Granulomatous Mastitis

by Sharon Hopkins

Granulomatous mastitis is a breast condition where the breast becomes inflamed and develops a tissue mass somewhat akin to a cancerous growth or tumor. The diagnosis of this condition is made difficult by the fact that it appears similar to breast cancer. This means that a doctor may require several tests to be performed in order to confirm a diagnosis of granulomatous mastitis. Although it may occur at any time, granulomatous mastitis most commonly occurs after a pregnancy, usually after about 2 years.

Women who suffer from this condition may experience the following symptoms:

  • Lump in the breasts
  • Fluid discharge from the breast
  • Tenderness
  • Inflammation
  • Breasts that appear warm to the touch
  • Retraction of the nipples
  • Pain
  • Enlarged lymph nodes
  • Fistulas
  • Fever
In cases of chronic granulomatous mastitis, the breasts may take on a wrinkled and pitted appearance as the mass continues to grow.

The mass inside the breast is termed a granuloma and it can be felt during a physical examination. It may also be detectable during a self-examination. A granuloma is a collection of immune cells and not a tumor. The doctor will usually order tests to be performed in order to rule out cancer. Great care must be taken by physicians, radiologists, pathologists and surgeons while diagnosing the condition because of its similarity to breast cancer. This is necessary to avoid mastectomies that are totally unnecessary.

Another problem in diagnosing and treating granulomatous mastitis lies in the fact that it could also be caused by a number of underlying disorders. Although the incidence of secondary granulomatous mastitis is rare, it could be caused by a number of conditions including tuberculosis, syphilis and other infections, sarcoidosis, diabetes and Wegener’s granulomatosis. When there is no detectable underlying cause it is termed as idiopathic granulomatous mastitis.

Some scientists think that granulomatous mastitis may be an extreme form of mastitis or inflammation of the breast that is experienced by some women who breastfeed. Others think that its incidence may be related to the use of hormone based birth control pills as it frequently occurs after breastfeeding has been discontinued and the woman resumes taking her hormone based contraceptives.

Idiopathic granulomatous mastitis is rarely diagnosed since diagnosis is a lengthy process that requires several other conditions to be excluded. It has long been suspected that that some cases diagnosed as idiopathic granulomatous mastitis may actually be something else entirely. Idiopathic granulomatous mastitis is usually diagnosed only in the more severe cases and after the onset of complications, since these cases are usually referred to a secondary breast care center. The milder cases usually resolve n their own or after being treated for symptomatic relief and therefore never require a diagnosis. For this reason, estimating the incidence of idiopathic granulomatous mastitis in the general population is a difficult task.

Testing the ganuloma to rule out cancer can require both imaging tests as well as surgery. Mammograms of the breast may be ordered and the doctor may order a biopsy to rule out cancerous cells.

The treatment for granulomatous mastitis may include medications such as steroids to combat the inflammation and analgesics for pain relief. Surgery may be necessary to remove the granuloma and drain the wound. However, there is a 50% chance of the granulomatous mastitis recurring even after a successful surgery.

One of the drawbacks of treating this condition with medications is that the long-term use of steroids can have adverse effects, but it still remains the most effective way to treat the condition. The length of such a treatment course will have to be weighed against the potential damage that the long-term use of steroids can cause. 
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