[Teat endoscopy as a diagnostic procedure in the goat]

Teat endoscopy as a diagnostic procedure in the goat is described in a clinical case of a proliferation in the wall of the teat cisterna. Modifications in proceeding and equipment compared to the common use of endoscopy in the teat of cattle are shown and the additional amount of information in comparison to palpation, sounding and sonography is evaluated.

Migration and lymphatic spread of calcified paraffinomas after breast augmentation

A 62 year old Chinese woman presented 25 years after having both breasts augmented with paraffin injections. Development of paraffinomas and multiple episodes of paraffin-related mastitis eventually resulted in bilateral mastectomies. The unusual distribution of migrated calcified paraffinomas in the thoracic wall and its lymphatic system is documented on computed tomography.

Conservative management of infective mastitis and breast abscesses after ultrasonographic assessment

Current practice in this unit for a suspected breast abscess is preliminary ultrasonographic scan, aspiration of any pus, antibiotic therapy and repeat aspiration in the outpatient clinic if necessary. Inflammatory masses are treated with antibiotics alone. A retrospective review of this strategy has been made. Over a 2-year interval 53 patients were admitted to hospital with a suspected breast abscess. Twenty-two abscesses were aspirated, of which 19 resolved and three required subsequent incision and drainage. Eight patients underwent primary incision and drainage, one of whom required a second drainage procedure. In five patients the abscess discharged spontaneously before intervention. The remaining 18 patients were found on ultrasonography to have inflammation without evidence of focal pus which settled with antibiotic therapy in all but two patients. One of these was found to have an inflammatory cancer and the other developed an abscess, which was drained. Aspiration combined with ultrasonographic imaging is an effective alternative to incision and drainage.

Mammographic and sonographic spectrum of non-puerperal mastitis

The goal of this study was to explore possible specific mammographic and sonographic features in women with non-puerperal mastitis (NPM), in order to make an accurate diagnosis and prevent unnecessary surgical procedures. From a group of 93 patients with NPM diagnosed between 1987 and 1992, the mammograms of 41, the sonograms and cytology of 47, and the histology of seven patients were retrospectively reviewed. Follow-up was performed on those without histology. In 20 of the 47 patients the inflammation was located subareolarly. In 50% of those with non-subareolar lesions, mammography showed a circumscribed lesion. Sonographically, all patients had an identifiable lesion either well or poorly defined. The majority of the lesions were cystic, but in 23 of 47 cases solid components were seen. Signs of infection in cystic lesions were observed in 25 of 47 cases. Posterior shadowing was not observed. During the follow-up period no breast malignancy was found. It is concluded that NPM has no specific mammographic or sonographic sign. Diagnosis should be made with additional diagnostic assessment, such as FNAB, which was diagnostic in all cases.

Breast infection. Mammographic and sonographic findings with clinical correlation

RATIONALE AND OBJECTIVES

To characterize the mammographic, sonographic, and clinical findings of breast infection and to determine characteristics that could help differentiate it from inflammatory breast carcinoma.

METHODS

The mammograms, sonograms, and clinical records of 21 consecutive patients who had mammography or sonography within 48 hours of presenting with breast infection were retrospectively reviewed. To exclude other causes of breast inflammation, patients were required to have histologic or aspiration results specific for infection.

RESULTS

Twelve of 19 (63%) mammograms were abnormal. Mammographic abnormalities included an irregular mass (6; 32%), focal asymmetric density (2; 11%), diffuse asymmetric density (2; 11%), circumscribed mass (1; 5%), and architectural distortion (1; 5%). Mammographic skin thickening, present in four (21%) patients, was focal in three and diffuse in one patient with primary breast Mycobacterium tuberculosis infection. No abnormally dense lymph nodes were demonstrated. There was no abnormal soft tissue gas. All 11 (100%) sonograms showed heterogeneous masses that contained internal echoes, 5 of these in patients who had normal mammograms. All 21 patients presented with clinical abnormalities, including palpable mass (20; 95%), pain (11; 52%), erythema (11; 52%), warmth (7; 33%), skin thickening or fixation (4; 19%), and breast swelling (3; 14%). One patient was lactating.

CONCLUSIONS

Mammographic, sonographic, and clinical abnormalities were usually present with breast infection that could mimic inflammatory carcinoma. However, diffuse mammographic skin thickening, edema, and dense lymph nodes were rare, and when present may prospectively suggest carcinoma or an unusual infection. Early surgical consultation is advised.

