Idiopathic granulomatous mastitis

Histopathology report of the left breast lesion showingshows chronic granulomatous mastitis without any necrosis.

• Quantiferon-TB: Negative, Brucella Abortus titre: <1:160 (negative), Brucella Melitensis titre: <1:160 (negative). No clinical or radiological suspicion of TB and sarcoidosis (normal chest radiograph). Based on these imaging and clinical features,she was labelled as a case of idiopathic granulomatous mastitis. She is doing fine and ishas been on active clinical surveillance for the last three years.

• Idiopathic granulomatous mastitis (IGM) is an uncommon benign chronic inflammatory disease of the breast of unknown aetiology ^1-3. It is characterised by noncaseating granulomatous inflammation and is most frequently seen in the young female of childbearing age ^1-3. Clinically and radiologically, it is challenging to differentiate IGM from the infectious aetiologies (such as tuberculosis, sarcoidosis and fungal infections) as well as breast malignancy. Hence, an early definitive histopathological diagnosis is mandatory to avoid misdiagnosis, unnecessary delay in the management and unnecessary mastectomies ^1,3. The commonest clinical presentation of IGM is a palpable unilateral breast mass (with or without pain) ^1-3. It has variable and non-specific appearance on the imaging. It is generally seen as an ill-defined heterogeneous, hypoechoic lesion with multiple tentacles on the ultrasound, focal asymmetric density on the mammogram and ill-defined heterogeneous masses, rim-enhancing lesions or nonmassnon mass enhancement (NME) with mixed kinetics on the MRI ^1-3. The treatment of IGM is controversial and includes options ranging from conservative management with antibiotics to wide local excision (WLE) and corticosteroid therapy ³.