Chronic Granulomatous Mastitis Research Articles

Chronic granulomatous mastitis in a patient with microprolactinoma

Chronic granulomatous mastitis in a patient with microprolactinoma

Isolated Breast Sarcoidosis

Background: Sarcoidosis is a rare non-caseating granulomatous disease of unknown origin that affects multiple systems in the body occurring more frequently in young women age 17-24 years. Cases with manifestations that doesn’t affect the common organs can be difficult to identify and delay the patient’s diagnosis, meaning that the finding of an isolated breast mass should include sarcoidosis as one of its differentials, to ensure early detection and a better prognosis. Case presentation: We present the case report of a 21-year-old female patient, who had noticed a palpable breast nodule associated with local pain and fever for 2 months. Physical examination detected palpable bilateral axillary lymph nodes, a nodule occupying the lateral quadrants of the left breast and bullous lesions, along with phlogistic signs in the same topography. The imaging exams of the chest, showed a solid-cystic complex in the lateral quadrants of the left breast, in addition to bilateral axillary lymph node enlargement. Laboratory tests was unremarkable. The histopathological tests detected fibroadipose tissue with noncaseating granulomas, neutrophilic microabscesses and Langerhans-type giant cells, causing chronic granulomatous mastitis, which may represent sarcoidosis. The lesions regresed after the use of corticosteroids. Conclusion: Despite its rarity, the clinical and imaging findings such as those of this patient, should warrant the consideration of breast sarcoidosis as a possible diagnosis given the importance of excluding similar conditions, such as neoplasms, early on.

Histochemical Demonstration of Fungi in Breast Diseases at University of Maiduguri Teaching Hospital-North Eastern Nigeria

Breast disease is a global public health concern, and recent research suggests that fungal infections may be linked to its development and progression. This study aims to investigate the presence of fungi in formalin-fixed paraffinembedded (FFPE) breast tissue samples diagnosed with various breast diseases, including breast cancer, using histological staining techniques. The study design was a retrospective cross-sectional study that used convenience sampling to retrieve 49 breast tissue blocks diagnosed with various breast diseases from the Histopathology archive of the University of Maiduguri Teaching Hospital, Nigeria. The samples were re-embedded with paraffin wax, sectioned, and stained using Haematoxylin and Eosin and Grocott Methanamine Silver Stain. The data collected was analyzed descriptively and using chi-square tests. Fibroadenoma was the most common diagnosis in the study (69.3%), followed by Chronic Granulomatous Mastitis (18.4%) and breast cancer (12.2%). The highest frequency of Fibroadenoma diagnosis was in the age range of 30-39, whereas the highest frequency of breast cancer diagnosis was in the age range of 20-29. The study found that fungal infections were present in breast tissue samples, and the highest percentage of positive Gomori Methenamine Silver (GMS) stain test results were found in breast disease cases with breast cancer with a significant p value of 0.0175. This study provides evidence of a potential association between fungal infections and breast diseases in North Eastern Nigeria. Further research is needed to fully understand the mechanisms underlying this association and its implications for breast cancer prevention and treatment.

Evaluation of the Status of Intraparenchymal Plasma Cells in Terms of IgG4 Expression in Patients Diagnosed With Idiopathic Granulomatous Mastitis

Background and Objectives Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory lesion that mimics the clinical symptoms of carcinoma. Another type of chronic granulomatous mastitis is immunological mastitis, which is related to the infiltration of IgG4 plasma cells. This study aims to determine the status of IgG4 positive plasma cells in IGM samples. Subjects and Methods This is an analytical-cross-sectional study. 46 women diagnosed with IGM were selected for the study using census method. The percentage of IgG and IgG4 in plasma cells was determined based on immunohistochemical method. Age and type of surgery were also recorded. The data was entered into SPSS software, version 22 and analyzed using statistical tests. P<0.05 were considered statistically significant. Results The mean age of patients was 35.02±6.82 years. The mean percentage of IgG positive plasma cells among tissue inflammatory cells was 6923±23.42 and the mean percentage of IgG4 positive plasma cells was 23.39±22.33. Among infiltrated plasma cells, 1.89% were positive for IgG4 and the ratio of IgG4 to IgG in plasma cells was 0.91. Based on the results of Pearson correlation test, a positive and significant correlation was found between the percentage of IgG4 and IgG in plasma cells (r=0.600, P=0.004). Conclusion A significant percentage of infiltrated plasma cells are IgG4 positive, which can play a role in the development of IGM. Therefore, further investigation and comparison with immunological mastitis is recommended.

