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Diagnostic and Interventional Imaging
Volume 93, n° 7-8
pages 586-596 (juillet 2012)
Doi : 10.1016/j.diii.2012.04.028
Idiopathic granulomatous mastitis: A report of twenty cases
 

Houssine Boufettal a, , Fatiha Essodegui b, Mohammed Noun a, Saïd Hermas a, Naïma Samouh a
a Department of Obstetrics and Gynaecology C, Ibn Rochd University Hospital, School of Medicine and Pharmacy, Aïn Chok University, Casablanca, Morocco 
b Central Radiology Department, Ibn Rochd University Hospital, School of Medicine and Pharmacy, Aïn Chok University, Casablanca, Morocco 

Corresponding author. 29, Lot. Abdelmoumen, Résidence Al Mokhtar, Derb Ghallef, 20340, Casablanca, Morocco.
Abstract
Introduction

Idiopathic granulomatous mastitis is a benign lesion of the mammary gland characterised by the presence of non-infectious inflammatory breast lesions limited to the lobules.

Objective

We report twenty cases of idiopathic granulomatous mastitis (IGM) with a discussion of epidemiology, clinical and diagnostic features, treatment and progress of this pathological entity.

Materials and methods

A retrospective study of twenty cases compiled from a ten-year period, from 952 pathological anatomy examinations carried out to investigate various breast pathologies.

Results

The patients had a mean age of 45.5years. Clinical examinations revealed a tumefaction measuring between 2.5 and 18cm in diameter. The mean size was 5.5cm. Mammography showed nodular lesions and sonography demonstrated hypoechoic nodules. On histological examination there was a granulomatous inflammatory infiltrate of epithelioid and giant cells, without caseation necrosis, made up of lymphocytes, plasma cells and neutrophils. Microbiology investigations were negative. Lesion involvement was principally lobulocentric. Surgical excision of the lesions was combined with corticosteroid therapy in twelve cases, with non-steroidal anti-inflammatory drugs in another four and with antibiotic therapy in four cases. The patients made good progress in the short-term.

Discussion and conclusion

IGM is a rare entity. It poses a problem of differential diagnosis because it clinically resembles other forms of mastitis. The diagnosis can be made with certainty on histological studies. The treatment is medical alongside surgical excision. The prognosis of this disease remains favourable.

The full text of this article is available in PDF format.

Keywords : Breast, Inflammation, Granuloma, Idiopathic


Idiopathic granulomatous mastitis is a benign lesion of the mammary gland characterised by the presence of non-infectious inflammatory breast lesions limited to the lobules. [1, 2, 3]. It is a rare nosological entity and for this reason it is not well known. It usually affects young women [4, 5, 6]. Its aetiology and pathogenesis remains a subject for debate [7, 8, 9]. It poses a problem of differential diagnosis because it clinically resembles other forms of mastitis and, most importantly, carcinomatous mastitis [10, 11, 12]. The purpose of this work is to study epidemiology, clinical and paraclinical characteristics, pathological anatomy features, treatment and progress of IGM, using a series of twenty cases managed in our hospital over a nine-year period from 2000 to 2009.

Materials and methods

We carried out a retrospective study of cases of IGM managed over the last 9years, from 2000 to 2009. During this period, twenty cases of idiopathic granulomatous mastitis were diagnosed among the 952 patients who were treated for breast pathologies. We then analysed the epidemiological, clinical, radiological, and histological data as well as information on the treatment and progression of patients with this clinical entity. Epidemiological, clinical, treatment and progression data were specified for all of our cases. The inclusion criteria were strictly based on histopathology: the only cases retained for this study were those with granulomatous breast lesions limited to the lobules. These granulomatous lesions were made up of polymorphous inflammatory cells and/or epithelioid and giant cells without caseation necrosis, and no pathogenic agents were found, including Koch’s bacillus on Ziehl-Neelsen staining and other pathogens on PAS and Gram staining.

