Mimic Breast Cancer Research Articles

Idiopathic granulomatous mastitis

: Idiopathic granulomatous mastitis (IGM) is a rare, benign breast condition characterized by multiple draining sterile breast abscesses. This condition of unknown etiology commonly presents in young, parous women with a recent history of lactation and of Mediterranean or Hispanic descent. IGM commonly presents unilaterally with localization in the upper outer quadrant but can present in any quadrant or both breasts concurrently. This disease can mimic breast cancer on various imaging modalities causing concern as well as presenting with erythema, breast edema, breast pain, and sinus tract formation. IGM is diagnosed through the exclusion of all other common pathogens and diseases as well as distinct histological findings of non-caseating granulomas and multinucleated giant cells upon core needle biopsy. IGM is a self-limiting disease and can self-resolve on an average of 5 months, but treatment modalities are recommended to help manage the symptoms. Treatment methods range from observation, steroids, methotrexate and surgical excision with relapse commonly occurring. Currently, no consensus within the literature exists on the best treatment strategy. Each treatment method has various advantages and disadvantages, therefore this review aims to provide focused, up-to-date guidance on of IGM. This review specifically highlights each treatment method, showcases studies on different treatment modalities in a comprehensive table, and provides a precise algorithm for clinicians on the workup and treatment of IGM.

A diffusion equation based algorithm for determination of the optimal number of fibers used for breast cancer treatment planning in photodynamic therapy

It is essential in interstitial Photodynamic therapy (iPDT) treatment planning to ensure a homogeneous distribution within a tumor volume using cylindrical diffusing fibers while keeping the surrounding tissue intact. Light distribution is simulated through two algorithms based on the diffusion equation assuming diffusers as light sources. The first algorithm analyzes the diffusion equation and studies the effects of different variables (optical properties, delivered power, diffuser length, and position). Next, optical properties of breast were applied to estimate the volume that receives accepted light dose from one diffuser. In the second algorithm, multiple diffusers were simulated in order to find the relation between the volume and the number of required diffusers which are needed to cover cubical or cylindrical volume with sufficient light dose. Throughout this study, real values of optical properties, clinical laser power, and treatment time were considered to evaluate sufficient light doses. This study is in agreement with previous works in that optical properties are the major factors influencing light distribution in iPDT. It is shown that for a homogeneous phantom mimicking breast cancer and cubical or cylindrical shape, the number of required fibers N equal W×L or D 2 respectively.

New Findings on Autoimmune Etiology of Idiopathic Granulomatous Mastitis: Serum IL-17, IL-22 and IL-23 Levels of Patients

Background Idiopathic Granulomatous Mastitis (IGM) is a benign chronic inflammatory breast disease that mimics breast cancer, and the etiopathogenesis has not yet been fully evaluated. Autoimmunity has received the most focus as a possible etiology. Our aim in this prospective clinical study was to investigate the possible association between the cytokines, interleukin IL-17, IL-22, IL-23 and IGM. Materials and Methods The current study was conducted in 26 women with histopathologically diagnosed IGM, and 15 control women of reproductive age having no breast disease history. Blood samples were collected, and serum concentrations of IL-17, IL-22, and IL-23 were determined. Results In the analysis of variables, the patients with IGM and the control group had statistically significant differences between serum IL-22 titers (p = 0.0378) and IL-23 titers (p = 0.0469. No statistically significant difference was found between IGM patients and the control group in serum IL-17 titers (p = 0.9724). Conclusion The results of the current study, especially pertaining to serum IL-22 and IL-23 levels, support the etiopathogenesis of IGM in favor of the autoinflammatory thesis. Nevertheless, this thesis should be supported by a large case number and prospective clinical studies.

Lymphocytic mastitis mimicking breast cancer in an elderly woman.

Lymphocytic mastitis mimicking breast cancer in an elderly woman.

