GranulomatousMastitis-Introduction.pptVIP

MANAGEMENT OF IDIOPATHIC GRANULOMATOUS MASTITIS Canon CHAN Department of Surgery, North District Hospital. Hong Kong SAR Idiopathic Granulomatous Mastitis (IGM) Kessler and Wolloch 1972 Cohen 1977 Chronic granulomatous lobulitis Absence of an obvious etiology Introduction Rare inflammatory breast disease Unknown etiology Women of childbearing age Simulate breast cancer Breast mass Nipple retraction Introduction Diagnosis is one of exclusion Infectious and noninfectious causes Carcinoma/ carcinomatous mastitis Wegener granuloma Sarcoidosis Tuberculosis Histoplasmosis Topic of interest The pathogenesis is not clear Etiology unknown Treatment strategy controversial Current arguments An etiology for an idiopathic disease? Oral contraceptive pills Pregnancy and lactation Infective Autoimmune process Immune response to extravasated secretions from lobules IGM - Presentation Pain Swelling/ mass Discharge/ galactorrhoea Nipple retraction Skin ulcers IGM – Physical examination Skin ulceration Mass Induration Abscess Fistula Enlarged lymph node Up to 15% of cases IGM - Investigations IGM - investigations Manage as a breast mass Mammography (MMG)/ Ultrasound (USG)/ Magnetic Resonance Imaging (MRI) Fine needle aspiration cytology (FNAC) Core biopsy Mammography in IGM Oblique view demonstrates a diffusely increase asymmetric density and enlarged axillary lymph nodes Mammography and IGM Small, multiple, ill-defined masses without microcalcification Most commonly reported finding of IGM is an asymmetrically increased density without a distinct margin or mass effect, though this is not specific Low sensitivity caused by dense breast tissue limits the value of MMG in this age group In patients having dense breast parenchyma, MMG may be negative Ultrasound and IGM Hypoechoic indistinctly bordered heterogeneous masses May be connected by a few tubular hypoechoic structures MRI and IGM Segmental heterogeneity Hypointense on precontrast T1-weighted images and hyper