Idiopathic Granulomatous Mastitis: Is It Still a Mysterious Entity?

Idiopathic granulomatous mastitis (IGM) is stereotypically described as a rare, mysterious breast disorder that is difficult to diagnose and treat. Initial literature about IGM consisted of case reports and retrospective case series. Understandably, this led to arbitrary, and occasionally contradictory, surgical and medical treatment approaches. Over the last two decades, IGM has markedly departed from its classical description. It is no longer that rare disease and the spectrum of clinical presentation has widely expanded, both locally and systematically. In addition, a relatively good number of recent multicenter, meta-analysis, systematic reviews, and consensus reports about IGM have become available. The advancements in the diagnostic techniques of IGM and the growing knowledge about IGM treatment options no longer justify the routine labeling of IGM as a mysterious entity. The preponderance of evidence is now in support of complementary, rather than contradictory, surgical and systemic immunosuppressive treatment. Patients with IGM are better treated under the care of a multidisciplinary team. This will facilitate personalizing the treatment according to the needs of each patient with the minimum possible morbidity. There is a need for a comprehensive classification system for IGM that reflects the clinical variants, the radiological patterns, and the pathological details of IGM. Such a classification will provide useful hints about the treatment, the likelihood of the recurrence, and the expected natural history of IGM.