Therapeutic and Diagnostic Challenge of Idiopathic Granulomatous Mastitis: A Case Report and Review of the Literature

Idiopathic Granulomatous mastitis (IGM) is a chronic benign inflammatory disease of the breast that may mimic breast cancer. It is most common in parous young fertile women, although it can occur in nulliparous. It affects mostly women of childbearing age with a history of breastfeeding. IGM is an idiopathic disease due to the influence of some environmental factors in genetically predisposed subjects. Several pathogenic hypothesis have been proposed in the last years (autoimmune, hormonal, infective genesis). Because the clinical presentation can mimic infectious mastitis or inflammatory carcinoma, the disease course is often protracted. The diagnosis is made by histopathology. Ultrasound, mammography, and magnetic resonance imaging are not specific; however, ultrasound and mammography should be done to exclude other pathologies. There is no universal treatment of GM. We report in this manuscript one case of IGM through which we mention a therapeutic and diagnostic challenge with a brief review of the literature. The management was successful despite the long way made by the patient before she acceded to a proper treatment.

Breast Inflammation Mimicking Breast Cancer on Multimodality Breast Imaging.

Breast Inflammation Mimicking Breast Cancer on Multimodality Breast Imaging.

C-MYC over-expression diffuse large B-cell lymphoma mimicking breast cancer metastases in young female

C-MYC over-expression diffuse large B-cell lymphoma mimicking breast cancer metastases in young female

Idiopathic granulomatous mastitis: a diagnostic challenge

Introduction: Idiopathic granulomatous mastitis is an uncommon and benign inflammatory breast disease that usually occurs in young women of childbearing age. Most common presentation is a slowly growing breast mass that is hard in consistency and can greatly mimic breast cancer. Mammographic and ultra-sonographic findings are non- specific and usually mimic malignant masses leading to higher BIRADS grading in reports. The only way to reach a definitive diagnosis is by histopathological diagnosis. Material & Methods: In the present study eight patients were presented to The Integrated Breast Care Centre (IBCC) department of AIIMS Rishikesh with breast lump or nipple discharge during January 2019 to June 2019. All the patients underwent mammography and ultrasonography followed by FNAC or Biopsy of the lesion as findings were mimicking malignant etiology. Results: On HPE all the patients showed features of granulomatous inflammation and diagnosis of idiopathic granulomatous mastitis was made. TB was excluded by CBNATT (Cartridge Based Nucleic Acid Amplification Test) examination of the aspiration cytology samples. To our knowledge, such a report is the first of its kind to address this topic in this region. Conclusion: In a young child-bearing age group female presenting with breast mass a differential of idiopathic granulomatous mastitis should also be considered. The clinicians as well as radiologists should be aware of this entity so that appropriate management may be done.

Clinicopathological study of granulomatous mastitis in Zagazig university hospitals

AbstractBackground: Granulomatous mastitis is a rare breast disorder first described by Kessler and wolloch in 1972, it mimics breast cancer and other inflammatory breast conditions for a great extent, and so careful clinical and radiological examination is required. Granulomatous mastitis is a pathological diagnosis needs expert pathologist. Treatment was exclusively surgical, now corticosteroids and other immunosuppressive drugs used as well prior to surgery.Methods: This prospective follow-up study was conducted on 36 patients from november2017 to Jun 2019, on patients diagnosed with granulomatous mastitis in Zagazig university hospitals, full clinical assessment and follow up for different treatment modalities in 6 months period (6 months cure rate).Results: Most of our patients were in child bearing period, presented mostly with breast mass accompanied by axillary lymphadenopathy. U/s features were mostly irregular hypoechoic mass and axillary lymphadenopathy. BIRADS classification were mostly 3 and 4. Most of the patients received medical treatment which showed better results than surgical treatment. Conclusion: Granulomatous mastitis may present by many ways confusing the physician, it needs high rate of suspicion and careful assessment as it mimics many other benign and malignant breast conditions, medical treatment has better results than surgical once as regard cure rate, recurrence and cosmetic outcomes. Key Words: Granulomatous mastitis, BIRADS score, breast mass, breast cancer.

