Granulomatous Mastitis: A Diagnostic Challenge

Abstract

Background
Granulomatous mastitis (GM) is often found in reproductive-age women. These patients are treated by the administration of
antituberculosis drugs. It is difficult to determine the exact cause of GM cytologically and histopathologically. Various etiologies i.e.,
tuberculosis, sarcoidosis, foreign bodies and immunological diseases may provide granulomatous inflammation features in the
tissue. High-sensitivity tests such as PCR can help to detect the presence of Mycobacterium tuberculosis (MT) as one of possible
etiologic agent. Accurate diagnosis will improve the treatment quality thus a better quality of life. The aim of this study was to
determine whether the granulomatous mastitis patients who referred to the Department of Anatomic Pathology Faculty of Medicine
Universitas Sriwijaya/Dr. Moh. Hoesin Palembang Hospital were caused by MT.
Methods
A descriptive observational study was performed. Thirty paraffin blocks of GM patients during the period of 1st October 2018 to 29th
September 2020 were collected. DNAs were extracted from tissue scrapings of the slides. Then, PCR analysis was conducted using
a specific primer IS6110 with around 200 bp PCR product.
Results
The mean age of the patients was 40.8 years (range: 23-67 years). There were six samples (20%) of GM produced the expected
amplicon. However, only three of six samples morphologically consistent with tuberculosis.
Conclusion
Granulomatous inflammatory reactions in the breast are not only caused by tuberculosis. Further study is needed to determine the
exact cause of this lesion. Despite high costs, PCR examination may become an alternative approach in determining the etiology of
GM.