Case Report of Granulomatous Mastitis: Clinical and Histological Aspects

INTRODUCTION: Idiopathic granulomatous mastitis (MGI), also known as granulomatous lobular mastitis is a rare chronic inflammatory disease of the breast of unknown etiology. It occurs mainly in young women, often with recent lactation. (Rossen, 1997). By the year 2003, only 120 cases were reported in the literature, which demonstrates the rarity of this condition and hence the scarcity of information on this disease. There are few reports in the literature on mammographic and sonographic appearances of MGI. The similarity of clinical and radiological granulomatous mastitis with breast cancer necessitates their differential diagnosis. The aim of this study is to discuss the clinical and histological aspects of MGI, an uncommon clinical condition, from a the case report. CASE REPORT FACTS: ASC, 21 years old, female, mulatto, married, housewife, two months ago visited the Mastology outpatient clinic of the Santa Izabel Hospital, in Joao Pessoa, Paraiba, Brazil, complaining of breast tenderness and nodularity of rapid growth in the lower left quadrant of the left breast. The patient made use of antibiotics, including various treatment regimens, without clinical improvement. She underwent biopsy with histopathological diagnosis of granulomatous mastitis. This was followed by treatment with corticosteroids with regression of inflammation and healing of fistulas. DISCUSSION: The condition was first described in 1972 by Kessler and Wolloch, who reported that the pathologic findings for granulomatous mastitis were unconnected to any specific infection, trauma or foreign body, thus drawing attention to their distinction. The pathogenesis and etiology of MGI are not well established because there is no evidence of any microorganism, the histochemical tests for pathogens were negative, thereby making it difficult to obtain an early diagnosis of this pathology. Perilobular distribution and characteristics of the granulomatous inflammation suggest cell-mediated reaction of one or more substances in the mammary secretion or lobular cells, but no specific antigens have been identified. As primary treatment, the literature recommends excisional biopsy, even leading to the emergence of complications such as recurrence, fistula and abscess formation. Excision is an important diagnostic and therapeutic tool since the removed material can be analyzed in the laboratory. According Akcan et. al, after its completion, there is no delay in wound healing, infection or recurrence, and additional therapies are not necessary.