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Study of clinico‐pathological changes before and after corticosteroid therapy in cases of idiopathic granulomatous mastitis

Idiopathic granulomatous mastitis (IGM) is an uncommon benign inflammatory breast disease.1 Its etiology remains controversial; however, some authors suggested that the presence of certain species of corynebacterium is a major causative aspect of IGM.2 Once the diagnosis is established and infection has been ruled out, management with steroid therapy may be initiated and is reported to be a valuable treatment.3 Surgery in the form of wide local excision (WLE) was the main treatment before 1980 but its main problem was recurrence, yet it is still performed depending on personal experience and preference.4 This study was performed to evaluate the clinical outcome of oral corticosteroids treatment (OCT) with/without surgery for IGM in correlation with histopathology before and after treatment. The study was conducted on 30 newly diagnosed female patients with IGM admitted to the Surgical Oncology Unit, Alexandria Main University Hospital (AMUH), in the period between January 2016 and December 2018. Patients were included in the study after pathological confirmation of IGM and microbiological exclusion of other causes of granulomatous mastitis such as tuberculosis, syphilis, and mycotic infection. Patients with history of connective tissue diseases, autoimmune diseases, or sarcoidosis were also excluded from the beginning as well as diabetic and osteoporotic patients. For all patients, tissue diagnosis was obtained by multiple core needle biopsies (CNB) under ultrasound (U/S) guidance before and after OCT. Treatment was initiated with oral prednisone (30– 60 mg) according to the severity of IGM based on Oktay Irkorucu classification,5 for (3– 6 months) according to patient's response with tapering of the dose on follow up (F/U) visits. For any breast mass(es) that did not disappear completely with OCT, WLE was done. McNemar test was used to analyze the significance between the different stages. All demographic data of the patients are shown in (Table 1). In the present study, 90% of patients presented with unilateral breast affection. Pain and/or tender mass (83.3%), skin induration (93.3%), and abscess formation (63.3%) were the most common manifestations, while erythema, nipple discharge, pau d'orange, TA B L E 1 Distribution of the studied cases according to different parameters (n = 30)