Re-evaluating if observation continues to be the best management of idiopathic granulomatous mastitis

BackgroundThe presentation of idiopathic granulomatous mastitis can mimic breast cancer. Therefore, awareness of the condition is important for surgeons. The current series is the largest in a US population. MethodsRetrospective chart review of patients treated at a county, safety-net hospital in Arizona. Cases were identified from January 2006 to January 2019. Sociodemographic information, clinical history, management, and outcomes were collected. ResultsThere were 145 occurrences of idiopathic granulomatous mastitis among 120 women. Most of the patients (92%) were of Hispanic ethnicity and born outside (87%) of the United States. The average age was 35 years. Nearly all patients (95%) were parous, with an average of 3 pregnancies. Most (88%) presented with a palpable mass, and more than half (54%) of these masses were painful. Six patients had prolactinomas or hyperprolactinemia, 11 patients were pregnant, and 5 were postpartum. Early in the time period studied, 6 patients underwent excision of the masses. The remaining 114 underwent planned observation after biopsy confirmation of the diagnosis. Two patients were lost to follow-up, and the other 112 patients with idiopathic granulomatous mastitis resolved spontaneously. Nineteen had more than 1 episode. Average time to resolution was 5 months (range 0–20). Adjusted log-normal regression analysis found that later age of first live birth was associated with greater time to resolution (P < .01). ConclusionIdiopathic granulomatous mastitis is a self-limited, benign condition that waxes and wanes and eventually resolves without resection. After diagnosis, medications are unnecessary, and operations can be limited to drainage procedures for fluid collections.

Breast Tuberculosis in Women: A Systematic Review.

Breast tuberculosis (TB) is rarely reported and poorly described. This review aims to update the existing literature on risk factors, clinical presentations, constitutional symptoms, diagnostic procedures, and medical and surgical treatments for breast TB. In all, 1,478 cases of breast TB were collected. Previous history of TB was reported in 19% of cases. The most common clinical appearance of the lesion was breast lump (75%). The most common associated finding was axillary lymphadenitis (33%) followed by sinus or fistula (24%). The most common symptoms were pain and fever, reported in 42% and 28% of cases, respectively. The most used diagnostic method was fine-needle aspiration cytology (32%), followed by biopsy (27%), acid-fast bacteria Ziehl-Neelsen stain (26%), culture (13%), and polymerase chain reaction (2%). These tested positive in 64%, 93%, 27%, 26%, and 58% of cases, respectively. The majority (69%) of patients received a 6-month anti-TB treatment (isoniazid, rifampicin, pyrazinamide, and ethambutol). Surgery consisted of excision in 39% of cases, drainage in 23%, and mastectomy in 5%. The great majority of patients had a positive outcome. It often mimics breast cancer, which makes it difficult to diagnose. Most patients, when diagnosed in time, respond to antitubercular therapy alone.

Abstract 4593: Inhibition of invasion of HER2-positive breast cancer cells by lysosome targeting drugs

Abstract Up to 20% of all breast cancers are over-expressing HER2/ErbB2, leading to malignant and invasive cancers with a poor patient outcome. Though good ErbB2-targeting treatments have been developed, metastasis formation and drug resistance are still major challenges for the long-term cure. This project aims to find out if some of the numerous pre-existing compounds and clinically approved drugs can be repurposed to treat or improve the treatment of HER2/ErbB2-positive breast cancer. We have therefore set up a high-throughput and high-content screen of the Prestwick Chemical Library to identify drugs that can reverse the ErbB2-induced, invasion-promoting, peripheral distribution of lysosomes. Using a breast cancer cell model expressing N-terminally truncated version of ErbB2, we mimic breast cancer that is resistant to the currently used antibodies, trastuzumab and pertuzumab. This cell line shows a highly invasive phenotype with increased activation of the lysosomal proteases, cysteine cathepsin B and L, as well as anterograde movement of lysosomes. This repositioning of the lysosomes enables them to fuse with the plasma membrane and empty their acidic and hydrolyzing content to the extracellular matrix, promoting invasion. Treatment with the clinically used drug lapatinib will reverse this phenotype. The cells ability to reverse the phenotype, through increasing the number of perinuclear lysosomes while removing lysosomes form cellular protrusions, was evaluated for each screened drug, using the ImageXpress Micro Confocal High-Content Imaging System. We have hereby identified eight drugs that can redirect lysosomes from the invadosome-like cellular protrusions to their non-invasive perinuclear position in ErbB2 expressing breast cancer cells. We are currently analyzing the impact of these drugs on breast cancer cell invasion though migration assays and three-dimensional invasion assays. We are also addressing their effect on lysosomal membrane permeabilization, lysosomal pH and investigating their effect on proteins that are known to be involved in lysosomal distribution. Clinically, our findings may facilitate repurposing or new development of drugs to treat HER2/ErbB2-positive and invasive breast cancers that are resistant to current treatments. Citation Format: Malene B. Hansen, Maria Postol, Davig A. Egan, Marja Jäättelä, Tuula Kallunki. Inhibition of invasion of HER2-positive breast cancer cells by lysosome targeting drugs [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4593.