A descriptive study of chronic granulomatous mastitis in Central India

Background: Chronic granulomatous mastitis is a rare benign breast condition that can mimic breast cancer. The present study was undertaken to assess the demographics, clinical presentation, etiology, diagnostic tools and management of patients with CGM.Methods: This descriptive observational study was conducted in total 83 women who presented with breast lump with tenderness associated with fever for more than 4 weeks of duration in the Department of General Surgery at Tertiary Care Centre from June 2018 to December 2020.Results: In all cases breast lump was chief complaint, of maximum (38.5%) had this illness since last 1 to 4 months. 48 patients had past history of tuberculosis. Axillary lymph node was enlarged in 24.1% and body temperature was raised in 57.8% of cases. Skins over the lump were presented with indurated with multiple pus discharging sinuses (50.6%) and palpable mass with erythema and ulcerative skin lesion (49.4%). On biopsy all the patients presented with granulomatous mastitis and on USG, hypoechoic mass was presents in all cases. Patients were managed medically by IV antibiotic and AKT (57.8%) and IV antibiotic with oral corticosteroid (42.2%). Incision and drainage were done in 74 cases while 8 required wide local excision and in 1 patient mastectomy was done.Conclusions: The histopathology remains the optimal diagnostic tool. Corticosteroid therapy has been shown to be efficacious for CGM, but in the existence of many complications, surgical treatment has been first method of choice. We consider that wide local excision is the better treatment choice if possible.

A Study on Outcome of Wide Local Excision in Chronic Granulomatous Mastitis

Background: Granulomatous mastitis can be divided into idiopathic granulomatous mastitis and granulomatous mastitis occurring as a rare secondary complication of a great variety of other conditions such as tuberculosis and other infections, sarcoidosis and granulomatosis with polyangitis. Idiopathic granulomatous mastitis (IGM) is an uncommon benign chronic inflammatory disease which can clinically and radiographically mimic abscess or breast cancer. Definitive diagnosis was made by histopathology and exclusion of an identifying etiology. Optimal treatment has not been yet established. Objectives: The aim of this study was to report and describe the clinical signs, radiological findings, managements, clinical course, and clinical outcomes after treatment of IGM. Materials and Methods: We conducted a descriptive cross-sectional study on 28 patients with chronic GM in Enam Medical College & Hospital collected in 1 year. The patient characteristics, clinical presentations, radiological findings, microbiological workups, tissue pathology, treatment modalities, outcomes were analyzed. We evaluated only the response of wide local excision and assess the recurrence up to 2 years after surgery on the treatment modalities to find out the proper treatments for chronic GM patient. Results: Twenty eight patients were diagnosed as chronic granulomatous mastitis. FNAC was conducted before excision. Twenty seven patients had chronic granulomatous mastitis and one patient had tuberculosis on histopathology. In the first setting, 28 patients were treated by surgery. Thirteen patients out of 28 had open wound after performing an excision in which healing by secondary intention was done. Ten patients had undergone primary closure and no complications. Conclusion: Chronic GM is an uncommon benign disease which is hardly distinguished from malignancy. There is not a significant difference among treatment modalities in term of time-to-healing and recurrence of disease. The result shows that surgery is outperformed by the shortest healing time. However, the surgical treatment must be chosen with careful due to high rate of wound complications. Multimodality treatment is recommended as the proper treatments for chronic GM patient. J Enam Med Col 2020; 10(3): 174-178

