Suppurative Mastitis Research Articles

The histologic diagnosis and the management of cystic neutrophilic granulomatous mastitis: a case report

BackgroundCystic neutrophilic granulomatous mastitis is a rare subtype of inflammatory mastitis characterized by a distinct histopathologic pattern, often associated with Corynebacterium species. This entity has been recently distinguished and should be differentiated from other types of chronic idiopathic mastitis due to its specific treatment.Case presentationA 44-year-old North African female patient, gravida 2, para 2, with no significant past medical history, presented with a 4-month history of a painful palpable mass in her left breast, with no history of trauma. Ultrasound imaging showed three lesions in the lower quadrant of the left breast, communicating with a superficial areolar abscess collection, creating a fistulous path to the skin. This ultrasound appearance was suspicious for suppurative mastitis; although, a necrotic tumor could not be ruled out. An ultrasound-guided needle biopsy revealed inflammatory and abscess features of the breast parenchyma without histological signs of malignancy. Steroid therapy and empirical antimicrobial treatment were started, and surgical excision was performed. Histologic features confirmed the diagnosis of cystic neutrophilic granulomatous mastitis. The patient recovered and was discharged due to clinical improvement.ConclusionCystic neutrophilic granulomatous mastitis is a recently defined entity, and its association with infection by Corynebacterium species can be detected by Gram stain and/or microbiological culture. Various treatment modalities are suggested, but the optimal treatment still requires further investigation.

Cytological Evaluation of Palpable Non-Neoplastic Breast Lesions among Women attended from Rural Community of Bangladesh: A Retrospective Cross-Sectional Study

Background: Non-neoplastic palpable breast disease is one of the most common disorders from which women suffer throughout the world. The use of fine-needle aspiration cytology (FNAC) method has proven to be quick, simple and cost-effective with minimum risk of complications in the evaluation of breast lumps. Objective: This study was planned to find out the common causes of various types of non-neoplastic breast lesions of female at different ages through fine needle aspiration cytology. Methodology: The retrospective cross-sectional study was carried out in the Department of Pathology at Monno Medical College& Hospital, Manikganj, Bangladesh. It lasted 2 years 6 months from July 1, 2019 to December 31, 2021. This study examined all breast lumps found in female patients. For data analysis, the patient's age and FNAC report were recorded. Aspirates were done using 5ml/10ml syringe and 23-gauge needle. Smears were stained with Papanicolaou stain. Results: The study included total 349 female patients with breast lesion. Among these, non-neoplastic lesions were 183(52.44%) cases and neoplastic lesions were 166(47.56%) cases. Among the lesions, 105(30.08%) cases were in fibrocystic changes; 28(8.02%) cases were in non-suppurative mastitis; 24(6.87%) cases were in suppurative mastitis (abscess), 14(4.01%) cases were in granulomatous mastitis. About 45(42.88%) cases of Fibrocystic changes, 13(44.84%) cases of non-suppurative mastitis and 9(37.5%) cases of Suppurative mastitis (abscess) were in the age group 21 to 30 years, 21 to 30 years and 41 to 50 years respectively. Conclusion: Fibrocystic changes are the commonest lesion in this study. Journal of Monno Medical College June, 2024; 10 (1):07-12

Case Series of Primary Breast Tuberculosis Presenting as a Lump: A Diagnostic Challenge

Tuberculosis of the breast is rare, even in countries where the disease is endemic. Breast tuberculosis usually occurs secondary to infection elsewhere. Less commonly, it may be the primary site with no demonstrable focus elsewhere. It is mainly encountered in immunosuppressed individuals, those with a history of trauma and suppurative mastitis. It commonly presents as a lump in the breast, but other presentations such as breast abscess, dull aching pain, nipple discharge, etc., have been reported. Multiparous and lactating women in their second to fourth decade are commonly affected. Studies have shown that microbiological diagnosis is limited to a few cases, and histopathology is the mainstay in diagnosing cases of breast tuberculosis. In the present case series, two cases (44-year-old and 40-year-old females) presented with a painless, ill-defined lump in the left breast. Another case (33- year-old female) presented with a lump in the left breast with dull aching pain. Constitutional symptoms were absent in all of the present case series patients. Microbiological positivity in the form of Cartridge-based Nucleic Acid Amplification Test (CBNAAT) positivity was seen in only one of the patients. Biopsy of all these cases showed non caseating granuloma. All the patients had primary breast tuberculosis with no other organ involvement. All the patients were started on standard antitubercular therapy with a fixed drug combination, following an initial delay due to the non caseating nature of the granuloma. All of them responded well to the therapy. The present case series compared the characteristics and delved deeply into the current data and research on breast tuberculosis to understand the same.

