Cases Of Granulomatous Mastitis Research Articles

Clinical characteristics and therapeutic strategy of granulomatous mastitis accompanied by Corynebacterium kroppenstedtii: a retrospective cohort study

BackgroundIncreasing evidence has suggested that Corynebacterium kroppenstedtii is associated with some cases of granulomatous mastitis, mostly based on pathology or microbiology. We aimed to identify the clinical characteristics and treatment regimens for granulomatous mastitis with Corynebacterium kroppenstedtii infection. Understanding these clinical features is essential for patient care.MethodsWe retrospectively collected data on 201 patients who were pathologically diagnosed with granulomatous mastitis and had microbiological results of either Corynebacterium kroppenstedtii or no bacterial growth and recorded and analysed their demographics, clinical characteristics, and clinical outcomes.ResultsThere were 107 patients in the CK group and 94 patients in the negative group. Sinus formation (x2 = 13.028, p = 0.000), time to complete remission at the first treatment period (Z = -3.027, p = 0.002), diameter of breast mass at first-time medical consultancy (Z = -2.539, p = 0.011) and recurrence (x2 = 4.953, p = 0.026) were statistically significant. Age (Z = -1.046, p = 0.295), laterality (x2 = 4.217, p = 0.121), time to presentation since the last delivery (x2 = 0.028, p = 0.868), BMI (Z = -0.947, p = 0.344), lactation time (Z = -1.378, p = 0.168), parity (x2 = 1.799, p = 0.180), gravida (Z = -0.144, p = 0.885), history of lactational mastitis or abscess (x2 = 0.115, p = 0.734), local trauma (x2 = 0.982, p = 0.322), hyperprolactinemia (x2 = 0.706, p = 0.401), erythema nodosum (x2 = 0.292, p = 0.589), and nipple discharge (x2 = 0.281, p = 0.596) did not demonstrate statistical significance. Regarding recurrence related to therapeutic strategy, except for surgery combined with immunosuppressants (x2 = 9.110, p = 0.003), which was statistically significant, none of the other treatment regimens reached statistical significance. The recurrence rate of patients in the CK group using rifampicin in their treatment course was 22.0% (x2 = 4.892, p = 0.027).ConclusionsGranulomatous mastitis accompanied by Corynebacterium kroppenstedtii more easily forms sinuses and has a higher recurrence rate. Both of the clinical characteristics may indicate that Corynebacterium kroppenstedtii plays an important role in the development and progression of granulomatous mastitis. Lipophilic antibiotics may be essential for granulomatous mastitis with Corynebacterium kroppenstedtii infection.

The diagnostic and therapeutic evaluation of Idiopathic granulomatous mastitis. A case series

Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory condition of the breast that is commonly found in young women of childbearing age with a history of recent breastfeeding. In our study, we aimed to present the detailed clinical and morphological features of IGM cases, diagnostic clues, and treatment. The most common clinical presentation is a unilateral, breast induration, nipple retraction, and even a multiple sinus formation often associated with an inflammation of the overlying skin. It usually mimics with breast abscess, rarely inflammatory breast cancer. Although etiology is still unknown. Many factors, including autoimmunity, infection, chemical agent, lactation, and hormonal imbalance, are supposed to play a role for etiology. Therefore, thorough history taking, examination, imaging, and histopathology make a proper diagnosis that determines the optimal management to be administered. We are presenting three cases of granulomatous mastitis from our clinical practice with varying clinical features. After the necessary investigation, we diagnose it as IGM. There is no definitive treatment guideline still now. In literature, many therapeutic operations, including conservative treatment, surgery, steroid, and immunotherapy, have been shown. However, we successfully treated this patient by conservative treatment, by incision and drainage, surgical debridement, or by in a combination of both, followed by regular dressing, antibiotics, and other supportive measures with no use of the steroid.