Results

We compiled a list of the 20 cases of idiopathic granulomatous mastitis out of 952 patients who were treated for breast pathologies, equating to a 2% incidence of IGM. All of our patients were female. They had a mean age of 38.1years with extreme values of 19years and 66years (Table 1). None of the patients presented a documented history of autoimmune disease. The time to presentation of idiopathic granulomatous mastitis in relation to the patient’s most recent birth ranged from 8days to 15years. The timescale was less than five years in 12cases, which equates to 60% of cases. Lactation was noted in 11 patients (55%), with the duration of breastfeeding ranging from 6months to 7years. Twelve of the patients were taking oestrogen-progesterone contraception, with the total duration ranging from one to 18years. Four of our patients were postmenopausal, equating to 20% of cases. The mean age of the menopause was 45.5years, with extreme values of 43years and 48years. None of the patients in our series had received hormone replacement therapy. Notable in the patients’ personal medical histories was suspicion of a breast abscess in 20% of them and surgery to the breast for an adenofibroma in one patient. A family history of breast cancer was found in one patient. None of the patients were smokers. None of the patients had a history of autoimmune disease. No family history of IGM was found in our case series. The mean duration of symptoms of granulomatous mastitis in our series was 5months with extreme values of 2weeks and 2years. The circumstances surrounding discovery of the disease included a breast mass in 18 patients (90% of cases) (Table 2). The mean size of the lesion was 5.5cm with extreme values of 2cm and 18cm in diameter. The predominant area involved was the upper outer quadrant. Axiliary lymphadenopathies were present in five patients (25% of cases). The other reasons for consultation by order of frequency were: a breast abscess in three patients (15% of cases), skin induration in two patients (10%), an inflammatory plaque in one patient (5%), a large and inflamed breast with no evident lesion in one patient (5% of cases) and isolated mastodynia in one patient (5% of cases) (Figure 1, Figure 2). Twelve cases involved the left breast (60%), while eight involved the right breast (40%). Involvement was unilateral in 19 cases (95% of cases) and in one case involvement was bilateral. Findings on mammography included an opacity in twelve patients (60%) (Figure 3, Figure 4), an asymmetric parenchymal density in three patients (15%), an opacity with spiculated margins in three patients (15%) (Figure 5), an opacity with indistinct margins and heterogeneous density in one patient (5%) (Figure 6) and calcifications in one patient (5%) (Table 3). Sonography findings were circumscribed images that were hypoechoic and homogeneous in six cases, and hypoechoic and heterogeneous in another six (Figure 7). Fifteen patients underwent Doppler sonography (75% of cases), and this showed increased vascularisation of the lesions and adjacent breast tissue (Figure 8).



Figure 1


Figure 1. 

Enlarged nodular left breast with inflammatory signs in a 32-year-old female.

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Figure 2


Figure 2. 

Enlarged nodular and inflammatory left breast in a 46-year-old female.

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Figure 3


Figure 3. 

Bilateral mammogram in profile: dense opacity with irregular margins in the left deep retroareolar region.

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Figure 4


Figure 4. 

Bilateral mammogram in profile: deep left retroareolar asymmetric density.

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Figure 5


Figure 5. 

Bilateral mammogram: masses smaller than a centimetre with irregular margins in the right retroareolar region: oblique view (a) and enlarged (b).

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Figure 6


Figure 6. 

Mammogram in profile of the left breast (with localised compression): opacity with irregular shape and margins and heterogeneous density in the left superficial retroareolar region.

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Figure 7


Figure 7. 

Sonogram of the right breast: multiple oval masses with polylobular margins with a heterogeneous echostructure that is predominantly hyperechoic with enlarged axiliary lymph nodes (a and b).

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Figure 8


Figure 8. 

Bilateral breast sonogram: multiple right breast masses with irregular margins and a highly hypoechoic echostructure with an irregular hyperechoic halo.

