Granulomatous Mastitis in Bangladesh: Pattern of Occurrence, Treatment Strategies and Prognosis

Author(s): Leea Amin, Mir Md Arafat Hossain, Muhammad Abdullah Bin Fahad, Md Bayezid khan, Sharukh Malik, Malay Halder Plabon, Devendra Raj Shah

Background: Granulomatous mastitis (GM) is an uncommon chronic inflammatory breast disease that clinically and radiologically mimics carcinoma. Differentiating between idiopathic granulomatous mastitis (IGM) and tubercular granulomatous mastitis (TGM) remains a diagnostic challenge, particularly in endemic regions like Bangladesh. Aim of the study: This study aimed to evaluate the clinical presentation, histopathological features, diagnostic challenges, and management outcomes of patients with granulomatous mastitis in a tertiary care center in Bangladesh.

Methods: The study was conducted in Ahsania Mission Cancer and General Hospital (AMCGH), a tertiary care facility located in Dhaka, Bangladesh, in the Department of Surgery, between January 2021 and December 2024. Additional data were collected from a limited number of cases managed under the private surgical practice at Uttara Popular Diagnostic Center.

Result: Among 98 patients, 80(81.63%) were diagnosed with idiopathic granulomatous mastitis and 18 (18.36%) with tubercular granulomatous mastitis. The mean age was 32.6 ± 6.8 years, with 90.3% of cases occurring in parous, premenopausal women. The most common presentation was a painful unilateral breast lump (77.4%). Radiological features were non-specific, and definitive diagnosis was made via core needle biopsy and histopathology. Anti-tubercular therapy was effective in TGM cases, while IGM was managed with corticosteroids and, in some cases, surgical excision. Recurrence was noted in 12.24% of IGM cases.

Conclusion: Granulomatous mastitis poses significant diagnostic and therapeutic challenges due to its clinical resemblance to malignancy and overlapping features between IGM and TGM. Histopathological confirmation remains essential, and treatment should be tailored based on etiology, emphasizing the need for accurate differentiation in endemic settings.