PROPORTIONS OF VARIOUS BENIGN BREAST LESIONS AMONG WOMEN PRESENTING AT TERTIARY CARE INSTITUTE OF INDIA: A CROSS-SECTIONAL STUDY

Background and Aim: Benign Breast Diseases (BBDs) is a group of non-cancerous breast diseases. A triple assessment which is done by a clinical examination, imaging like ultrasonography (USG) or mammography and a pathological examination – FNAC or core needle biopsy, during the initial consultation, allows clinicians to give immediate reassurance to most of the patients. The aim of the study was to find out the proportions of various benign breast lesions among women aged 18 years and above. Material and Methods: A prospective study was conducted in the Department of Surgery, Tertiary care institute of India for a period of 20 Months. Based on the pilot study sample size derived was found to be 102. A performa was filled with patient particulars, history and clinical findings in female patient attending department of surgery OPD with breast related symptoms. Patients will be followed up with histopathological, cytological and radiological studies in indicated cases. The patients will be followed up for 1 year. Most common benign breast related symptoms and condition among the study group and probable risk factors for the same will be analyzed. Results:The commonest case among the study population was fibroadenoma 37 (36.27%). The next common was acute breast abscess, followed by fibrocystic disease (9). Lump alone detected either by patient herself or by the clinician was the most common presenting complaint in around 40 patients, followed by lump with pain in around 37, followed by either pain, nipple discharge. Fibroadenoma could be diagnosed clinically with an accuracy of about 89%. Abscess breast, phyllodes tumor and galactocele and few cases of granulomatous mastitis was also able to be diagnosed clinically. Conclusion: Fibrocystic disease is commonest amongst proliferative breast lesions followed by Sclerosing adenosis. Breast abscess is the commonest lesion amongst inflammatory breast lesions. Breast self-examination and health education to females is very important in cases of benign proliferative lesions.
 Key Words: Benign Breast Diseases, Fibroadenoma, Phyllodes tumor, Ultrasonography

Granulomatous lesions !! Expected guests in unexpected places

Introduction: Granulomatous lesions in various sites have different modes of presentation, different etiologic factors with identical histological patterns. The aim was to study the occurrence of granulomatous lesions at uncommon sites. Materials and methods: A retrospective study of histopathological specimens received over a period of one year from June 2017 to May 2018 was done and cases of granulomatous lesions of various sites reported on histopathological examination were reviewed along with Ziehl-Neelsen (ZN) and Fite-Faraco (FF) staining. Results: Out of total 3623 histopathology specimens, 61 (1.7%) were granulomatous lesions of which 28 (45.9%) were AFB (Acid-fast bacilli) positive. 20 cases (32.7%) were granulomatous lymphadenitis out of which 12 (19.6%) were positive for AFB. 4 (6.5%) out of 13 (21.3%) granulomatous skin lesions showed AFB positivity. 6 (9.8%) cases of granulomatous mastitis (1 was AFB +ve), 4(6.5%) cases of granulomatous synovitis (2 were AFB +ve), 3 (4.9%) cases of granulomatous endometritis (2 were AFB+ve) were seen. 2 (3.3%) cases each of granulomatous epididymitis and appendicitis were noted. 1(1.6%) case of HIV positive hysterectomy specimen showed positivity for AFB. 1 (1.6%) case each of granulomatous lesions was found in the salivary gland, thyroid, testis, parietal pleura, nasal septum, suture granuloma of the fallopian tube, lipoma with foreign body granuloma, sinus tract, intestine, and omentum. Conclusion: In the present study tuberculosis was the most common cause of granulomatous lesions of various sites. Histopathology plays an important role in the diagnosis and management of a variety of granulomatous lesions. Special stains play a vital role in the diagnosis of infectious granulomatous lesions.

Two Cases of Granulomatous Mastitis Caused by Infection with Corynebacterium spp.

Two Cases of Granulomatous Mastitis Caused by Infection with Corynebacterium spp.