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Microbiology investigations were carried out in eighteen patients, using breast discharge or breast biopsy samples. These examinations were negative for Koch’s bacillus, Corynebacteria and all other bacteria. Cytological investigations were carried out for two patients in our series, and these showed polymorphous inflammatory cells without specificity. The main feature of the histology results was the presence of an epithelioid and giant cell granuloma without caseation necrosis, which was seen in all of our patients, while ductal involvement such as occlusion or ectasia was noted in three patients, or 15%, fat necrosis in two patients, or 10%, and collagen fibrosis in one patient (Figure 9, Figure 10). Treatment for this disease is medical and surgical. Sixteen patients underwent a surgical procedure, which consisted of wide surgical excision of the tumour in 13 patients (75% of cases), abscess drainage and tumourectomy in two patients and abscess drainage in one patient. All of our patients had received treatment with drugs, consisting of a ten-day course of antibiotic therapy with amoxillin or combined amoxicillin and clavulanic acid in 14 patients (80% of cases). Non-steroidal anti-inflammatory drugs as well as antibiotics were prescribed to six patients (30% of cases) for an average duration of 7days, while five patients (25%) were prescribed corticosteroids as a first line treatment in the form of prednisone at a dose of 1mg/kg per day for 2months with gradual dose reduction.



Figure 9


Figure 9. 

Histological findings showing idiopathic granulomatous mastitis characterised by epithelioid and giant cell granulomas within a polymorphous inflammatory infiltrate (enlarged×10).

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Figure 10


Figure 10. 

Epithelioid and giant cell granuloma seen on the optical microscope (yellow arrow) made up of giant cells (blue arrow) and epithelioid cells (white arrow) enlarged×40.

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Progress in both the short and medium term was marked by symptoms resolving in all of our patients. These cases being on average 4years old (between 3 and 7years), full resolution had been seen in sixteen patients (85% of cases). Four cases had a recurrence after treatment was stopped and needed to restart corticosteroid therapy. Data concerning the symptomatology of the patients in our series are summarised in Table 4, Table 5.

Discussion

A number of terms have been used to designate granulomatous mastitis: lobular granulomatous mastitis, non-infectious granulomatous mastitis, post-partum or post-lactation granulomatous mastitis [13, 14, 15]. These last two have not been adopted because the implications are not always specific to the disease given the length of time that can pass between giving birth or breastfeeding and the disease developing. Furthermore, use of the term “lobular” may not always be accurate given that ductal lesions may be reported in this disease [16, 17, 18, 19].