CHRONIC BREAST INFECTIONS: CHALLENGING CONDITION TO DIAGNOSE AND TREAT; AN OVERVIEW OF 70 CASES

Objective: To share our experience of clinical features and management strategies for treatment of chronic breast infections.
 Study Design: Case series.
 Place and Duration of Study: Combined Military Hospital Rawalpindi, from Feb 2016 to Feb 2018.
 Methodology: We prospectively enrolled patients with diagnosis of chronic breast infections over a period of two years. All patients with infections (less than one month old) were excluded from the study. We studied the demographic characteristics like age, clinical presentation, histopathological features, treatment given and response to the treatment.
 Results: A total of 70 patients were enrolled in the study. Patients age was between 21-75 years with mean age of 42 ± 5 years. Most common clinical presentation was lump and in duration with abscess in 23 (33%) cases, mass with discharging sinuses in 16 (23%) cases, while 7 (10%) cases had recurrent abscess. Diagnosis was made on core biopsy in 21 cases and in remaining cases with incision and drainage. Histopathology confirmed diagnosis of Idiopathic Granulomatous mastitis in 30 (43%) cases, acute on chronic mastitis in 27 (38%) and chronic granulomatous mastitis in 13 (18%) cases. Out of all cases 29 (41%) showed response to antibacterial treatment while 27 (38%) cases responded to anti tuberculous treatment. Spontaneous resolution occurred in 11 (16%) cases while 3 (4%) cases responded to antifungal treatment.
 Conclusion: Chronic breast infections are a challenging condition to diagnose and treat for breast surgeons and can present with diverse range of clinical features.

Mastitis Quística Granulomatosa Neutrofílica, Reporte De Caso

Cystic neutrophilic granulomatous mastitis (CNGM) is a recently characterized entity, with specific histopathological details that differentiate it from other types of chronic idiopathic mastitis. The presence of gram-positive bacilli within cystic-like spaces surrounded by neutrophils, in a context of suppurative granulomatous inflammation, define this entity. The importance of its recognition in the diagnostic report lies in its association with infection by corynebacterial species, so that treatment with antibiotics can be targeted, beyond the anti-inflammatory treatment that is usually administered to idiopathic mastitis.We describe the case of a 35-year-old female patient with no related history, with intermittent breast pain, associated with the presence of multiple hard, palpable nodules in both breasts, with results from multiple previous private biopsies that described chronic granulomatous mastitis with a tubercular reaction, for which she received treatment for tuberculosis. Despite this, the clinical response was partial. Histological slides were reviewed at the institution and the diagnosis of CNGM was then established.The presentation of this case was considered important due to its low recognition among pathologists, despite presenting characteristics already defined by previous studies.

O-29 Negative Sexual Outcomes in Patients With Chronic Granulomatous Mastitis from Sao Paulo, Brazil

O-29 Negative Sexual Outcomes in Patients With Chronic Granulomatous Mastitis from Sao Paulo, Brazil

Solving the Dilemma of Congenital and Pathological Breast Asymmetry Using Modified Supine Oblique Sitting Marking Technique

Background: The female breast is one of the most attractiveaesthetic areas in female anatomy. The size, shape, andsymmetry of the breasts can have a dramatic effect on thewomen's well-being, poor self-esteem, altered self-image, andother psychological effects. All surgical techniques was donebased in the presurgical marking. However it is of little valueif symmetry procedure will be done in other breast.Material and Methods: We retrospectively reviewed 41patients admitted to our multi-disciplinary team breast clinicin Ain Shams University Hospital, between July 2015 andSeptember 2019. Patients' age ranged from 14 to 63 years.Congenital and pathological breast asymmetries were includede.g.: Chronic granulomatous mastitis, burns, and tumors ofthe breast (benign and malignant masses). Physiological breastasymmetry were excluded from the study.Patients were operated upon using the modified SOSmarking technique and followed-up for a mean of 13.24months post-operatively (range 3-30 months). All patientswere photographed before and after the surgery. Post-operativephotographs of these patients were examined by five plasticsurgeons (3 men and 2 woman). We compared both breastsusing a 5 point subscale consisting of volume, contour, placementof the breast mound, scar and the inframammary foldand all patients were asked to complete a satisfaction questionnairebased on the Harvard scale.Conclusion: It is a novel marking technique solved thedilemma of changing the pre-operative plane according to theintraoperative judgment and altering the amount of tissue to beexcised or reconstructed in patients suffering from congenitaland pathological breast asymmetry. It is technical easy to learn,reliable with satisfactory aesthetic outcome especial in congenitalasymmetries, with acceptable complication rate.