Abstract P3-14-10: Intralesional steroid injection: A novel method to treat the symptoms of idiopathic granulomatous mastitis

Abstract Background: Idiopathic granulomatous mastitis (IGM) is a chronic, inflammatory breast condition of benign nature that can clinically mimic breast cancer. Patients frequently present with a large, painful breast mass with associated inflammatory changes of the skin, and possible ulceration or fistula of the breast. Attempted methods for symptomatic relief include surgical excision and medical therapies including oral corticosteroids. Due to the success of treating dermatologic conditions with intralesional steroid injections, it was hypothesized that injecting the subdermal lesions of IGM may benefit patients with this disease. The use of intralesional steroid injections for the treatment of IGM has not been previously described in the literature. Methods: Retrospective chart review was performed on a series of four patients with IGM who received intralesional steroid injections between August 2017 and April 2018. Patients were selected for treatment with injections based on their subjective report of painful breast lesions, lesion characteristics including size and depth, and the patient's desire to stop oral steroid therapy due to side effects despite active or residual disease. Data were collected on demographics, initial physical examination findings, prior and current treatments, characteristics of disease, details of injections performed, objective and subjective response to treatment, and recurrence. Results: All patients presented with breast pain and either a mass, swelling, or hardness of the breast. Each patient received between one and three injection treatments, with one to four lesions treated in each session. Patients demonstrated improvement in subjective and objective symptoms after 87.5% of injection sessions (7 out of 8) by the subsequent follow-up visit (21-34 days). During the study period, three patients experienced resolution of at least one breast lesion within about 2 months (31-139 days, mean 68 days) without recurrence. One patient had four breast lesions that completely resolved (35-217 days, mean 88 days), but three of them recurred (63-217 days, mean 149 days). Conclusion: In a small group of patients with idiopathic granulomatous mastitis, intralesional steroid injections were associated with an improvement in both subjective symptomatic relief and objective breast lesion characteristics in most cases. This treatment was associated with a good rate of lesion resolution and a low short-term recurrence rate. Citation Format: Manst DJ, Ganschow PS, Marcus EA, Holden C, Datta S. Intralesional steroid injection: A novel method to treat the symptoms of idiopathic granulomatous mastitis [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-14-10.

Pathogens in patients with granulomatous lobular mastitis

ObjectiveGranulomatous lobular mastitis (GLM) is a rare inflammatory disease of the breast that clinically mimics breast cancer. However, its etiology is not completely defined. The purpose of this study was to systematically study the bacteriology of GLM using advanced detection technology. MethodsParaffin-embedded tissue from patients with GLM was collected. DNA was extracted from the samples and analyzed using next-generation sequencing (NGS) technology, and the data were processed using bioinformatics analyses. ResultsA total of 40 patients were recruited into the study. A bioinformatics analysis revealed that a total of 17 genera or 19 species of pathogens were present in 39 of the GLM patients (97.5%). These included bacteria, fungi, and Mycobacterium tuberculosis complex group. Bacteria were found in 39 of the patient cases, while fungi were present in five. Only one case tested positive for M. tuberculosis complex. In addition, a single genus of pathogen was found in nine patients (23.1%), whereas 30 patients (76.9%) tested positive for multiple pathogens. ConclusionsThis study profiled the microbiota of patients with GLM using NGS technology, which provides more useful information for establishing patient treatment plans.

