Rare Breast Disease Research Articles

Clinicopathological features, psychological status, and prognosis of 33 patients with occult breast cancer.

Occult breast cancer (OBC) has traditionally been considered to be a carcinoma of unknown primary origin with a favorable prognosis and can be treated as stage II-III breast cancer. Due to the small number of cases and limited clinical ex-perience, treatments vary greatly around the world and no standardized treat-ment has yet been established. To investigate the clinicopathological features, psychological status and prog-nostic features of patients with OBC. The clinicopathological data of 33 OBC patients diagnosed and treated in the Affiliated Hospital of Xuzhou Medical University and Xuzhou Central Hospital from November 2015 to November 2022 were retrospectively analyzed. The psychological status of OBC patients was evaluated by the Self-rating Anxiety Scale and Self-rating Depression Scale. Patients' emotions, stress perception and psychological resilience were evaluated by the Positive and Negative Affect Schedule, the Chinese Perceived Stress Scale, and the Connor-Davidson Resilience Scale (CD-RISC), respectively. Patient survival was calculated using the Kaplan-Meier method, and survival curves were plotted for analysis with the log-rank test. Univariate and multivariate survival analyses were performed using the Cox regression model. The 33 OBC patients included 32 females and 1 male. Of the 33 patients, 30 (91%) had axillary tumors, 3 (9%) had a neck mass as the primary symptom; 18 (54.5%) had estrogen receptor-positive tumors, 17 (51.5%) had progesterone receptor-positive tumors, and 18 (54.5%) had Her-2-positive tumors; 24 (72.7%) received surgical treatment, including 18 patients who underwent modified radical mastectomy, 1 patient who underwent breast-conserving surgery plus axillary lymph node dissection (ALND), and 5 patients who underwent ALND alone; 12 patients received preoperative neoadjuvant therapy. All 30 patients developed anxiety and depression, with low positive affect scores and high negative affect scores, accompanied by a high stress level and poor psychological resilience. There were no differences in the psychological status of patients according to age, body mass index, or menopausal status. The overall survival and disease-free survival (DFS) of all the patients were 83.3% and 55.7%, respectively. Univariate analysis demonstrated that the initial tumor site (P = 0.021) and node stage (P = 0.020) were factors that may affect patient prognosis. The 5-year DFS rate of OBC patients who received radiotherapy was greater (P < 0.001), while the use of different surgical methods (P = 0.687) had no statistically significant effect on patient outcomes. Multivariate analysis revealed that radiotherapy (P = 0.031) was an independent prognostic factor. Receiving radiotherapy had a significant effect on the CD-RISC score (P = 0.02). OBC is a rare breast disease whose diagnosis and treatment are currently controversial. There was no significant difference in the efficacy of other less invasive surgical procedures compared to those of modified radical mastectomy. In addition, radiotherapy can significantly improve patient outcomes. We should pay attention to the psychological state of patients while they receive antitumor therapy.

English

Gigantomastia is a rare breast disease with massive bilateral enlargement of breast causing physical and psychosocial disability for the patient. Diffuse pseudoangiomatous stromal hyperplasia causing gigantomastia is a very rare presentation. We present a case of 45-year-old female with bilateral gigantomastia and cyclical mastalgia, who underwent bilateral mastectomy, postoperatively diagnosed with pseudoangiomatous hyperplasia. Gigantomastia is a rare condition characterised by excessive breast tissue growth resulting in massive enlargement of both breast. An arbitrary definition for gigantomastia is breast size more than 1.5 kg or when the breast tissue comprises 3 % or more of patients total body weight. Gigantomastia is accompanied by skin ulceration, postural problems, back pain, traction nerve injury and social stigmata. It is physically and psychosocially disabling for the patient. The aetiopathogenesis of gigantomastia is poorly understood, but generally classified as idiopathic, drug induced (penicillamine, cyclosporine) and due to hormonal imbalance (gestational and pubertal).1 Pseudoangiomatous stromal hyperplasia (PASH) is a benign mesenchymal proliferative disease of the breast which is usually an incidental finding accompanying other breast pathology like fibroadenoma, fibrocystic disease, breast cancer, gynaecomastia etc. It was first described by Vuitch, Erlandson and rosen (1986). Ibrahim et al. reported the occurrence of incidental microscopic PASH in breast specimens as around 23 %.2 Around 200 cases of PASH presenting as a tumoral palpable mass is there in literature. Another very rare and under recognised presentation is as diffuse PASH with bilateral or unilateral massive breast enlargement. Here we report a case of diffuse PASH with gigantomastia and a review of literature.