Two cases of granulomatous mastitis complicated by erythema nodosum

Two cases of granulomatous mastitis complicated by erythema nodosum

Developing a Breast Fine Needle Aspiration Biopsy Service in Peru

Abstract 6 Background: Breast cancer incidence is increasing in developing countries. In 2010, 57.8% of breast cancers in Peru were at least stage III at diagnosis. Federal and regional Peruvian institutions partnered with several organizations, including UCSF, to improve access and quality of breast cancer care in Peru. Phase 1 involved screening with clinical breast exam, creating a community-based referral system for women with masses, and promoting evaluation of lesions using fine needle aspiration biopsy (FNAB) by trained physicians, with treatment at the regional cancer institute. Curricula for each activity were developed and validated. During phase 1, in-country FNAB expertise was recognized as limited. For phase 2, the critical objective was to solidify local capacity for high-quality FNAB and integrate FNAB into standard of care for breast cancer. Methods: Three main activities were completed during phase 2. 1) Develop a Training of Trainers (ToT) curriculum for FNAB, and identify master trainers and trainees. 2) Facilitate endorsement of a national approach to training FNAB and undertake preliminary rollout in La Libertad region. 3) Strengthen interpretation and reporting of FNAB results. Results: A 5-day ToT pilot course occurred during October 19-23, 2014. Prior to the course, women with palpable masses were identified during a breast screening campaign and scheduled for FNAB. Regional, national and international clinical teams observed, procured and interpreted FNAB. Four new cases of cancer and eight cases of granulomatous mastitis were diagnosed. Slide quality before and after the training intervention will be compared. Following the course, a one-day validation meeting including physicians and national leaders took place at the national cancer center in Lima, Peru. FNAB was endorsed for early diagnosis and triage. Conclusions: To ensure sustainability of FNAB, cytology fellowships and training centers are needed. Strengthening partnerships will be critical for long-term capacity. An electronic reporting system will be developed to replace paper-based methods. Funding: Norwegian Cancer Society/Norwegian Breast Cancer Society (NCS/NBCS), Susan G. Komen for the Cure, The PATH Catalyst Fund. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.

Idiopathic granulomatous mastitis: imaging update and review

ObjectivesThe purpose of this study was to review the imaging features of idiopathic granulomatous mastitis (IGM) with clinical and pathology correlation.MethodsWith institutional review board (IRB) approval, a retrospective search of the surgical pathology database from January 2000 to July 2015 was performed. Clinical, imaging and histology findings were reviewed. Cases of granulomatous mastitis without a known source, diagnosed with percutaneous or surgical biopsy, were included in our analysis.ResultsSeventeen cases of IGM were identified with imaging available for review. The majority of patients presented with a palpable abnormality, whereas a minority were asymptomatic with an abnormal screening mammogram. At imaging, IGM most often demonstrated a focal asymmetry at mammography, a hypoechoic mass with irregular or angular margins at ultrasound, and robust enhancement with mixed progressive and plateau kinetics at magnetic resonance imaging (MRI). Axillary lymph nodes were reactive in appearance at ultrasound. Molecular breast imaging performed in one case showed mild focal asymmetric radiotracer uptake.ConclusionIGM is a rapidly progressive rare inflammatory condition of the breast resulting in non-necrotizing granuloma formation. Imaging features mimic breast carcinoma and diagnosis can be difficult. Radiologists’ awareness of this condition is essential to prevent delayed or unnecessary treatment.Teaching points• Idiopathic granulomatous mastitis is rapidly progressive inflammatory condition.• Imaging features may mimic breast carcinoma or infection.• Ultrasound shows irregular hypoechoic masses with increased vascularity and sinus tracts.• MRI shows irregular, enhancing masses or non-mass enhancement with microabscesses.• MRI is useful for assessment of breast involvement and response to treatment.

A microbiological and clinical review on Corynebacterium kroppenstedtii.

The genus Corynebacterium represents a taxon of Gram-positive bacteria with a high G+C content in the genomic DNA. Corynebacterium kroppenstedtii is an unusual member of this taxon as it lacks the characteristic mycolic acids in the cell envelope. Genome sequence analysis of the C. kroppenstedtii type strain has revealed a lipophilic (lipid-requiring) lifestyle and a remarkable repertoire of carbohydrate uptake and utilization systems. Clinical isolates of C. kroppenstedtii have been obtained almost exclusively from female patients and mainly from breast abscesses and cases of granulomatous mastitis. However, the role of C. kroppenstedtii in breast pathologies remains unclear. This review provides a comprehensive overview of the taxonomy, microbiology, and microbiological identification of C. kroppenstedtii, including polyphasic phenotypic approaches, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, and the use of 16S rRNA gene sequencing. A clinical review presents reported cases, various antimicrobial treatments, antibiotic susceptibility assays, and antibiotic resistance genes detected during genome sequencing. C. kroppenstedtii must be considered a potential opportunistic human pathogen and should be identified accurately in clinical laboratories.

