Diagnosis of Idiopathic Granulomatous Mastitis in a Sudanese Woman

Abstract

Idiopathic granulomatous mastitis (IGM) is a relatively rare specific chronic inflammatory process of unknown etiology, that diagnostically overlaps with common breast pathologies in Sudan, namely breast cancer (BC) and tuberculous mastitis (TBM). We report the case of a 34-year-old female who presented with a 1-month history of a painful lump in the lower outer quadrant of her left breast. A tru-cut biopsy showed features of granulomatous inflammation suggestive of IGM. Four months later, she presented with similar features and fine-needle aspiration cytology (FNAC) confirmed the presence of IGM and excluded the presence of both, BC and TBM. Histology once again confirmed the diagnosis of granulomatous mastitis with no evidence of breast cancer. Grocott's Methenamine Silver, Ziehl-Neelsen stain, and polymerase chain reaction were negative and accordingly the possibility of fungal infection and TBM were excluded. To our knowledge, this is the first case report of IGM in Sudan. FNAC helped in correct diagnosis of our case and importantly, conditions such as BC and TBM were both excluded as common mimickers of IGM. Although breast biopsy is the main golden approach in the diagnosis of IGM in addition to the usefulness of adjunct ancillary microbiological techniques, still further research is needed to establish whether FNAC can be a reliable tool in the diagnosis of IGM with the common practice of this diagnostic tool in Sudan.

Keywords: Breast cancer; idiopathic granulomatous mastitis; tuberculous mastitis.