Red flags for the differential diagnosis of granulomatous mastitis: a case report

BackgroundGranulomatous mastitis (GM) is a rare benign chronic inflammatory breast disease. GM presents as a heterogeneous illness with variable clinical presentations, and its diagnosis is usually made by exclusion. There are no guidelines for the treatment of GM. This manuscript describes the management of a patient with GM, initially unsuccessfully treated outside our clinic under a diagnosis of mastitis. The patient’s history, physical examination, and needle biopsy flagged the patient’s findings as nonmalignant; however, imaging studies indicated a tumor. Differential diagnosis became a critical element of her care. This case report represents a valuable resource to foster more assertive clinical practice in managing patients with GM. The case coordination and its course were led by a team from an outreach clinic that provides health care services to underserved communities in the state of Michigan.Case presentationA 41-year-old G1P1 Hispanic female immigrant from Central America presented with a rare breast disease, granulomatous mastitis. A similar presentation occurred 5 years before pregnancy when she had an episode of pain and swelling in the left breast, which resolved spontaneously. She sought our services after being diagnosed with mastitis that was unsuccessfully treated. Physical examination revealed a nodular mass in the outer quadrants of the left breast without regional lymphadenopathy. Needle biopsy showed fibrohistiocytic and florid inflammatory reactions, with no evidence of invasive carcinoma. However, this result was inconsistent with the degree of abnormality revealed by the mammogram (BI-RADS grade 5), ultrasound, and physical examination. Full incisional biopsy revealed cystic neutrophilic GM. The surgical procedure, antibiotics, and corticosteroids resulted in a successful combination to secure the stable control of the symptoms and progression of this rare benign breast disease to date.ConclusionsThis patient’s case highlights the importance of integrated communication among front-line primary care and other health care professionals to reduce the risk of invasive procedures and avoid institutional costs. GM is a rare disease. We raised the manifold red flags in which the multiple professional chains recruited to care for this patient were concerning for advanced breast cancer. The lack of experience and evidence-based medicine contributed to the contradictory interpretation of the findings on GM's diagnosis.

Prognostic Molecular and Biological Characteristics of Phyllodes Tumors of the Breast.

Prognosis for some histological variants of a rare breast disease, phyllodes tumors, is evaluated. The prognostic potential of some molecular biological factors significantly correlating with breast cancer prognosis is evaluated on a unique clinical material (244 cases with benign, intermediate, and malignant phyllodes tumors). The development of benign phyllodes tumor relapse directly correlated with the number of G0/1-phase cells and inversely correlated with the number of cells in the G2+M and S phases. The level of steroid hormone receptors in phyllodes tumors cannot serve as a prognostic marker predicting the disease course. The presence of somatic mutations of TP53 gene and loss of heterozygosity of specific intragenic loci in the tumor correlate with the development of disease relapse (p<0.05).

Mastitis granulomatosa: experiencia de 5 años

IntroductionGranulomatous mastitis is a rare breast disease. There is no consensus on the optimal treatment. The aim of this study was to analyse the characteristics of this disease and its management in our centre and to compare the findings with those reported in the literature. Material and methodsWe conducted a descriptive retrospective study of patients with a diagnosis of granulomatous mastitis in our centre between 2013 and 2018. ResultsNone of the 4women with a histological diagnosis of granulomatous mastitis had a recent history of pregnancy, lactation, or contraceptive treatment. One patient was a smoker and another had a history of trauma. The most common symptom was a unilateral palpable mass. Mammography/tomosynthesis and ultrasonography were performed in all patients and the definitive diagnosis was based on histological analysis after core needle biopsy. Two patients received no treatment (only observation) and the other 2received medical treatment. There was only one complication (breast abscess). ConclusionsTo establish a definitive diagnosis of granulomatous mastitis and to rule out breast cancer, histological study is necessary due to the low specificity of other tests.

Successful Treatment of Granulomatous Mastitis Associated With Corynebacterium kroppenstedtii With Prolonged Antimicrobial Therapy

Abstract Granulomatous mastitis is a rare breast disease that classically occurs in parous women of reproductive age. In recent years, an association has been reported between this condition and Corynebacterium species, which are gram-positive bacilli that are endogenous to the skin. We describe a case of granulomatous mastitis associated with Corynebacterium kroppenstedtii, a lipophilic organism with an affinity for the lipid-rich mammary glands. We highlight the need to consider this pathogen to guide investigation and describe the diagnostic challenges related to isolation and identification of the organism. In addition, we report on successful treatment of the patient with a prolonged course of a combination of clarithromycin and rifampin.

264. Core Needle Biopsy (CNB) to Differentiate Plasma Cell Mastitis From Breast Cancer

Background: Plasma cell mastitis is a rare breast disease which has been described under different terms such as comedomastitis, mastitis obliterans, pseudotubercolosis, periductal mastitis and recently mammary duct ectasia. ItÕs not uncommon to be misdiagnosed as cancers like comedocarcinoma in pathologic examination. Plasma cell mastitis usually presents with pain, tenderness, nipple discharge and usually an indurated peri-areolar breast lump when the acute phase subsides. ItÕs very common for this condition to be confused with malignant lesions specially when the overlying skin is involved, inflammatory changes are dominant, nipple retraction is present or large and multiple axillary lymph nodes exist.

Erythema nodosum associated with granulomatous mastitis: report of two cases

Granulomatous mastitis is a rare breast disease characterized by chronic inflammation. Clinical presentation of granulomatous mastitis usually mimics malignancy or infection. Coincidence of granulomatous mastitis and erythema nodosum is a quite rare feature. In this paper, we aimed to present two young women with granulomatous mastitis accompanied by erythema nodosum and successfully treated with corticosteroids. Granulomatous mastitis should be kept in the mind for differential diagnosis of erythema nodosum.

