Family Medicine Residency Program, McLaren Macomb Hospital, 1000 Harrington Blvd, Mount Clemens, MI, 48043, USA.
Department of Pharmacology and Toxicology, College of Osteopathic Medicine, Michigan State University, 44575 Garfield Road, Building UC4., Clinton Township, MI, 48038, USA.
J Med Case Rep. 2020 Nov 10;14(1):215. doi: 10.1186/s13256-020-02563-x.
Granulomatous mastitis (GM) is a rare benign chronic inflammatory breast disease. GM presents as a heterogeneous illness with variable clinical presentations, and its diagnosis is usually made by exclusion. There are no guidelines for the treatment of GM. This manuscript describes the management of a patient with GM, initially unsuccessfully treated outside our clinic under a diagnosis of mastitis. The patient's history, physical examination, and needle biopsy flagged the patient's findings as nonmalignant; however, imaging studies indicated a tumor. Differential diagnosis became a critical element of her care. This case report represents a valuable resource to foster more assertive clinical practice in managing patients with GM. The case coordination and its course were led by a team from an outreach clinic that provides health care services to underserved communities in the state of Michigan.
A 41-year-old G1P1 Hispanic female immigrant from Central America presented with a rare breast disease, granulomatous mastitis. A similar presentation occurred 5 years before pregnancy when she had an episode of pain and swelling in the left breast, which resolved spontaneously. She sought our services after being diagnosed with mastitis that was unsuccessfully treated. Physical examination revealed a nodular mass in the outer quadrants of the left breast without regional lymphadenopathy. Needle biopsy showed fibrohistiocytic and florid inflammatory reactions, with no evidence of invasive carcinoma. However, this result was inconsistent with the degree of abnormality revealed by the mammogram (BI-RADS grade 5), ultrasound, and physical examination. Full incisional biopsy revealed cystic neutrophilic GM. The surgical procedure, antibiotics, and corticosteroids resulted in a successful combination to secure the stable control of the symptoms and progression of this rare benign breast disease to date.
This patient's case highlights the importance of integrated communication among front-line primary care and other health care professionals to reduce the risk of invasive procedures and avoid institutional costs. GM is a rare disease. We raised the manifold red flags in which the multiple professional chains recruited to care for this patient were concerning for advanced breast cancer. The lack of experience and evidence-based medicine contributed to the contradictory interpretation of the findings on GM's diagnosis.
肉芽肿性乳腺炎（GM）是一种罕见的良性慢性乳腺炎。GM 表现为一种异质性疾病，临床表现多样，其诊断通常通过排除法得出。目前尚无 GM 治疗指南。本文描述了一位 GM 患者的治疗过程，该患者在我们诊所外曾被误诊为乳腺炎，经治疗无效。患者的病史、体格检查和针吸活检均提示为非恶性肿瘤，但影像学检查显示为肿瘤。鉴别诊断成为其治疗的关键。本病例报告为管理 GM 患者提供了宝贵的资源，以促进更积极的临床实践。该病例的协调和治疗过程由密歇根州一个为服务不足社区提供医疗服务的外展诊所的团队主导。
一位 41 岁的 G1P1 西班牙裔移民女性，来自中美洲，患有罕见的乳腺疾病，即肉芽肿性乳腺炎。她在怀孕前 5 年曾出现过一次左侧乳房疼痛和肿胀的类似症状，后来自行缓解。她因被诊断为乳腺炎且治疗无效而寻求我们的服务。体格检查发现左侧乳房外象限有一个结节状肿块，无区域性淋巴结肿大。针吸活检显示纤维组织细胞和明显的炎症反应，无浸润性癌的证据。然而，这一结果与乳房 X 线摄影（BI-RADS 分级 5）、超声和体格检查所显示的异常程度不一致。全切除活检显示囊状中性粒细胞性 GM。手术、抗生素和皮质类固醇的联合应用成功地控制了症状，并稳定地控制了这种罕见的良性乳腺疾病的进展。
该患者的病例强调了一线初级保健和其他医疗保健专业人员之间进行综合沟通的重要性，以降低侵入性程序的风险并避免机构成本。GM 是一种罕见疾病。我们提出了多个警示信号，参与该患者治疗的多个专业链都对晚期乳腺癌表示担忧。缺乏经验和循证医学导致 GM 诊断结果的解释存在矛盾。
