Granulomatous lobular mastitis: a complex diagnostic and therapeutic problem

Area of Science:

• Breast pathology
• Inflammatory diseases

Background:

• Granulomatous lobular mastitis (GLM) is a rare chronic inflammatory breast condition.
• Its clinical and radiological presentation can mimic breast carcinoma, leading to diagnostic challenges.
• Optimal diagnostic criteria and treatment strategies for GLM remain unclear.

Purpose of the Study:

• To evaluate diagnostic difficulties associated with granulomatous lobular mastitis.
• To discuss the outcomes of surgical treatment for GLM.

Main Methods:

• Retrospective review of 21 patients with histologically confirmed GLM.
• Analysis of diagnostic imaging (mammography, ultrasound, MRI) and treatment approaches.
• Data collected between January 1995 and May 2005.

Main Results:

• Common symptoms include breast mass and pain.
• Mammography and ultrasound findings can be inconclusive or suggest benign disease, but do not exclude malignancy.
• Magnetic resonance imaging (MRI) may aid diagnosis in equivocal cases. Recurrent cases were treated with limited excision due to suspected carcinoma.

Conclusions:

• Diagnostic imaging modalities like mammography and ultrasound are not definitive for ruling out malignancy in suspected GLM.
• MRI can be valuable for further evaluation when initial imaging is non-diagnostic.
• Fine-needle aspiration cytology can be useful but challenging; wide surgical excision is therapeutic and diagnostic.