Radiological review of ten cases of granulomatous mastitis of the breast

Purpose Granulomatous mastitis of the breast is a rare entity that can mimic breast carcinoma. It can be linked with tuberculosis (TB) or be idiopathic. There is often discrepancy between the clinical signs, the mammo or ultrasound (US) appearances and the histology result. This may result in multiple biopsies and difficult explanations to anxious patients. The aim of this review was to determine whether a specific radiological appearance can be identified which, in conjunction with the benign histology, might provide reassurance in cases of radio-clinical discrepancy and avoid the need for multiple biopsies. Methods and materials All cases of granulomatous mastitis diagnosed between 2012 and 2014 were reviewed; the clinical and radiological presentations were correlated with the histology. The outcomes and treatment of the patients were also documented. Results Ten patients presented with a palpable lump graded P2-P5. Two different radiological patterns were identified: five patients had features of non-specific inflammatory changes in mammo and/or US (M2-3, US 2-3), five patients had a U4 US with non-specific asymmetric density (ASD) in mammography. Two patients had two biopsies, one patient had three biopsies. No malignancy was identified. Conclusion Despite an initial clinical presentation that can mimic a carcinoma, the association of non-specific mammo findings, U3 or U4 US findings and granulomatous mastitis at the initial biopsy should be enough to prove the lack of malignancy

Cancer du sein traité par antibiotherapie ? Mastite granulomateuse à corynébactérie

Granulomatous mastitis is a rare disease, often associated with Corynebacterium infection. It raises the problem of diagnosis of breast tumor with a fast evolution and inflammatory character. We report two cases of granulomatous mastitis with Corynebacterium. It concerns the clinical and radiological description, followed by the therapeutic alternatives and future of the patients. The clinical presentation is variable. The treatment consists in a surgical procedure of resection. The medical treatment based of corticosteroids also proves efficient. The association between Corynebacterium presence and this pathology seems frequent and needs a specific bacteriological search.

下肢脂肪織炎を伴った肉芽腫性乳腺炎の1例

症例は35歳，女性．2週間前より右乳房腫瘤と疼痛を自覚し，前医を受診した．膿瘍形成を認め切開排膿を受けた．同時期に左足関節部の発赤，腫脹および疼痛が出現している．症状の改善はみられず，また下肢痛で歩行が困難になり当科を受診し，入院となった．入院後，抗菌薬治療を行ったが症状は改善しなかった．乳腺の針生検では肉芽腫性乳腺炎を考える所見であり，下肢の病変はそれに伴った脂肪織炎と考えた．プレドニゾロン30mg/日を内服開始すると，乳腺・下肢の症状は著明に減退した．経過中乳腺炎の再燃を認めたが，徐々にプレドニゾロンを減量し，治療開始後約1年8カ月で中止となった．その後，再燃なく経過している．肉芽腫性乳腺炎と脂肪織炎の同時発症はまれであり，文献的考察を加え報告する．

結節性紅斑を伴った肉芽腫性乳腺炎の1例

結節性紅斑を伴った肉芽腫性乳腺炎の1例

Granulomatous Mastitis - A Rare Disease that Mimic Breast Cancer

INTRODUCTION: Granulomatous mastitis (IGM) is a benign breast disease first described by Kessler and Wolloch in 1972. Clinically and radiologically it may mimic breast carcinoma. The aim of this study is to describe a case of granulomatous mastitis. REPORT: A 37 years old woman with a history of right breast pain and inflammation for 5 months. She reported fever and she used antibiotic (Cephalexin 500mg and ciprofloxacin 500mg), no improvement in clinical status. She denied family history of breast cancer and report a history of oral contraceptive use. A physical examination showed a large area of induration in right breast, multiple abscesses, and a fistula with a pus-like discharge in the medial part of the patient’s right breast. Axillary lymph nodes are presents. Ultrasonography showed mammary inflammatory process in the right breast. She performed two biopsies, with the result of pathological anatomic chronic granulomatous mastitis, no signs of malignancy. She initiated clinical treatment with prednisone (60mg/day) with significant improvement. DISCUSSION: Granulomatous mastitis is a rare, benign, but disfiguring inflammatory disease of the breast. This disease usually affects women of child-bearing age with a history of oral contraceptive use. It is characterized by chronic, non-caseating granulomatous lobulitis of unknown etiology. Diagnosis is made by excisional biopsy: histology shows epithelioid and multinucleated giant cell granulomas limited to the mammary lobules with microabcesses the treatment of choice for IGM has not yet been established. Prior to 1980, because of the clinical impression of a possible malignancy, surgical excision of the entire lesion was suggested. Complications seem to be related to both the disease process and the surgical procedure and include skin ulceration, abscess formation, fistulae, wound infection, and recurrence. Some patients had relapses in the form of chronic mastitis after excisional biopsies. Two decades ago, DeHertogh suggested complete resection or open biopsy with 60 mg/kg/day prednisolone therapy for treatment of granulomatous mastitis. Several other reports ofusing 60 mg/kg/day prednisolone to treat IGM have also been published CONCLUSION: The granulomatous mastitis can mimic breast carcinoma on clinical and mammographic examinations ; greater awareness of the rare entity is mandatory to avoid unnecessary mastectomies.

