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