The term granulomatous mastitis was introduced by Veyssiere et al. [3] in 1967 who were the first team to describe IGM. From the viewpoint of clinical features, histology and progression, it was truly established as an individual entity by Kessler and Wolloch [20] in 1972. Very little is known to this day about its aetiology and pathogenicity. Several hypotheses have been put forward to explain this secondary inflammatory reaction to mechanical, traumatic, hormonal or metabolic factors. The initial cause is suggested to be damage to the ductal epithelium that causes extravasation of glandular secretions into the connective tissue of the lobule creating local inflammatory lesions [21, 22, 23, 24, 25, 26]. Others have also proposed immunological disorders [27, 28, 29, 30]. An autoimmune process has been suggested in patients who have undergone pregnancies, with the disease usually arising in the 6years after the pregnancy [14]. The specific inflammatory involvement, identical to that of cutaneous lesions, notably in its high quantities of mature neutrophils and with no identifiable infectious organism, would seem to be an argument for incorporating this entity into the category of hidradenitis suppurativa and consequently into the neutrophilic dermatoses, meaning that the systemic dimension of this entity could be understood in this way [9]. The patient’s age at the time of diagnosis varies depending on the series, ranging from 17 to 83years [19, 31, 32, 33, 34, 35]. The mean age for developing the disease was 38years old in our series, with extreme values ranging from 19 to 66years. It most commonly affects women of reproductive age, but it can also be seen in postmenopausal women [36, 37, 38, 39]. This was borne out by our series, in which four women were postmenopausal. In general, IGM develops in the 5years following the patient’s most recent birth [1193637, 19, 36, 37]. In our series, 60% of patients presented the disease within 5years post-partum. The patient is usually in a good clinical condition and fever is rarely seen. Inflammatory signs, whether systemic or localised to the breast, are a characteristic of IGM [12, 33, 36, 40]. In our series, six patients presented local inflammatory signs at the time of the clinical examination. The nodule- or tumefaction-type lesions can have either distinct or indistinct margins, and may be either hard or firm [1, 2, 4, 5, 6, 7, 8, 19]. In our series five patients presented hard lesions and three others had firm lesions. The size of the lesions is variable, on average between 5 and 8cm. The sizes reported in the literature usually range from 0.5 to 15cm [10, 18, 20]. In our patients, the mean size of the lesions was 6.5cm and ranged from 2.5 to 15cm in diameter. Nipple retraction and sagging are not reported often in the literature but this is a further factor for exploring differential diagnosis from a malignant process [34]. Nipple retraction and sagging were observed in one patient. One explanation proposed for this nipple retraction is the spread of fibrosis in later-stage disease [12, 33, 36]. IGM is often unilateral, but a few cases of bilateral involvement have been reported [1, 4, 18]. One of our patients had bilateral involvement. Secondary axiliary lymphadenopathies may occur and they have been reported in between 40 and 60% of cases in a number of series [1, 2, 4]. In our series, axiliary lymphadenopathies were found in three cases (37.5 %). Mammography carried out at the inflammatory stage showed an overall increase in breast density associated with skin thickening. Findings could include a single, homogeneous nodular opacity with distinct margins or disorganised straight lines producing an image of diverging tracts [19, 23, 24, 25, 26, 27, 28, 29, 38, 41]. Sonography is carried out as an adjunct to mammography. It often demonstrates non-specific images in IGM that can also be suggestive of malign disease. The features most commonly described are single or multiple irregular hypoechoic masses that are sometimes heterogeneous [15, 23, 24, 25, 26, 27]. These images were found in half of the cases in the series reviewed by Balaabidia [1] and by Engin [42]. The areas surrounding the lesion often have a hyperechoic structure [15, 26]. In our series, ten patients (55.6 %) presented this pattern. Hypoechoic tubular lesions, either separated or contiguous, were found in 66% of the cases described by Han [44] and in half of the cases reported by Lee [41]. According to Engin [42], if multiple heterogeneous images with relatively circumscribed margins and a tubular configuration combined with a large hypoechoic mass appear on sonography, this must prompt the clinician to