Anaplastic large cell lymphoma of breast masquerading suppurative mastitis on cytology

Breast is an uncommon site of extra nodal lymphoma accounting for 2.2% of all extra nodal lymphomas. B cell lymphomas are more common than T cell types. The most common subtype is Diffuse Large B Cell Lymphoma. Breast lymphoma is very challenging to diagnose as it has nonspecific clinical and radiological features. We report a rare case of primary T cell lymphoma in a 20-year-old female. It was misdiagnosed as abscess on ultrasound and as suppurative mastitis on fine needle aspiration cytology (FNAC). However, excisional biopsy was suggestive of lymphoma and immunohistochemistry confirmed it as ALK positive, anaplastic large cell lymphoma. Even though FNAC is a part of the diagnostic triad for breast lesions, potential pitfalls cannot be overlooked and must be correlated with biopsy.

Negative pressure wound therapy promotes healing and reduced pain in patients with acute suppurative mastitis

BackgroundThe purpose of this study was to compare the outcomes of vacuum sealing drainage (VSD) and conventional incision and drainage (I&D) for treating acute suppurative mastitis.MethodsHospital medical records were searched for patients 20–50 years of age who were diagnosed with acute suppurative mastitis from January 2014 to December 2018, and treated with traditional I&D or VSD. Patients were divided into those treated with VSD and I&D, and outcomes including pain, healing time, length of hospital stay, and length of antibiotic course were compared between the groups. Pain was evaluated with a numeric rating scale from 0 (no pain) to 10 (most severe pain). Subgroup analysis of lactating women was also performed.ResultsThere were 110 women who received traditional I&D, and 105 women that received VSD included. The 2 groups were similar with respect to age (31.1 ± 4.8 vs. 29.9 ± 4.4, p = 0.058), and disease characteristics. The median pain score of women who received VSD (5 [IQR 5–6]) was significantly less than that of women who received I&D (8 [IQR 7–8]) (p < 0.001). The time for healing was significantly less in women who received VSD (40 days [IQR 30–45 days]) compared to I&D (60 days [IQR 45–70 days]) (p < 0.001). The length of hospital say and the length of antibiotic treatment were similar between the 2 groups. Results were similar for lactating women.ConclusionsVSD is effective for treating acute suppurative mastitis with reduced pain and shortening healing time.

Some Udder Problems associated with productivity in Goats

The aim of this article was study the mastitis of a goat under farmer Egyptian conditions. This work was conducted on a private farm containing50baladigoats suffering from symptoms of mastitis. All environmental factors were recorded as housing condition, breeding, health problems, production and feeding. Morphological examination of the udder were carried out. Milk samples of infected goats, were collected for bacterial isolation and sensitivity test. Animals were treated with systemic and local intramammary broad spectrum antibiotic. The results indicated that, 35 cases (70 %) were responded to treatment, and showed normal reproductive and productive performances.15 cases (30 %) of chronic mastitis do not respond to treatment and breeding. Post-mortem examination of these cases revealed widespread diffused chronic mastitis throughout the affected udder. Tissue specimens of infected udder and supra mammary lymph node were fixed in 10% formalin for histopathological examination. Bacteriological examination revealed isolation of Staph aureus, Corynebacterium pyogenes, Salmonella spp., E coli in a single or mixed with other bacteria as Pasteurella spp. Fungus suspect Asperigillus spp. infection and yeast, suspect Candida spp. Pathological examination revealed chronic diffused suppurative and chronic granulomatous mycotic mastitis. In conclusion, mastitis is an important disease of goats and prevention of infection is the key for disease control. Good environ mental and hygienic housing of milking practices are a necessity to minimize the impact of this disease.

