Figure 1:Clinical symptoms of case 1 This was a 33 years old patient who had recurrence at the upper outer part of the left breast 3 months after wide surgical excision. A, the fistula was presented on the left breast before anti-tuberculosis treatment. B, the fistula was cured after 6 months of anti-TB treatment.

Figure 2: Clinical symptoms of case 2 This was a 42 years old patient who accepted anti-TB treatment as primary therapy, who presented ulcerative skin lesions, sinus, abscess, and nipple retraction before treatment. A, ulcerative skin lesions were presented before anti-tuberculosis treatment. B, the ulcerative skin lesions were cured after 9 months of anti-tuberculosis treatment. C, the breast presented soft and normal 3 years later of follow up.

Figure 3 Multiple hypoechoic masses in the ultrasonographic evaluations of a patient with IGM. One lesion was located in the inner lower quadrant of the left breast (A), and another lesion was located in the outer upper quadrant (B).

Figure 4 Mammographic finding, showing a mass in the left breast of an IGM patient.

Figure 5 Microscopic findings for a core needle biopsy specimen, showing dilated ducts with a surrounding inflammatory infiltrate of lymphocytes, plasma cells, granuloma formation (?) and giant cells (?). (H&E stain �100 and inlet magnification �200).

Characteristics (n=36)

Positive

Negative

 

 

 

Breast lump

32 (88.9%)

4 (2.8%)

 

 

 

Painful swelling

22 (61.1%)

14 (38.9%)

 

 

 

Ulcerative skin lesions

10 (27.8%)

26 (72.2%)

 

 

 

Sinus formation

8 (22.2%)

28 (77.8%)

 

 

 

Nipple retraction

11 (30.6%)

25 (69.4%)

 

 

 

Abscess

6 (16.7%)

30 (83.3%)

 

 

 

Table1 Clinical characteristics of patients with IGM

Imaging modality

No. (%)

 

 

 

Ultrasonography (n=36)

 

 

 

 

Hypoechoic lobulated mass

16 (44.4%)

 

 

Mixed-echogenicity parenchymal mass

11 (31.6%)

 

 

 

Irregular tubular mass and parenchymal

9

(25%)

distortion

 

 

 

 

 

Abscess

6

(16.7%)

 

 

 

Skin thickening

8

(22.2%)

 

 

 

Fistula tract

5

(13.9%)

 

 

Axillary lymph node enlargement

10 (27.8%)

 

 

BI-RADS category 4-5

14 (38.9%)

 

 

 

Mammography (n=22)

 

 

 

 

Asymmetric increased density

10 (45.5%)

 

 

 

Ill-defined mass

3

(13.7%)

 

 

 

Calcification

1

(4.5%)

 

 

 

Axillary lymph node enlargement

7

(31.8%)

 

 

 

BI-RADS category 4-5

6

(27.2%)

 

 

 

Table2 Ultrasonography and mammography findings in patients with IGM

BI-RADS, Breast Imaging Reporting and Data System.

No.

Age

Location

Diagnostic

Pre-treatment

Drugs

Duration

Outcome

 

 

 

 

 

 

 

 

1

33

L

Biopsy

Drainage and wide

R+I+E

6 months

Cured

 

 

 

 

excision

 

 

 

 

 

 

 

 

 

 

 

2

42

L

Core needle biopsy

-

R+I+E

9 months

Cured

 

 

 

 

 

 

 

 

3

36

R

Core needle biopsy

-

R+I+P

6 months

Cured

 

 

 

 

 

 

 

 

4

40

R

Core needle biopsy

Drainage

R+I+E

6 months

Cured

 

 

 

 

 

 

 

 

5

44

L

Core needle biopsy

-

R+I+E

6 months

Cured

 

 

 

 

 

 

 

 

6

39

R

Core needle biopsy

-

R+I+P

6 months

Cured

 

 

 

 

 

 

 

 

7

37

L

Core needle biopsy

Drainage

R+I+E

9 months

Cured

 

 

 

 

 

 

 

 