Diagnostic techniques and multidisciplinary approach in idiopathic granulomatous mastitis: a revision of the literature.

Idiopathic granulomatous mastitis (IGM) is a chronic benign inflammatory disease of the breast that may mimic breast cancer. It is most common in parous young fertile women, although it can occur in nulliparous women and in men. IGM is an idiopathic disease due to the influence of some environmental factors in genetically predisposed subjects. Several pathogenic hypothesis have been proposed in the last years (autoimmune, hormonal, infective genesis). IGM presents as a painful palpable mass located in one of the two udders. The skin is usually normal but could present signs of inflammation with or without lymph nodes involvement. Ultrasonography, mammography, magnetic resonance can be diagnosed an IGM, but pathognomonic radiological signs has not yet reported in literature. Biopsy findings show granulomatous lesion centered on the breast lobule, as in granulomatous mastitis induced by tuberculosis or sarcoidosis. The aim of this review of literature is to verify the development of new advanced diagnostic techniques and multidisciplinary approach for this condition. In the last years innovative approaches have modified IGM diagnosis and therapy, avoiding surgery in most of cases, introducing a more conservative medical approach based on recent etiopathological hypothesis. (www.actabiomedica.it)

A case of complicated cyst mimicking breast cancer

A case of complicated cyst mimicking breast cancer

Charcoal granuloma mimicking breast cancer: an emerging diagnosis.

BackgroundImage-guided charcoal injection in suspicious breast lesions for preoperative localization is a procedure that has been increasing over the years because it is safer, faster, and more affordable when compared to needle-wire preoperative localization. To date, no complications have been associated with the method. However, in recent years there have been some reports about charcoal granulomas mimicking malignant lesions in some postoperative patients or in a conservative follow-up.PurposeTo report a series of 11 cases which had suspicious imaging findings for malignancy and resulted in charcoal granulomas on histopathological analysis.Material and MethodsA database of 1650 patients that attended our center from January 2007 to June 2018 was reviewed and detected 495 patients who had been previously submitted to ultrasound-guided charcoal marking in a breast lesion. Then, patients whose imaging studies were compatible with new suspicious lesions on mammography, breast ultrasound, and/or magnetic resonance imaging and biopsy of this new lesion indicating charcoal granuloma were selected.ResultsFrom 495 patients who had undergone charcoal localization injections in previous biopsies, we selected 11 who had new lesions with malignant characteristics on imaging studies but histopathological analysis resulted in charcoal granuloma.ConclusionCharcoal granuloma should be considered in patients with previous preoperative injection localization, since the residual charcoal in the breast tissue may form granulomas and mimic malignant lesions on follow-up imaging studies.

Clinical, mammographic, and ultrasonographic characteristics of diabetic mastopathy: A case series

PurposeDiabetic mastopathy (DMP) is a rare benign breast lesion that mimics breast cancer on ultrasound. Our aims were to identify patient characteristics and imaging features of the disease. MethodsWe conducted retrospective searches of our database for DMP lesions that were pathologically confirmed between January 2004 and November 2015. Mammographic and ultrasound features were reviewed by two experienced radiologists. ResultsTwelve women were identified with 16 lesions. Most patients (83%) had type 2 diabetes mellitus (DM) and over half were insulin-dependent (58.3%), with a mean time of 16.9 years between the diagnosis of DM and that of DMP. There were negative findings on mammography for 46.7% of the lesions, including larger-sized lesions. Ultrasound revealed various features, including irregular shape (81.3%), indistinct margins (100%), parallel orientation to the chest wall (93.8%), marked hypoechogenicity (87.5%), and posterior shadowing (62.5%). ConclusionsDMP was more common in patients with longstanding DM; in particular, type 2 DM and insulin-dependent patients. DMP lesions were usually occult on mammography, despite the relatively large size of DMP, which may help distinguish DMP from invasive cancer. Ultrasound detected several features that are also present in invasive cancer, making tissue sampling necessary to distinguish these.