Radical Unilateral Mastectomy for Fibrosed Gangrenous Udder in a Lactating Goat

Mastitis reflects the inflammation of the mammary gland, which may occur due to any bacterial infection secondary to teat injury or poor management (Marogna et al., 2010). Radical mastectomy (unilateral or bilateral) is a salvage procedure and indicated in cases of chronic suppurative mastitis, gangrenous mastitis and neoplastic or hyperplastic conditions of the udder (Andreasen et al., 1993; El-Maghraby, 2001; Canle et al., 2004). Gangrenous mastitis is a peracute form of mastitis, characterized by necrosis of the udder tissue, caused by alpha-toxins (Smith and Sherman, 2009). Physical examination of the udder is characterized by discolored (blue- blackish or blue-greenish) and cold udder (Ribeiro et al., 2007). Gangrenous mastitis is one of the most difficult forms of mastitis to be treated (Bloway, 1993), and in very severe cases, gangrene may lead to toxemia and loss of animal life (Ribeiro et al., 2007). Unilateral or bilateral mastectomy is recommended as a pain-relieving procedure for extensive lesions involving udder and in cases of chronic mastitis, gangrenous lesions, or neoplasia (Canle et al., 2004). The present case report describes unilateral mastectomy for the management of incurable extensive fibrosis of udder while allowing the other mammary gland to continue lactation.

Measurement of apparent diffusion coefficient in discrimination of benign and malignant axillary lymph nodes.

PurposeWe aimed to determine the contribution of the apparent diffusion coefficient (ADC) value in the detection of axillary lymph node metastasis.Material and methodsBreast magnetic resonance of 58 patients, performed in the radiology clinic of our hospital between 2015 and 2017 were examined retrospectively, and 43 lymph nodes in 43 patients were included in the study. They were evaluated morphologically on T1W and T2W sequences, and the lymph nodes showing rounded shape, focal or diffuse cortical thickness of more than 3 mm, and partial or total effacement of fatty hilum were included in the study. Subsequently, their ADC values were measured.ResultsThere were 43 lymph nodes, 20 of which were malignant and 23 of which were benign. While the mean ADC value of malignant axillary lymph nodes was 0.749 10–3 mm2/s (0.48-1.342), it was 0.982 10–3 mm2/s (0.552-1.986) for benign lymph nodes. When the ADC cut-off value was taken as ≤ 0.753 × 10–3 mm2/s, its discrimination power between benign and malignant axillary lymph nodes was as follows: sensitivity – 60%; specificity – 91.3%; accuracy – 76.7%; positive predictive value – 85.7%; and negative predictive value – 72.4%.ConclusionsThere was no significant difference between mean ADC value of 12 lymphadenopathies (LAP) associated with inflammatory breast diseases (granulomatous mastitis and acute suppurative mastitis) and mean ADC value of metastatic lymph nodes. However, the ADC value of lymph nodes showing thickened cortex due to systemic inflammatory diseases was over 1, and there was a statistically significant difference when compared with metastatic lymph nodes.

High-Risk Factors for Suppurative Mastitis in Lactating Women.

BackgroundAcute mastitis is a common disease occurring in postpartum lactating women. This study aimed to identify the high-risk factors for suppurative mastitis (SM) in women who were breastfeeding.Material/MethodsA total of 262 non-SM patients and 63 SM patients admitted to the Department of Breast and Thyroid Surgery of Liaocheng People’s Hospital were retrospectively enrolled in this study. The high-risk factors for SM during lactation were determined by assessing admission time after acute mastitis, galactostasis, primipara or pluripara, nipple injuries, antibiotic treatment course, and diabetes.ResultsThe incidence of SM in patients with admission time greater than 72 h after occurrence of acute mastitis was significantly higher than that in patients whose admission time was less than 72 h (p<0.0001). Patients with galactostasis were more prone to develop SM compared to patients without galactostasis (p<0.0001), and the incidence of SM in primiparous patients was significantly higher than that in pluriparous patients (p=0.003). The incidence rate of SM was significantly higher in patients with diabetes than in patients without diabetes (p=0.002). Patients with nipple injuries were more prone to suffer from SM relative to the patients without nipple injuries (p<0.0001). However, there was no significant difference in the incidence of SM according to the antibiotic treatment course (p=0.134).ConclusionsSM during lactation was closely associated with admission time after the occurrence of acute mastitis, galactostasis, primipara, diabetes, and nipple injuries.