8

28

R

Core needle biopsy

-

R+I+E

1 months

Prednisolone

 

 

 

 

 

 

 

 

9

30

R

Core needle biopsy

-

R+I+E

6 months

Cured

 

 

 

 

 

 

 

 

10

46

R

Core needle biopsy

Prednisolone

R+I+E

9 months

Cured

 

 

 

 

 

 

 

 

11

36

R

Core needle biopsy

-

R+I+P

6 months

Cured

 

 

 

 

 

 

 

 

12

26

R

Biopsy

Drainage and wide

R+I+P

12 months

Cured

 

 

 

 

excision

 

 

 

 

 

 

 

 

 

 

 

13

31

L

Core needle biopsy

-

R+I+E

6 months

Cured

 

 

 

 

 

 

 

 

14

26

R

Core needle biopsy

-

R+I+E

6 months

Cured

 

 

 

 

 

 

 

 

15

19

L

Core needle biopsy

Drainage

R+I+E

6 months

Cured

 

 

 

 

 

 

 

 

16

47

R

Core needle biopsy

-

R+I+E

6 months

Cured

 

 

 

 

 

 

 

 

17

39

L

Core needle biopsy

-

R+I+E

6 months

Cured

 

 

 

 

 

 

 

 

18

45

R

Core needle biopsy

Prednisolone

R+I+P

9 months

Mastectomy

 

 

 

 

 

 

 

 

19

34

R

Biopsy

Drainage and wide

R+I+E

9 months

Cured

 

 

 

 

excision

 

 

 

 

 

 

 

 

 

 

 

20

29

R

Core needle biopsy

-

R+I+E

6 months

Cured

 

 

 

 

 

 

 

 

21

33

L

Biopsy

Drainage and wide

R+I+P

6 months

Cured

 

 

 

 

excision

 

 

 

 

 

 

 

 

 

 

 

22

45

L

Core needle biopsy

-

R+I+E

6 months

Cured

 

 

 

 

 

 

 

 

23

30

L

Core needle biopsy

Drainage

R+I+P

6 months

Cured

 

 

 

 

 

 

 

 

24

40

R

Core needle biopsy

-

R+I+E

7 months

Cured

 

 

 

 

 

 

 

 

25

38

R

Core needle biopsy

Prednisolone

R+I+E

6 months

Cured

 

 

 

 

 

 

 

 

26

42

L

Core needle biopsy

-

R+I+E

6 months

Cured

 

 

 

 

 

 

 

 

27

37

L

Biopsy

Drainage and wide

R+I+P

10 months

Cured

 

 

 

 

excision

 

 

 

 

 

 

 

 

 

 

 

28

48

L

Core needle biopsy

-

R+I+P

2 weeks

Prednisolone

 

 

 

 

 

 

 

 

29

56

R

Core needle biopsy

-

R+I+E

6 months

Cured

 

 

 

 

 

 

 

 

30

31

L

Biopsy

Drainage and wide

R+I+E

8 months

Cured

 

 

 

 

excision

 

 

 

 

 

 

 

 

 

 

 

31

26

R

Core needle biopsy

-

R+I+E

6 months

Cured

 

 

 

 

 

 

 

 

32

39

R

Biopsy

Drainage and wide

R+I+P

8 months

Cured

 

 

 

 

excision

 

 

 

 

 

 

 

 

 

 

 

33

44

L

Core needle biopsy

-

R+I+E

6 months

Cured

 

 

 

 

 

 

 

 

34

37

R

Core needle biopsy

-

R+I+P

6 months

Cured

 

 

 

 

 

 

 

 

35

42

L

Core needle biopsy

-

R+I+E

6 months

Cured

 

 

 

 

 

 

 

 

36

25

L

Core needle biopsy

Prednisolone

R+I+E

6 months

Cured

 

 

 

 

 

 

 

 

Table3 Clinical outcomes of 36 patients treated with anti-TB therapy

R+I+E, patients were treated with rifampicin plus isoniazid and ethambutol

R+I+P, patients were treated with rifampicin plus isoniazid and pyrazinamide