suspect granulomatous mastitis. Another feature observed was absorption of the ultrasound beam in the posterior part of the lesions, as reported by Van Ongeval [7] and in the series reviewed by Alper [21] in 23% of patients. Other features that may be found are parenchymal distortion that may be extensive and images of an abscess that may have a secondary fistula. In cases in which abscesses have developed, sonography can be used to assess lesion size and to better understand which type of drainage (puncture or surgical debridement) should be used [15, 26, 44]. Doppler sonography was carried out by Engin [42] in seven patients and showed an increase in arterial and venous vascularisation around the lesions in 75% of cases. These observations, however, remain non-specific to the disease, and indeed the same features can be found in other breast pathologies, particularly those involving malignancy [16, 42, 43]. Doppler sonography was carried out in 14 patients in our series. It revealed increased vascularisation of the lesions and the adjacent breast tissue. Recently, numerous studies have reported using MRI to investigate breast pathologies [23, 24, 27]. This technique demonstrates lesions suspicious for malignity in the form of irregular tissular masses with an abnormal contrast uptake after injection of gadolinium chelates. In the series reviewed by Alper [21], MRI demonstrated a homogeneous mass with irregular margins in two patients, parenchymal distortion in three patients and parenchymal asymmetry in one patient although two of these six patients had presented a normal mammogram. One patient with recurrent granulomatous mastitis who underwent MRI presented imaging of a lesion that had the appearance of an abscess. This examination remains totally non-specific, since the same features can be seen in breast carcinoma. Some authors believe that MRI would be useful to evaluate the extent and reduction of lesions over time [23, 27]. Imaging can confirm mastitis but only histology enables a diagnosis to be made [40, 43, 44]. Abnormal blood results are often reported in patients with IGM. This means that investigations of aetiology and immunology include C3, C4, CH50, antinuclear antibodies, anti-DNA, anti-streptolysin count and syphilis serology [12, 33, 36]. These investigations may show abnormalities when IGM is present in the context of systemic disease. Microbiology investigations looking for a non-specific infection in patients who have developed abscesses almost always have negative results [27, 33]. Corynebacterium accolens was isolated as a human pathogen from a breast abscess in a patient presenting granulomatous mastitis [45, 46, 47]. In our cases, microbiology investigations, including those for Koch’s bacillus and Corynebacteria, were negative. Fine needle aspiration is a valuable technique, as it reveals Langhans or Müller epithelioid cells. In addition to these, other cells found in varying proportions are macrophages, foam cells, lymphocytes and plasma cells. Epithelial cells may be present and sometimes show slightly atypical regeneration that could be mistaken for malignity [8, 20, 34]. Cytology specimens examined with specific stains (PAS, Grocott etc.) to investigate pathogenic agents may be used. Microbiology of the specimen enables an organism to be investigated. Fine needle aspiration does have limitations concerning technical issues and problems of interpretation. Biopsy, however, allows IGM to be diagnosed with certainty [8, 19, 20, 33, 34, 35, 36, 37, 38]. Pathological anatomy studies back up this diagnostic certainty. Lesions may be confluent and this can mean that they jut outside of the breast lobule, which explains the appearance of multiple confluent nodules or hypoechoic tubular nodules on sonography. A hyperechoic peripheral halo corresponds to the wall of surrounding fibrosis that borders the granulomas [1]. This finding leads to a problem of differential diagnosis with tuberculosis, especially in countries where it is endemic, but the predominance of neutrophils and the absence of caseation necrosis is an argument in favour of granulomatous mastitis [8, 9, 10]. IGM clinically poses a problem of differential diagnosis with carcinomatous mastitis due to nipple retraction, hardness, fixed position, orange peel skin and lymphadenopathies. The diagnosis of IGM may equally be proposed in bacterial, parasitic or mycotic infections of the breast, as well as in non-infectious granulomatous lesions (lipophagic granuloma or fat necrosis, sarcoidosis, plasma cell mastitis, lymphocytic mastitis etc.). These different pathologies can be distinguished by means of histological investigations [34, 36].