A retrospective study of surgical affections of mammary glands in cattle and buffaloes and their management in the field.

The present retrospective study was conducted from 2003 to 2015 in Egypt to document common surgical affections of the udder and teat in cattle and buffaloes, and determine medical and surgical treatment options that are feasible in a field setting. We diagnosed 19 different surgical affections and classified them into 4 groups according to their location. Teat orifice affections (12.41%) included imperforate teat, contracted teat orifice, enlarged teat orifice, and black spot. Teat cistern affections (23.76%) included teat fistula, dilated teat cistern, teat polypi, and webbed teat. Teat surface affections (50.35%) included sore teat, supernumerary teat, sloughed teat, teat papilloma and fibropapilloma, teat wounds, and teat viral lesions. Udder affections (13.48%) included hypermastia, udder wounds, and suppurative and gangrenous mastitis. In cattle, the number of surgical affections located on the teat surface (20 ± 5.4) was significantly higher compared with other locations as well as compared with buffaloes (P<0.05). No treatment was indicated in 24% of recorded cases. Medical and surgical treatment was indicated in 73.75% of affected animals. Favorable results were achieved with the recommended treatments when applied in the field.

Microbial agents in macroscopically healthy mammary gland tissues of small ruminants.

BackgroundHealth of mammary glands is fundamental for milk and dairy products hygiene and quality, with huge impacts on consumers welfare.MethodsThis study aims to investigate the microbial agents (bacteria, fungi and lentiviruses) isolated from 89 macroscopically healthy udders of regularly slaughtered small ruminants (41 sheep, 48 goats), also correlating their presence with the histological findings. Multinomial logistic regression was applied to evaluate the association between lesions and positivity for different microbial isolates, animal age and bacteria.ResultsTwenty-five samples were microbiologically negative; 138 different bacteria were isolated in 64 positive udders. Coagulase-negative staphylococci were the most prevalent bacteria isolated (46.42%), followed by environmental opportunists (34.76%), others (10.14%) and pathogens (8.68%). Most mammary glands showed coinfections (75%). Lentiviruses were detected in 39.3% of samples. Histologically, chronic non-suppurative mastitis was observed in 45/89 glands, followed by chronic mixed mastitis (12/89) and acute suppurative mastitis (4/89). Only 28 udders were normal. Histological lesions were significantly associated with the animal species and lentiviruses and coagulase-negative staphylococci infections. Goats had significantly higher risk to show chronic mixed mastitis compared to sheep. Goats showed a significantly lower risk (OR = 0.26; 95% CI [0.06–0.71]) of being infected by environmental opportunists compared to sheep, but higher risk (OR = 10.87; 95% CI [3.69–37.77]) of being infected with lentiviruses.DiscussionThe results of the present study suggest that macroscopically healthy glands of small ruminants could act as a reservoir of microbial agents for susceptible animals, representing a potential risk factor for the widespread of acute or chronic infection in the flock.

Host responses associated with chronic staphylococcal mastitis in rabbits

Staphylococcal infection causes substantial economic losses in commercial rabbit production systems, and is associated with a wide variety of lesions, including chronic suppurative mastitis, which mainly affects breeding females. Most chronic staphylococcal infections in rabbits are caused by the ST121 lineage of Staphylococcus aureus, although other less common lineages, such as ST96 can also be involved. The aims of the present study were to characterise the host immune response in natural cases of mastitis in rabbits caused by S. aureus, to evaluate any relationship between peripheral and local immunity and to investigate the effect of different S. aureus genotypes on these immune responses.Adult multiparous female rabbits that were affected with chronic staphylococcal mastitis (n = 204) were enrolled into the study. Histological and immunohistochemical evaluations of mammary glands were undertaken, as well as flow cytometric analyses of blood. S. aureus isolates from the mammary glands were identified by multilocus sequence typing. Differences in the number of infiltrating cells were detected, depending on the type of pathology, with more immature lesions demonstrating greater cellularity, characterised by greater numbers of T lymphocytes, macrophages and plasma cells. A relationship was seen between the cells in blood and mammary tissues, the most notable being the positive correlation between monocytes and tissue macrophages. When glands were infected with ST96 strains, fewer granulocytes (P < 0.01) and greater numbers of B cells (P < 0.01), T cells (P < 0.001), CD4+ T cells (P < 0.001) and CD8+ T cells (P < 0.01) were detected, compared with mammary glands that were infected by ST121 strains of S. aureus.

