathology, Guilan University of Medical Sciences, Rasht, Iran.
Seyed Mahmoud
SM
Habibzadeh
Department of Radiology, Guilan University of Medical Sciences, Rasht, Iran.
Khosheh
K
Rasam
Respiratory Diseases Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran.
Sara
S
Massahniya
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001707:Biopsy, Needle / Q000379:methods; D001940:Breast / Q000473:pathology; D001971:Bromocriptine / Q000627:therapeutic use; D003879:Dermatologic Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D058890:Granulomatous Mastitis / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D006727:Hormone Antagonists / Q000627:therapeutic use; D006801:Humans; D007492:Iran; D008327:Mammography; D008727:Methotrexate / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome; D016217:Ultrasonography, Mammary; D055815:Young Adult
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D003879:Dermatologic Agents; D006727:Hormone Antagonists; D001971:Bromocriptine; D008727:Methotrexate
Breast; Core needle biopsy; Corticosteroid therapy; Granulomatous mastitis; Methotrexate