Granulomatous mastitis: A 5-year single-center case series from North Africa

Granulomatous mastitis (GM) is a rare, benign, chronic inflammatory breast disease that clinically mimics malignancy. Despite increased recognition, GM remains difficult to diagnose and manage due to its nonspecific presentation and unclear etiology. To characterize the clinico-radiological and histopathological spectrum of granulomatous mastitis, identify factors associated with recurrence, and propose a context-specific diagnostic and therapeutic algorithm suitable for low-resource settings. A retrospective analysis of all histologically confirmed GM cases treated at CHU Mohammed VI Oujda from 2019 to 2024 was conducted. Demographic, clinical, imaging, histopathological, and therapeutic data were extracted and analyzed. Recurrence risk was assessed based on management strategies and clinical presentation. Forty-five cases of GM were identified. The mean age was 34 years; 78 % were multiparous and 91 % had a history of breastfeeding. The most frequent presentation was a unilateral breast mass (84 %), often painful (65 %) with inflammatory signs (47 %). Imaging findings were nonspecific; ultrasound showed irregular hypoechoic masses in 68 % of cases. Histopathology confirmed non-caseating lobulocentric granulomas in all cases. Corticosteroids were administered in 40 %, surgery in 35 %, while 15 % had spontaneous resolution. The recurrence rate was 18 %, predominantly among those managed conservatively or without corticosteroids. GM poses diagnostic and therapeutic challenges, particularly in resource-limited contexts. Accurate histopathological diagnosis is essential to avoid mismanagement. Recurrence appears more likely with conservative strategies, highlighting the need for standardized, individualized management. A diagnostic and therapeutic algorithm is proposed to guide clinical decision-making.