Опыт применения программной санации с использованием устройства АМП-01 в комплексном лечении гнойных лактационных маститов

Relevance The treatment of suppurative lactation mastitis remains urgent surgical problem. Despite significant advances of modern medicine in the treatment and prevention of surgical infections, mastitis is one of the first places in the structure of postpartum purulent-inflammatory complications, making towards them to 26-67% of cases. Until recently, it remained the most common traditional method of surgery at a mastitis, comprising the wide opening purulent focus one or more radial slits without a radical excision of nonviable tissue. Application of active surgical treatment purulent diseases has improved the results of treatment in this complex surgical pathology. However, its implementation in practical surgery is complicated because absence or imperfection of special technical means for active drainage, which leads to poor-quality sanitation purulent cavity and lengthens treatment time. The purpose of the study Analysis of immediate and long-term results treatment of suppurative lactation mastitis using a device AMP-01. Results and their discussion The use of active surgical method for the treatment of patients with GLM (main group, the comparison group 2) have led to a significant reduction in the duration of treatment and get good functional and cosmetic results compared to the comparison group 1 (the traditional method). A comparative study of treatment results in the study group research using the method of rehabilitation program using the device AMP-01 in the comparison group 2 with flow-suction method there are some differences. The use of primary suture in combination with active aspiration of wound and in the creation of a permanent purulent cavity vacuum of 80-100 mm of water. Art. It provides better sanitation of purulent focus and leads to the blocking of its walls and speed up recovery. Therefore, the results of treatment in the study group were slightly better for all the assessment criteria immediate and long-term results compared with a comparison group 2. Conclusion Application of the rehabilitation program using the device AMP-01 in treatment patients with GLM allows significantly accelerate clearance of the wounds from necrotic tissues, microbial bodies, stimulates regeneration processes, all of which helps to reduce the treatment durstion and getting good immediate and long-term clinical results. Method rehabilitation program using the device AMP-01 had advantages over other methods of active surgical treatment for all the assessment criteria of immediate and late treatment results.

Multinucleate Giant Cells in FNAC of Benign Breast Lesions: Its Significance.

Multinucleate giant cells are described in breast aspirates. However, due to its rarity very few cases have been described cytologically. Hence recognition and correct interpretation of their presence is difficult, yet crucial for accurate diagnosis. The prospective study of FNAC (fine needle aspirate cytology) of breast lumps was conducted for a period of six months. Direct smears were prepared from the material aspirated. In case of fluid aspirates, centrifuge done and cell sediment was used for making smears. Smears were alcohol fixed and stained with PAP/H&E or air dried smears were stained with Leishman stain. Further smears were subjected to immunocytochemistry using vimentin and CD34 markers to know the origin of multinucleate giant cells. We have reported 11 cases of breast lesions, which showed multinucleate giant cells on FNAC. Out of the 11 cases, Cytologically six cases showed granuloma debris with relative proportion of epithelioid histiocytes, lymphocytes, neutrophils and multinucleate giant cells. Two cases were diagnosed as acute suppurative granulomatous mastitis. Two cases of fibroadenoma and one case of fat necrosis showed multinucleate giant cells. Immunocytochemistry showed vimentin positivity in both stromal and histiocytic type of multinucleate giant cells and in isolated histiocytes. CD34 was focally positive in histiocytic type of giant cells. An effort is made to distinguish between the stromal and histiocytic type giant cells in non-neoplastic breast lesions. Further molecular studies have to be done to know the exact histogenesis and role of these multinucleate giant cells in benign lesions.