Treatment is essentially surgical, consisting of wide excision of the lesion preceded by corticosteroid therapy, the aim of which is to shrink and limit the lesions [12, 33, 48, 49, 50]. Corticosteroids have only been used occasionally and if they have shown some efficacy, they must not be used without being combined with antibiotics [50, 51]. A high failure rate for corticosteroid treatments is reported in the literature and the incidence of recurrence varies between 16 and 50% of cases depending on the series [12, 33, 36]. This presents an opening for other treatment alternatives, namely methotrexate and antibiotics [9, 10, 11]. Cases of recurrence or relapse have been reported several years after the patient has recovered [18, 26, 29]. Four patients in our series had a recurrence after stopping treatment and needed to restart corticosteroids; one of these patients relapsed three times. However, a resolution of symptoms was seen in all cases.

Close and regular monitoring will aim to detect disease recurrence at the earliest opportunity in order to avoid repeated surgical interventions. Monitoring only, with neither surgery nor corticosteroid therapy, has been reported by some authors with signs resolving and no disease recurrence in 50% of cases [1].

Conclusion

Granulomatous mastitis is rare and presents a problem of differential diagnosis in terms of imaging features, with particular reference to breast cancer. It should be stated that the main value of sonography is to demonstrate abnormalities that may be suitable for biopsy, which then enables a diagnosis to be made. The clinical context, the variability of imaging features on examinations done at close intervals and principally histological examination allow the diagnosis to be drawn out and the treatment to be adapted, avoiding disfiguring surgery. The treatment of choice is wide surgical excision of the lesions, combined with corticosteroid therapy in order to avoid relapse. Regular monitoring is indispensable in order to detect disease recurrence at the earliest opportunity and therefore to avoid further surgical interventions. The prognosis is generally good. Nonetheless, patients may take some time to make good progress and experience disease recurrence with repeated interventions and this can lead to disfiguring sequelae.

Disclosure of interest

The authors declare that they have no conflicts of interest concerning this article.