Value of shear wave elastrography image classification in the diagnosis of breast masses

Objective: To analyze the image features of shear wave elastrography (SWE) in breast masses, and to evaluate their values in the differentiation of benign and malignant breast lesions. Methods: A total of 361 patients with 403 breast lesions who simultaneously underwent conventional ultrasound and SWE examination from February 2015 to January 2018 were selected. Diagnosis in all patients was confirmed by aspiration biopsy or operative pathology. The SWE images were collected and the elastic images were divided into 5 types. The SWE image features of different breast pathological types were summarized, and their values in benign and malignant breast lesion diagnoses were evaluated. Results: The main features of benign breast lesion were type Ⅰ and Ⅱ, the main features of the malignant lesion were type Ⅳ and Ⅴ, and the proportion of which were 43.6% (71/163), 37.4% (61/163), 22.1% (53/240) and 57.9% (139/240), respectively. Type Ⅲ accounted for a certain proportion in both benign and malignant lesions. The SWE image features of benign and malignant lesions were compared and a significant difference was observed (P<0.001). The type Ⅴ features were mainly observed in invasive ductal carcinoma, invasive lobular carcinoma and other types of invasive carcinoma, while the type Ⅳ features were mostly presented in ductal carcinoma in situ and mucinous carcinoma. Fibroadenoma, fibroadenosis accompanied with fibroadenoma, and fibroadenosis were featured with type Ⅰ. Both intraductal papilloma and benign phyllodes tumor were mostly type Ⅱ, while type Ⅲ and Ⅴ were more common in chronic granulomatous mastitis. When type Ⅰ and typeⅡof breast lesions were classified as benign features while type Ⅳ and Ⅴ were malignant features, the sensitivity and specificity of breast malignant lesion diagnosis were 91.2% and 84.7% by application of SWE combined with breast imaging reporting and data system (BI-RADS). The sensitivity of combined diagnosis was slightly lower than that of conventional ultrasound (P>0.05), but the specificity was significantly higher than conventional ultrasound (P<0.01). Conclusion: The SWE is a simple and effective method. Combination of SWE with conventional ultrasound may improve the diagnostic differentiation of benign and malignant breast lesions.

A rare case of non-tuberculous mastitis

A 15-year-old girl presented with left breast lump with purulent discharge. During the last three months she lost 4 kg weight. There was evening rise of temperature which was not associated with joint pains or chills. She had received three courses of antibiotics earlier in the other healthcare center, with no response. Ultrasound scan showed multiple cutaneous sinuses and FNA report findings were suggestive of chronic granulomatous mastitis. As the patient was not responding to multiple antibiotics courses, HRZE (Anti Tubercular Treatment, ATT) was started. But after three months of ATT she developed multiple sinus tracts filled with fluid and with superficial ulcerations, which was aspirated, sent for analysis and oral Moxifloxacin 400 mg was added. DNA based line probe assay detected Non Tuberculous mycobacterium (NTM) and was referred for NTM species identification. Molecular genetics assay identified Mycobacterium chelonae/ Mycobacterium immunogenum species and HRZE regimen was stopped. Patient was started on oral clarithromycin, linezolid according to sensitivity report. She responded well and repeat ultrasound scan showed significant resolution of the sinus and there was no discharge. NTM should be considered for breast infections that recur despite standard antibiotic therapy or ATT. Keywords: nontuberculous mastitis; anti tubercular therapy; antibiotics; young female

Tuberculosis of the breast

We report a case of granulomatous mastitis caused by Mycobacterium tuberculosis in an immunocompetent woman with chronic inflammatory lesions of the breast. It was diagnosed by detection of mycobacteria DNA using polymerase chain reaction technique targeting IS6110 insertion element of M. tuberculosis complex in a paraffin-embedded histological specimen. The primary breast tuberculosis is rare, even in countries where the incidence and prevalence of pulmonary and extra pulmonary tuberculosis are high. It should be suspected in female patients with chronic granulomatous mastitis with no apparent cause. The cornerstone of treatment is antituberculous chemotherapy, and surgery is rarely required.

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.

Mastitis tuberculosa

We report a case of granulomatous mastitis caused by Mycobacterium tuberculosis in an immunocompetent woman with chronic inflammatory lesions of the breast. It was diagnosed by detection of mycobacteria DNA using polymerase chain reaction technique targeting IS6110 insertion element of M. tuberculosis complex in a paraffin-embedded histological specimen. The primary breast tuberculosis is rare, even in countries where the incidence and prevalence of pulmonary and extra pulmonary tuberculosis are high. It should be suspected in female patients with chronic granulomatous mastitis with no apparent cause. The cornerstone of treatment is antituberculous chemotherapy, and surgery is rarely required http://dx.doi.org/10.7705/biomedica.v33i1.1426

Mastitis Crónica Granulomatosa: una enfermedad que mimetiza el cáncer de mama

The chronic granulomatous mastitis is a rare condition that affects women in their childbear- ing years, with clinical, mammographic, eco- graphic and hystological characteristics that ressemble a breast carcinoma. Effective proto- cols for the diagnosis and treatment of this dis- ease have been proposed, but none of them have been able to become the gold standard in treat- ment for this group of patients. The purpose of this review is to establish the differential diagno- sis with breast carcinoma and the best approach for this challenging pathology.