Bilateral Mastectomy for Successful Management of Chronic Suppurative Mastitis in a Black Bengal Doe (Capra Hircus)

Bilateral Mastectomy for Successful Management of Chronic Suppurative Mastitis in a Black Bengal Doe (Capra Hircus)

P67. Successful treatment of suppurative granulomatous mastitis (GM), using prolonged aggressive ultrasound-guided aspiration

Introduction: Management of this rare inflammatory breast condition remains controversial. With no coherent treatment rationale described in literature, reporting of novel treatment methods is critical. This descriptive case outlines the avoidance of open surgery in the treatment of a complex abscess associated with IGM, with full resolution of symptoms.

Genotypic characterization and evaluation of an antibiotic resistance of Trueperella pyogenes (Arcanobacterium pyogenes) isolated from milk of dairy cows with clinical mastitis

Trueperella pyogenes, recently reclassified from the genus Arcanobacterium, is considered the causative agent of acute suppurative mastitis called summer mastitis. T. pyogenes produces a variety of known and putative virulence factors that include pyolysin and factors promoting adhesion to host cells. The objective of this study was to report the presence of virulence genes in T. pyogenes isolates that were identified as etiological agents of clinical mastitis in cows, as well as to determine antimicrobial resistance and distribution of selected determinants that can be associated with phenotypic resistance among these isolates. The presence of genes (plo, nanH, nanP, cbpA, fimA, fimC, fimE, fimG, tet(W), erm(X), erm(B)) was examined by conventional PCRs. Resistance to 10 antimicrobial agents was determined by the broth microdilution method. Among T. pyogenes isolates of bovine mastitis origin the genes encoding all virulence factors occurred. Besides pyolysin gene plo, the fimA was the only gene detected in all isolates, whereas other virulence factor genes were found with different frequencies. Phenotypic antimicrobial resistance was observed to tetracycline (85.5% isolates) and erythromycin (9.1%). Isolates non-susceptible to erythromycin simultaneously exhibited increased MIC of pirlimycin. Beta-lactams were active against isolates. We found the correlation between the presence of tetracycline and macrolide resistance genes and corresponding resistance phenotype. Genotypic characterization of a large number of T. pyogenes isolates from different herds performed in this study may be useful in explanation, which virulence factors play a significant role in the establishment of bovine mammary gland infection.

Outbreak of bovine clinical mastitis caused by Mycoplasma bovis in a North Italian herd

This report describes an outbreak of Mycoplasma bovis mastitis affecting 45 cows in a herd of 122 dairy cattle in Northern Italy. Clinically, the outbreak was characterized by agalactia, multiple swollen and painless quarters, high milk somatic cell count and unresponsiveness to conventional antibiotic therapy. M. bovis was isolated from the milk samples of all the 32 affected cows tested and from the mammary tissue of three affected cows that underwent necropsy. No other pathogens were isolated from these samples. Lesions in two of the necropsied cows were characterized by mild chronic suppurative mastitis and galactophoritis. The other necropsied cow showed a chronic necrosuppurative and pyogranulamaous galactophoritis, a condition not previously associated with M. bovis. M. bovis was detected immunohistochemically in the lumen of the affected mammary ducts suggesting that ascending infection via the teat canal was the likely route of transmission. No other intralesional pathogens were demonstrated microscopically.

Strains of Staphylococcus aureus and pathology associated with chronic suppurative mastitis in rabbits

Staphylococcal mastitis is one of the main reasons for culling adult does from commercial rabbitries. The aim of this study was describe the spectrum of gross and microscopic lesions in 178 cases of chronic staphylococcal mastitis in adult does and to determine whether there is a correlation between Staphylococcus aureus genotypes and pathology. On the basis of histopathology, chronic mastitis was differentiated into abscesses (66.3%), suppurative mastitis with a lobular pattern (7.9%), cellulitis (19.6%) and mixed lesions (6.2%). Pathological presentations were not related to S. aureus genotype.

Abszedierende Mastitis bei einem 4 Wochen alten Kind

This is a case report of a four week old newborn, presenting with a red and swollen right breast gland. Clinical examination and ultrasound confirmed the diagnosis of a suppurative mastitis. The abcess was incised and drained and systemic antibiotic therapy started. Staphylococcus aureus was isolated from the culture. The important aspects of aetiology, pathogenesis, diagnosis and therapy of suppurative mastitis in the newborn are discussed in a short literature review.