References

Belaabidia B., Essadki O., El Mansouri A., Sqalli S. Mastite granulomateuse idiopathique : à propos de huit cas avec revue de la littérature Gynecol Obstet Fertil 2002 ;  30 : 383-389 [inter-ref]
Sanctis D.P., Maglietta R., Betta P.G. Idiopathic granulomatous mastitis. Report of case clinically and mammographically simulating breast carcinoma Pathologica 1994 ;  86 : 222-223
Veyssiere C., Vives M., Smadja A. Difficultés diagnostiques de la tuberculose mammaire. Le problème de la mastite granulomateuse Lille Chir 1967 ;  22 : 104-109
Ayeva M.D., Perrotin F., Le Franc T.Q. Mastite granulomateuse idiopathique. Revue de la littérature illustrée par quatre observations J Gynecol Obstet Biol Reprod 1999 ;  28 : 800-807
Imotos S., Kiyata T., Kodama T. Idiopathic granulomatous mastitis. Case report and review of the literature JPM/J Clin Oncol 1997 ;  27 : 274-277
Paksoy N., Kaur A.C., Muezzinoglu B. Idiopathic granulomatous mastitis. Report of a case diagnosed with fine needle aspiration cytology Acta Cytol 1999 ;  43 : 481-484
Van Ongeval C., Schraepen T., Van Steen A. Idiopathic granulomatous mastitis Eur Radiol 1997 ;  7 : 1010-1012 [cross-ref]
Gabor C. Granulomatous lobular mastitis drug induced galactorrhea and blunt trauma Breast J 1999 ;  5 : 398-403
Join-Lambert O., Fraitag S., Ribadeau-Dumas F., Leguern A.S., Behillil S., Del Castillo F.J., and al. Is granulomatous mastitis a localized form of hidradenitis suppurativa? Eur J Dermatol 2009 ;  19 : 513-514
Shyamala C.B., Prasad K.R.K., Gajamam R.A.O. Chronic granulomatous mastitis. Review of 26 cases with special reference to chronic lobular mastitis Indian J Pathol Microbiol 1992 ;  35 : 38-43
Yip C., Jayaram G., Swan M. The value of cytology in granulomatous mastitis. A report of 16 cases from Malaysia Aust NZJ Surg 2000 ;  7 : 103-105 [cross-ref]
Jorgensen M.B., Nielsen D.M. Diagnosis and treatment of granulomatous mastitis Am J Med 1992 ;  93 : 97-101 [cross-ref]
Binelli C., Lorimier G., Betrand G., Parvey F. Mastite granulomateuse et corynébactéries. À propos de deux observations J Gynecol Obstet Biol Reprod 1996 ;  25 : 27-32
Boufettal H., Hermas S., Noun M., Samouh N. Mastite granulomateuse idiopathique bilatérale Imagerie Femme 2009 ;  19 : 262-264 [inter-ref]
Boo-Yung, Choe Y.H. Granulomatous mastitis mammographic and sonographic appearances Am J Radiol 1999 ;  173 : 317-320
Gulgun E., Acunas G. Granulomatous mastitis. Gray scale and color doppler sonographic findings J Clin Ultrasound 1999 ;  29 : 101-106
Royer B. Lésions inflammatoires du sein Ann Pathol 1999 ;  19 : 406-411 [inter-ref]
Salem A., Bennaceur R., Driss M., Mehiri S., Mrad K., Rajhi H., and al. Imagerie des mastites granulomateuses idiopathiques Imagerie Femme 2008 ;  18 : 46-54 [inter-ref]
Pourbagher A., Tokmak N., Pourbagher M.A., Koc Z. Idiopathic granulomatous mastitis: a report of three cases Eur J Radiol Extra 2005 ;  56 : 1-5 [cross-ref]
Kessler E., Wolloch Y. Granulomatous mastitis: a lesion clinically simulating carcinoma Am J Clin Pathol 1972 ;  58 : 642-646
Alper A., Hizir A., Mehmet A., Hulya A. Granulomatous lobular mastitis: a complex diagnostic and therapeutic problem Word J Surg 2006 ;  30 : 1403-1409
Sato N., Yamastita H., Kosaki N., Watanabe Y. Granulomatous mastitis diagnosed and followed up by fine needle aspiration cytology and successfully treated by corticosteroid therapy. Report of a case JPM/J Surg 1996 ;  26 : 730-733 [cross-ref]
Sabate J.M., Clotet M., Gomez A., De las Heras P., Torrubia S., Salinas T. Radiologic evaluation of uncommon inflammatory and reactive breast disorders Radiographics 2005 ;  25 : 411-424 [cross-ref]
Memis A., Bilgen I., Ustun E.E., Ozdemir N., Erhan Y., Kapkac M. Granulomatous mastitis: imaging findings with histopathologic correlation Clin Radiol 2002 ;  57 : 1001-1006 [cross-ref]
Heer R., Shrimankar J., Griffith C.D.M. Granulomatous mastitis can mimic breast cancer on clinical, radiological or cytological examination: a cautionary tale Breast 2003 ;  12 : 283-286 [cross-ref]
Yilmaz E., Lebe B., Usal C. Mammographic and sonographic findings in the diagnosis of idiopathic granulomatous mastitis Eur Radiol 2001 ;  11 : 2236-2240 [cross-ref]