Primary non-Hodgkin’s lymphoma of the breast treated nonsurgically: report of three cases

Extranodal non-Hodgkin's lymphoma (NHL) is a rare breast disease. Here we report three cases of primary NHL of the breast. The first patient was a 29-year-old woman with a firm mass in her right breast with ipsilateral axillary lymphadenopathy. An excisional biopsy revealed NHLs. Clinical stage was IIAE. The tumor and enlarged lymph nodes had successfully been treated following the combination therapy. The second patient was a 70-year-old women with an elastic hard mass in her left breast. An excisional biopsy revealed NHLs and clinical stage was 1AE. The tumor disappeared following the combination therapy. The third patient was a 67-year-old women with a hard mass in her left breast. Core needle biopsy revealed NHLs and clinical stage was 1AE. The tumor disappeared following chemotherapy. All patients are alive with no evidence of recurrence 4-8 years after the initial treatment. Although a standard treatment has yet to be established, an initial treatment with combination therapy without surgical intervention including axillary dissection appears to be appropriate for this rare disease.

Solitary amyloid tumor of the breast

Primary breast amyloidosis is uncommon and the solitary amyloid tumor of the breast is rarely mentioned in literature. We report the clinical history of a woman presenting with mammograms an area of clustered microcalcifications, with irregular and pleomorphic morphology, mimicking the onset of a cancer. The core biopsy specimens resulting in breast amyloidosis were in disagreement with the radiological Breast Imaging Reporting and Data System (BI-RADS) risk, category 4. Moreover, specimens from abdominal subcutaneous fat and bone marrow biopsies showed no evidence of deposition of amyloid material, allowing exclusion of a systemic disease. Because it is reported the frequent association between breast amyloidosis and malignant lesions, a surgical excision of the microcalcifications was performed. Final histology confirmed the benign nature of the lesion consisting in a solitary amyloid tumor of the breast. This case stresses the importance of multidisciplinary collaboration between Radiologists, Surgeons and Pathologists to achieve a correct diagnosis and treatment of this rare breast disease.

Granulomatous mastitis: surgical outcomes.

To report the clinical and pathological features and surgical treatment outcomes of patients with granulomatous mastitis. Case series. Ankara Oncology Training and Research Hospital, between 1999-2003. Data of 16 patients with granulomatous mastitis treated surgically by total excision with disease-free margins were reviewed. Patients given additional medical therapy or treated with mastectomy because of the size and extent of the disease were excluded. The mean age of patients at the time of diagnosis was 31.8 (range: 22-45 years). All patients were diagnosed from the pathological tissue specimens obtained by surgery. Clinical and radiological examinations suggested breast carcinoma in 82.1% patients. Except one patient who developed a fistula from the incision which was treated again with surgery, no other complications were noted, including recurrence of disease during a median follow-up period of 12.8 months (range: 4-30 months). Although granulomatous mastitis is a rare benign breast disease, it usually mimics breast carcinoma both clinically and radiologically, making the diagnosis difficult and challenging. As long as good cosmetic results can be achieved, surgical excision is quick, safe and effective treatment method for idiopathic granulomatous mastitis.

Feasibility of Surgical Management in Patients with Granulomatous Mastitis

Granulomatous mastitis (GM) is a rare inflammatory breast disease of unknown etiology. Although it usually presents with sinus formation and abscesses, it may mimic the clinical characteristics of breast cancer. The aim of this study was to identify the clinical, radiologic, and pathologic characteristics of patients with GM and to show the results of surgical treatment in these patients. A chart review was performed for patients that were treated with a diagnosis of GM at the Breast Unit, Department of Surgery, Istanbul Medical Faculty, University of Istanbul, between September 1998 and January 2003. Eighteen patients were eligible for this study. The median age was 41.5 years (range 16-80 years). Seventeen patients were evaluated by both ultrasonography and mammography; whereas one young patient only had ultrasonography. Three patients were further examined with color Doppler ultrasonography and magnetic resonance imaging (MRI). Fourteen patients (78%) presented with a mass as the chief symptom, with a median size of 3.9 cm (range 1-8 cm), whereas four patients presented with fistula in their breasts. None of the radiologic techniques distinguished benign disease from cancer in any of the 14 patients that presented with a mass except one patient with normal mammography findings. Ultrasonography was only helpful to localize the abscess associated with a fistula tract in one patient. Therefore fine-needle aspiration biopsy (FNAB) was performed in six patients, followed by surgical excisional biopsy. The remaining eight patients with a clinical suspicion of malignancy underwent wide surgical excision with frozen section analysis under general anesthesia. All of the FNAB and frozen section evaluations revealed benign findings. All of the 18 patients underwent a wide excisional biopsy and had a definitive histopathologic diagnosis of GM. The median follow-up was 36 months (range 6-60 months). Only one patient had a recurrent disease, which was diagnosed at 12 months. GM is a rare breast disease that mimics cancer in terms of clinical findings. Preoperative radiologic diagnosis might be difficult. Complete surgical excision is the treatment of choice.