Cabergoline and Low-Dose Steroid Therapy İn Idiopathic Granulomatous Mastitis

Abstract

Cabergoline and Low-Dose Steroid Therapy İn Idiopathic Granulomatous Mastitis

Abstract

Introduction: Idiopathic granulomatous mastitis(IGM) is a rare, chronic granulomatous inflammatory disease of the breast. It is mostly seen in young women with a history of breastfeeding. It typically presents as a painful lump in the breast, erythema, focal abscess formation, skin ulceration, or fistula. The etiology and pathogenesis of IGM could not yet be well understood. It is thought to be caused by a localized autoimmune response against fat and protein-rich secretions leaking from the lobules due to previous hyperprolactinemia. There is no definite treatment protocol defined for IGM. Pharmacological agents and surgical interventions are used alone or in combination in the treatment. In this study, we aimed to examine the results of patients who were treated with cabergoline and low-dose steroids for IGM in our center. Methods: In this study, the files of patients who were treated with cabergoline and steroids for idiopathic granulomatous mastitis in our clinic were reviewed retrospectively. 36 patients were included in the study. The patients were invited to the outpatient clinic for the final examination. Demographic characteristics of the patients, symptoms at presentation, examination findings, laboratory tests, radiological imaging, tru-cut biopsy results, microbiological culture results, treatment doses and durations, remission times, surgery requirements, and recurrence were recorded. Results: All 36 patients included in the study were women of childbearing age. The most common presenting complaint was a palpable painful mass. Abscesses were present in 12 patients. Ulcers were observed in 9 patients and fistulas were observed in 4 patients. The most common involvement was in the lower outer quadrant. S.aureus was detected in the culture of 1 patient. Complete recovery was observed in 20 of 36 patients as a result of the treatment. The mean duration of remission was 2.85±2.54 months. The treatment of 29 (74.3%) patients was completed medically. Surgical excision was performed in 7 patients with a residual lump. No recurrence was observed during the follow-up period of 27.88 ± 8.21 months. Conclusion: The treatment of IGM is still controversial. The fact that cabergoline and low-dose steroid therapy provides remission in a short time, minimizes the need for surgery, and does not relapse in medium-term follow-up shows that it is a successful option in IGM treatment.

Keywords

• Idiopathic granulomatous mastitis
• cabergoline
• steroid

References

1. 1.Kessler E, Wolloch Y. Granulomatous mastitis: alesion clinically simulating carcinoma. Am J ClinPathol. 1972;58: 642-6. doi: 10.1093/ajcp/58.6.642.PMID: 4674439.
2. 2.Deng Y, Xiong Y, Ning P, et al. A case managementmodel for patients with granulomatous mastitis: aprospective study. BMC Womens Health. 2022; 22:143.doi: 10.1186/s12905-022-01726-w. PMID:35501850; PMCID: PMC9063211.
3. 3.Lin CH, Hsu CW, Tsao TY, Chou J. Idiopathicgranulomatous mastitis associated withrisperidone-induced hyperprolactinemia. DiagnPathol. 2012; 7: 2. doi: 10.1186/1746-1596-7-2.PMID: 22221904; PMCID: PMC3261802.
4. 4.Steuer AB, Stern MJ, Cobos G, et al. ClinicalCharacteristics and Medical Management ofIdiopathic Granulomatous Mastitis. JAMA Dermatol.2020; 156: 460-464.doi:10.1001/jamadermatol.2019.4516. PMID: 31968055; PMCID: PMC6990845.
5. 5.Aghajanzadeh M, Hassanzadeh R, Alizadeh Sefat S,et al. Granulomatous mastitis: Presentations,diagnosis, treatment and outcome in 206 patientsfrom the north of Iran. Breast. 2015; 24: 456-60. doi: 10.1016/j.breast.2015.04.003. Epub 2015 Apr 29.PMID: 25935828.
6. 6.Hovanessian Larsen LJ, Peyvandi B, Klipfel N,Grant E, Iyengar G. Granulomatous lobular mastitis:imaging, diagnosis, and treatment. AJR Am JRoentgenol. 2009; 193: 574-81. doi:10.2214/AJR.08.1528. PMID: 19620458.
7. 7.Diesing D, Axt-Fliedner R, Hornung D, et al.Granulomatous mastitis. Arch Gynecol Obstet. 2004;269: 233-6. doi: 10.1007/s00404-003-0561-2. Epub2003 Dec 19. PMID: 15205978.
8. 8.Agrawal A, Pabolu S. A Rare Case of IdiopathicGranulomatous Mastitis in a Nulliparous Womanwith Hyperprolactinemia. Cureus. 2019; 11: e4680.doi: 10.7759/cureus.4680. PMID: 31328071;PMCID: PMC6634339.