Comparison of breast cancer metastasis models reveals a possible mechanism of tumor aggressiveness

In breast cancer patients, the lungs are among the first sites of cancer metastasis, and in nearly one quarter of metastatic patients, the exclusive first event. Two common mouse models mimic breast cancer lung colonization and distal metastasis: an orthotopic model and intravenous (IV) cell injections. Gene expression analysis of pulmonary lesions from these two methods demonstrated high inter-model resemblance. However, microRNA (miRNA) expression profiles were not compared. In this study, we compared the overall miRNA expression profiles (miRNome) of the orthotopic and IV breast cancer metastasis models and identified significant miRNome changes between the two models. Overexpression of the most significant candidate, miR-96 or downregulation of its validated gene-target, ABCE1 reduced cancer cells 2D/3D cell movement and proliferation in vitro, and abated tumor growth and metastasis formation in vivo. Human data analysis further strengthened miR-96/ABCE1 role in breast cancer tumor aggression. Taken together, our results indicate that IV- and orthotopic models differ by their miRNome. Specifically in our study, breast cancer aggressiveness was dictated by miR-96 regulating ABCE1. Overall, miRNome analysis of various metastatic cancer models may lead to the identification of candidate genes critical to metastasis development.

Abstract 2136: Transcriptome analysis of osteoblasts fused with cancer-derived exosomes

Abstract Breast cancer tumors have a high rate of metastasis and certain aggressive subtypes favor the bone environment. Clinically, it is estimated that metastatic breast cancer has a prevalence of up to 70% of bone tumors. Exosomes are important in cell-cell communication, and are increasingly being recognized as key contributors for priming targeted tissues for metastasis. Despite numerous advances in exosome detection and cargo characterization, transcriptional effects of cancer exosomes on targeted cells remain difficult to characterize at physiologically relevant levels. This is largely due to a combination of limited exosome secretion/uptake and an inability to segregate affected cells from the population. Conventional approaches to circumvent these limitations include spiking cell environments with exosome quantities far in excess of physiological concentrations. We sought to analyze the transcriptional effect of cancer exosomes on cells that have uptaken cancer-derived exosomes in a dynamic co-culture environment. In order to accomplish this, we first engineered a human breast cancer cell line (MDA-MB-231) to express GFP labeled exosomes. This novel cell line expresses three GFP fusion proteins for tetraspanin exosome markers (CD9, CD63, and CD81) known to be found on exosomes derived from MDA-MB-231 cells. Stable, intrinsic, fluorescent labeling of three exosome markers allows for an improved, more sensitive method for the analysis of exosome transfer. We can now examine transfer representing a more diverse pool of exosomes requiring no manipulation post exosome isolation prior to visualization. To investigate breast cancer exosome-mediated alterations on gene expression in bone cells to mimic breast cancer bone metastasis, this GFP exosome expressing line (MDA-MB-231 exo-GFP) was co-cultured with a mouse osteoblast cell line (MC3T3) then analyzed via flow cytometry to quantify the uptake of cancer exosomes in target cell population over time. MC3T3 cells that become GFP positive, indicative of exosome mediated transfer, increased from 0.91% of the population on day 3 post co-culture to 17.3% on day 14. Subsequent cell sorting and RNA-seq of GFP positive MC3T3 populations yielded novel insights into the progressive transcriptional effect of cancer exosomes on target cells. Future research will expand upon this approach to examine the effects on bone cells non-metastatic and metastatic cancer cell lines have on the metastatic niche through exosome-mediated signaling. This approach introduces a novel method for prolonged transcriptional analysis of cancer and target cell co-culture allowing the segregation of exosome affected and unaffected subpopulations of target cells. This study was funded by DOD grant BC151687. This work was conducted under the auspices of the USDOE by LLNL (DE-AC52-07NA27344). Citation Format: Nicholas H. Hum, Kelly A. Martin, Gabriela G. Loots. Transcriptome analysis of osteoblasts fused with cancer-derived exosomes [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 2136.