Lee J.H., Oh K.K., Kim E.K., Kwack K.S., Jung W.H., Lee H.K. Radiologic and clinical features of idiopathic granulomatous lobular mastitis mimicking advanced breast cancer Yonsei Med J 2006 ;  28 (47) : 78-84 [inter-ref]
Sakr A.A., Fawzy R.K., Fadaly G., Abdel Baky M. Mammographic and sonographic features of tuberculous mastitis Eur J Radiol 2004 ;  51 : 54-60 [cross-ref]
Kocaoglu M., Somuncu I., Ors F., Bulakbasi N., Tayfun C., Ilkbahar S. Imaging findings in idiopathic granulomatous mastitis: a review with emphasis on magnetic resonance imaging J Comput Assist Tomogr 2004 ;  28 : 635-641 [cross-ref]
Tse G.M.K., Poon C.S., Law B.K., Pang L.M., Chu W.C., Ma T.K. Fine needle aspiration cytology of granulomatous mastitis J Clin Pathol 2003 ;  56 : 519-521 [cross-ref]
Al-Khaffaf B., Knox F., Bundred N.J. Idiopathic granulomatous mastitis: a 25-year experience J Am Coll Surg 2008 ;  206 : 269-273 [cross-ref]
Asoglu O., Ozmen V., Karanlik H. Feasibility of surgical management in patients with granulomatous mastitis Breast J 2005 ;  11 : 108-114 [cross-ref]
Azlina A.F., Ariza Z., Anni T., Hisham A.N. Chronic granulomatous mastitis: diagnostic and therapeutic considerations World J Surg 2003 ;  27 : 515-518 [cross-ref]
Lester S.C. Differential diagnosis of granulomatous mastitis Breast J 2004 ;  25 : 1915-1919
Mathelin C., Riegel P., Chenard M.P., Brettes J.P. Association of corynebacteria with granulomatous mastitis Eur J Obstet Gynecol Reprod Biol 2005 ;  119 : 260-261 [cross-ref]
Chabrol A., Beyne-Rauzy O., Adoue D. Mastite granulomateuse : problèmes diagnostiques et thérapeutiques Rev Med Int 2008 ;  29 : 110-111 [inter-ref]
Howell J.D., Baker F. Granulomatous mastitis. Report of a further two cases and a comprehensive literature review Breast 1994 ;  3 : 119-123 [cross-ref]
Tuncbilek N., Karakas H.M., Okten O. Imaging of granulomatous mastitis: assessment of three cases Breast 2004 ;  3 : 510-514 [cross-ref]
Taylor G., Paviour S., Musaad S., Jones W., Holland D. Clinicopathological review of 34 cases of inflammatory breast disease showing an association between corynebacteria infection and granulomatous mastitis Pathology 2003 ;  35 : 109-119 [cross-ref]
Boufettal H., Noun M., Hermas S., Samouh N. Tuberculose mammaire : à propos de huit cas Imagerie Femme 2009 ;  19 : 188-197 [inter-ref]
Lee J.H., Oh K.K., Kim E.K., Kwack K.S., Jung W.H., Lee H.K. Radiologic and clinical features of idiopathic granulomatous lobular mastitis mimicking advanced breast cancer Yonsei Med J 2006 ;  28 : 78-84 [inter-ref]
Engin G., Acunas G., Acunas B. Granulomatous matitis: gray scal and color doppler sonographic findings J Clin Ultrasound 1999 ;  27 : 101-106 [cross-ref]
Boufettal H., Noun M., Samouh N. Cancer du sein chez la femme jeune au Maroc Cancer Radiother 2010 ;  14 : 698-703 [inter-ref]
Han B.K., Choe Y.H., Park J.M., Moon W.K., Ko Y.H., Yang J.H., and al. Granulomatous mastitis: mammographic and sonographic appearances Am J Roentgenol 1999 ;  173 : 317-320
Sriram K., Moffatt D., Stapledon R. Tuberculosis infection of the breast mistaken for granulomatous mastitis: a case report Cases J 2008 ;  25 : 273 [cross-ref]
Ang L.M., Brown H. Corynebacterium accolens isolated from breast abscess: possible association with granulomatous mastitis J Clin Microbiol 2007 ;  45 : 1666-1668 [cross-ref]
Al-Niaimi F., Patel A., Blessing K., Fox R., Burden A.D. Cutaneous actinomycosis presenting as chronic mastitis Clin Exp Dermatol 2010 ;  35 : 149-151 [cross-ref]
Bani-Hani K.E., Yaghan R.J., Matalka I.I., Shatnawi N.J. Idiopathic granulomatous mastitis: time to avoid unnecessary mastectomies Breast J 2004 ;  10 : 318-322 [cross-ref]
Lai E.C., Chan W.C., Ma T.K., Tang A.P., Poon C.S., Leong H.T. The role of conservative treatment in idiopathic granulomatous mastitis Breast J 2005 ;  11 : 454 [cross-ref]
Boufettal H., Mahdaoui S., Noun M., Hermas S., Samouh N. Mastite granulomateuse idiopathique avec bonne évolution sous traitement médical Rev Med Int 2011 ;  32 : 26-28
Hovanessian L.L.J., Peyvandi B., Klipfel N., Grant E., Iyengar G. Granulomatous lobular mastitis: imaging, diagnosis, and treatment AJR 2009 ;  193 : 574-581



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