9. 9.Wang J, Xu H, Li Z, et al. Pathogens in patients withgranulomatous lobular mastitis. Int J Infect Dis.2019; 81: 123-127. doi: 10.1016/j.ijid.2019.01.034.Epub 2019 Jan 24. PMID: 30685592.
10. 10.Johnstone KJ, Robson J, Cherian SG, et al. Cysticneutrophilic granulomatous mastitis associatedwith Corynebacterium including Corynebacteriumkroppenstedtii. Pathology. 2017; 49: 405-412. doi:10.1016/j.pathol.2017.01.006. Epub 2017 Apr 22.PMID: 28442140.
11. 11.Ergin AB, Cristofanilli M, Daw H, Tahan G, GongY.Recurrent granulomatous mastitis mimickinginflammatory breast cancer. BMJ Case Rep. 2011;2011: bcr0720103156. doi: 10.1136/bcr.07.2010.3156. PMID: 22715267;PMCID: PMC3062046.
12. 12.Kutsuna S, Mezaki K, Nagamatsu M, et al. TwoCases of Granulomatous Mastitis Caused byCorynebacterium kroppenstedtii Infection inNulliparous Young Women withHyperprolactinemia. Intern Med. 2015; 54: 1815-8.doi: 10.2169/internalmedicine.54.4254. Epub 2015Jul 15. PMID: 26179543.
13. 13.Nikolaev A, Blake CN, Carlson DL. Associationbetween hyperprolactinemia and granulomatousmastitis. Breast J. 2016; 22: 224-31. doi:10.1111/tbj.12552. PMID: 26705962.
14. 14.Holla S, Amberkar MB, Kamath A, KamalkishoreMK, Ommurugan B. Risperidone InducedGranulomatous Mastitis Secondary toHyperprolactinemia in a Non-Pregnant Woman-ARare Case Report in a Bipolar Disorder. J Clin DiagnRes. 2017; 11: 01-03. doi:10.7860/JCDR/2017/20733.9278. Epub 2017 Jan 1.PMID: 28273980; PMCID: PMC5324425.
15. 15.Rosen, P.P. Rosen’s Breast Pathology, 3rd edn.Philadelphia: Lippincott Williams and Wilkins,2009: 42-45.
16. 16.Prasad S, Jaiprakash P, Dave A, Pai D. Idiopathicgranulomatous mastitis: an institutional experience. Turk J Surg. 2017; 33: 100-103. doi:10.5152/turkjsurg.2017.3439. PMID: 28740959;PMCID: PMC5508231.
17. 17.Akcan A, Oz AB, Dogan S, et al. IdiopathicGranulomatous Mastitis: Comparison of Wide LocalExcision with or without Corticosteroid Therapy.Breast Care (Basel). 2014; 9: 111-5. doi:10.1159/000360926. PMID: 24944554; PMCID:PMC4038310.
18. 18.Freeman CM, Xia BT, Wilson GC, et al. Idiopathicgranulomatous mastitis: A diagnostic andtherapeutic challenge. Am J Surg. 2017; 214: 701-706.doi: 10.1016/j.amjsurg.2017.07.002. Epub2017 Jul 8. PMID: 28739122.
19. 19.Baslaim MM, Khayat HA, Al-Amoudi SA.Idiopathic granulomatous mastitis: a heterogeneous disease with variable clinical presentation. World JSurg. 2007; 31: 1677-81. doi: 10.1007/s00268-007-9116-1. PMID: 17541683.