Mastitis crónica granulomatosa idiopática: reporte de un caso

Idiopathic chronic granulomatous mastitis is a rare disease in women at the reproductive life with clinic, mammographic, echographic and cytological characteristics suggestive of breast cancer. We report a case of breast pathology in a 35 years old woman who had a sensitiveness and eritematous tumor localized in the left breast. With the diagnosis of "mastitis", she was treated with antibiotics and corticoids for two weeks. Because the lesion and the sensitiveness persist and the mammographic and ecographic controls were suggestive of malignancy, the tumor was surgically removing. The histopathological diagnosis was idiopatic chronic granulomatous mastitis.

Pilot study of radiofrequency ablation therapy without surgical excision for T1 breast cancer: evaluation with MRI and vacuum-assisted core needle biopsy and safety management

There is increasing demand for minimally invasive treatments for small breast cancer mainly because of the desire for better cosmetic results. Although radiofrequency ablation (RFA) is an attractive approach as a local control method for small breast cancer, the problems of histological effectiveness and safety management remain. A total of 29 patients including one patient with bilateral breast cancer were enrolled in this study. The mean tumor size of 30 breasts was 12.8 mm (range 5-19 mm). Under general anesthesia, RFA was performed with a Cool-tip RF system (Valleylab, Boulder, CO, USA) after sentinel lymph node biopsy. Postoperative evaluation with magnetic resonance imaging (MRI) and vacuum-assisted core needle biopsy was done 3-4 weeks after RFA before radiotherapy. Ablated tumors were evaluated with hematoxylin-eosin (H&E) and nicotinamide adenine dinucleotide (NADH)-diaphorase staining. If needed, adjuvant chemo and/or endocrine therapy was performed. All patients except one completed one session of RFA. The mean temperature near the center of the tumors was 89.6°C (range 78-100°C). Postoperative MRI showed the ablated zone clearly in all patients. MRI revealed no hypervascularity of the tumors in the ablated zone. Evaluation with H&E staining of the tumors showed remarkable degenerative changes in only three patients. NADH-diaphorase staining showed no viable tumor tissue in 24 patients out of 26 examined. Three patients received small diameter grade 3 skin burns, two on the outside of the thigh from the grounding pad and one on the breast skin. One patient had a breast lesion like a chronic granulomatous mastitis resulting from overreaction of the ablated zone. RFA therapy appeared relevant and applicable for patients with small breast cancer. Because small skin burns were observed as adverse events, close attention should be paid in the course of the RFA procedure.

Fasciolosis (liver fluke) of the breast in a male patient: A case report

Fasciolosis is an uncommon disease in this region, as are parasitic infections of the breast. This report describes a 56-year-old man with a previous history of liver abscess presenting with a painful breast mass. He underwent a mastectomy and is well. The pathological findings revealed chronic granulomatous mastitis with Fasciola spp. ova. The literature on this very rare condition is reviewed.

Chronic granulomatous mastitis: diagnostic and therapeutic considerations.

To review the clinical presentation, histopathological features, and optimal treatment of chronic granulomatous mastitis, the authors conducted a retrospective study of 25 women admitted to a teaching hospital in Malaysia between January 1998 and December 2000 who met the required histologic criteria. The primary outcome measures were morbidity and recurrence of the disease. Thirteen patients presented with a breast mass clinically mimicking breast cancer, and 12 patients had breast induration and abscess formation. In addition, 8 of these patients had recurrent breast disease. Clinical and imaging diagnosis has often been difficult and inconclusive, so histopathology remains the optimal diagnostic tool. Of interest, 50% of patients experience recurrences, and long-term follow-up is therefore necessary. The authors concluded that, because chronic granulomatous mastitis is a rare benign breast condition that may be misdiagnosed as breast carcinoma, complete resection should be accomplished whenever possible. Steroid therapy may be an adjuvant for optimal treatment. Awareness among surgeons and pathologists should also be emphasized to avoid unnecessary misdiagnosis and treatment.