Contrast-Enhanced Breast Ultrasonography

The purpose of this study was to identify histopathologic correlates for the varied appearances of breast masses on contrast-enhanced ultrasonography (CEUS). Contrast-enhanced ultrasonography was performed in 104 patients (age range, 19-86 years) after administration of a sulfur hexafluoride microbubble contrast agent, and enhancement patterns were classified as no enhancement, peripheral enhancement, homogeneous enhancement, regional enhancement, and heterogeneous enhancement. All patients' histologic slides were reviewed and correlated with CEUS findings. In malignant masses, heterogeneous enhancement corresponded to tumor cell cords or clusters in a variable amount of desmoplastic stroma. Homogeneous enhancement corresponded to hypercellularity in the whole mass, or ductal carcinoma in situ (DCIS) was predominant. Regional enhancement corresponded to a DCIS component. Peripheral enhancement corresponded to a DCIS component, hypercellularity or adenosis at the periphery, and low-degree cellularity, degeneration, fibrosis, or necrosis in the center. No enhancement was present in 1 case of low-grade DCIS. In benign masses, heterogeneous enhancement corresponded to loose cell proliferation in a more sclerotic stroma. Homogeneous enhancement corresponded to diffuse hypercellularity, an inflammatory cell infiltrate, or intraductal papilloma. Regional enhancement corresponded to focal hypercellularity or intraductal papilloma within a dilated duct. No enhancement corresponded to desmoplastic stroma. Peripheral enhancement was shown in 1 case of granulomatous mastitis with an inflammatory infiltrate at the periphery and necrosis in the center. Breast mass CEUS findings correlated with histologic features.

A CASE OF GRANULOMATOUS MASTITIS ASSOCIATED WITH A GASTRIC CANCER

A case of granulomatous mastitis associated with a gastric cancer is reported. A 75-year-old female was seen at the hospital because of anorexia and epigastric fullness. Physical examination revealed a thumb tip-sized firm lump unexpectedly in the upper outer quadrant of the left breast with enlarged axillary lymph nodes, highly suggestive of a breast cancer. On the other hand, the upper gastrointestinal examination revealed a Borrmann type III gastric cancer. The patient was admitted for the purpose of the surgical treatment. Gastrectomy for the cancer was performed, followed by simple mastectomy with axillary dissection. Histopathologic examination demonstrated no breast carcinoma but a granulomatous mastitis, namely, granulomatous inflammation involving the mammary lobules and lymph nodes. Etiologically, the granulomatous mastitis may be classified into infectious and noninfectious types. Despite failure to demonstrate tubercle bacilli, fungi or other causative microorganisms, the present case is judged to belong to the infectious type because of its association with marked regional lymphadenopathy. Though vanishingly rare, the granulomatous mastitis should be considered as one of the masqueraders of breast cancer.

La mastite granulomateuse : une nouvelle maladie systémique ?

One case of granulomatous mastitis (GM) with systemic manifestations (oligoarthritis, episcleritis) is reported. The outcome was favourable ; an early relapse responded to corticosteroid therapy. The authors describe this benign inflammatory disease. The causes of GM are obscure, but BM might well be an autoimmune disease. Surgery can be avoided by giving corticosteroids in effective doses.

Granulomatous mastitis: a report of seven cases.

The clinical history and histological features of seven cases of granulomatous mastitis are presented. The lesion occurs in young parous women as a tender extra-areolar breast lump. Histologically, non-caseating discrete granulomas are present, confined to breast lobules with, in three cases, coalescence of the granulomas and microabscess formation. Pathogenesis of the changes is discussed. It is thought that granulomatous mastitis is an entity morphologically distinct from duct ectasia/plasma cell mastitis and the commoner forms of granulomatous breast diseases.