20. 20.Marriott DA, Russell J, Grebosky J, et al.Idiopathic granulomatous lobular mastitismasquerading as a breast abscess and breastcarcinoma. Am J Clin Oncol. 2007; 30: 564-5. doi:10.1097/01.coc.0000184683.13865.df. PMID:17921721.
21. 21.Longman CF, Campion T, Butler B, et al. Imagingfeatures and diagnosis of tuberculosis of the breast.Clin Radiol. 2017; 72: 217-222. doi:10.1016/j.crad.2016.11.023. Epub 2017 Jan 6.PMID: 28065639.
22. 22.Taylor GB, Paviour SD, Musaad S, Jones WO,Holland DJ. A clinicopathological review of 34 casesof inflammatory breast disease showing anassociation between corynebacteria infection andgranulomatous mastitis. Pathology. 2003; 35: 109-19.PMID: 12745457.
23. 23.Schelfout K, Tjalma WA, Cooremans ID, et al.Observations of an idiopathic granulomatousmastitis. Eur J Obstet Gynecol Reprod Biol. 2001; 97:260-2. doi: 10.1016/s0301-2115(00)00546-7.PMID: 11451563.
24. 24.Wolfrum A, Kümmel S, Theuerkauf I, Pelz E,Reinisch M. Granulomatous Mastitis: A Therapeuticand Diagnostic Challenge. Breast Care (Basel). 2018;13: 413-418. doi: 10.1159/000495146. Epub 2018Nov 23. PMID: 30800035; PMCID: PMC6381909.
25. 25.Lai EC, Chan WC, Ma TK, et al. The role ofconservative treatment in idiopathic granulomatous mastitis. Breast J. 2005; 11: 454-6. doi:10.1111/j.1075-122X.2005.00127.x. PMID: 16297091.
26. 26.Tang A, Dominguez DA, Edquilang JK, et al.Granulomatous Mastitis: Comparison of NovelTreatment of Steroid Injection and CurrentManagement. J Surg Res. 2020; 254: 300-305. doi:10.1016/j.jss.2020.04.018. Epub 2020 Jun 1. PMID: 32497924.
27. 27.Sakurai K, Fujisaki S, Enomoto K, Amano S,Sugitani M. Evaluation of follow-up strategies forcorticosteroid therapy of idiopathic granulomatousmastitis. Surg Today. 2011; 41: 333-7. doi:10.1007/s00595-009-4292-2. Epub 2011 Mar 2.PMID: 21365412. .
28. 28.Néel A, Hello M, Cottereau A, et al. Long-termoutcome in idiopathic granulomatous mastitis: awestern multicentre study. QJM. 2013; 106: 433-41.doi: 10.1093/qjmed/hct040. Epub 2013 Feb 13.PMID: 23407345.
29. 29.Hugon-Rodin J, Plu-Bureau G, Hugol D, Gompel A.Management of granulomatous mastitis: a series of14 patients. Gynecol Endocrinol. 2012; 28: 921-4.doi: 10.3109/09513590.2012.683075. Epub 2012Jun 25. PMID: 22731702.
30. 30.Tian C, Han X, Liu Z, Lv X, Ning P. Methotrexateand low-dose corticosteroid: An effective alternateagainst corticosteroid-resistant granulomatouslobular mastitis. J Obstet Gynaecol Res. 2022; 48:2956-2963. doi: 10.1111/jog.15396. Epub 2022 Aug15.PMID: 36319195.