Mammographic appearances of mammary duct ectasia that mimic carcinoma in a screening programme

The aim of this study is to demonstrate the spectrum of mammographic appearances of mammary duct ectasia that mimic carcinoma in a breast cancer screening programme. Between February 1989 and March 1993, 40,003 women underwent screening mammography as part of the Western Australia Women's Cancer Prevention Unit screening programme. Fine needle aspiration or excisional biopsy was performed on 1437 women, and 12 cases of cytologically or histologically confirmed mammary duct ectasia were detected. A total of 14 mammographic abnormalities from 12 asymptomatic female patients were biopsied, and confirmed to represent mammary duct ectasia. The mammographic spectrum included eight areas of microcalcification (two of which were extensive), three spiculated masses and three lobulated, partially smooth masses. Five of these women showed no other mammographic stigmata of mammary duct ectasia in either breast. Additional features of mammary duct ectasia, including nipple retraction, retro-areolar duct dilatation or macrocalcification were identified in seven women. Mammographic features of mammary duct ectasia are frequently detected in asymptomatic women undergoing screening mammography and cause no diagnostic dilemma. Occasionally mammary duct ectasia will have a mammographic appearance that is indistinguishable from carcinoma, necessitating breast biopsy. In this study 40% of those women with mammary duct ectasia that were submitted for biopsy had no other feature of mammary duct ectasia that could have suggested the pre-operative diagnosis.

[Inflammatory lesions of the breast: indication for MR-mammography?]

In a retrospective study the value of MR imaging of the breast in inflammatory changes was evaluated. The signal enhancement of 8 patients with histopathologically verified inflammatory carcinomas and 9 patients with global mastitis as well as local inflamed lesions was analysed. Neither signal behaviour nor signal/time relation were suitable to differentiate between malignant and benign changes. In conclusion inflammatory changes of the female breast are not indicated to be examined with MR imaging.

Patterns of radioiodine uptake by the lactating breast

Breast uptake of radioiodine, if not suspected, may be misinterpreted as thyroid cancer metastasis to the lung. To characterize the patterns of radioiodine breast uptake, we retrospectively studied 20 radioiodine scans that were performed within 1 week of cessation of breast feeding. Four patterns of uptake were identified: "full", "focal", "crescent" and "irregular". The uptake was asymmetric in 60% (left > right in 45%, right > left in 15%), symmetric in 25% and unilateral in 15% of cases. A characteristic full bilateral uptake was present in 40% of cases. In three cases with the irregular pattern, caused in part by external contamination with radioactive milk, the uptake closely mimicked lung metastases. Delayed images, obtained in one case, showed an apparent radioiodine shift from the breast to the thyroid, suggesting that the presence of breast uptake can modulate radioiodine uptake by thyroid tissue. In a case of unilateral breast uptake, a history of mastitis was obtained, which to our knowledge has not been previously reported. Breast uptake of radioiodine may take several scintigraphic patterns that are not always characteristic of the lactating breast and may affect the apparent extent of thyroid remnant/metastasis.

Idiopathic granulomatous mastitis. Report of a case clinically and mammographically simulating breast carcinoma

A case of bilateral idiopathic granulomatous mastitis in a 67-year-old woman is described. The clinical presentation and mammographic findings raised strong suspicions of malignancy, excluded by the histological examination, which made it possible also to rule out possible known causes of granulomatous inflammation of the breast.

[Non-puerperal mastitis in real time and color Doppler ultrasound]

Differential diagnosis distinguishing between nonpuerperal mastitis and inflammatory cancer of the breast is difficult, the conventional method being mammography. In our study, we present the typical findings gained by sonography of 16 patients with nonpuerperal mastitis. They do not differ significantly from those cases with breast cancer. From these 16 patients, 7 were additionally examined using Colour and Pulsed Wave Doppler Sonography. International literature offers little practical knowledge in this field. In the immediate surroundings of the inflammation, we were able to represent up to four arterial vessels per patient. The parameters of the flow velocity wave form of these vessels were compared to those of the vessels in the correspondent quadrant of the contralateral breast. In all cases, the maximum systolic and the minimum end diastolic velocities were higher than in the contralateral breast, giving evidence of an increased vascularity. In 6 cases, the pulsatility and resistance indices in the inflammatory vessels were lower because of a decreased peripheral resistance of the vessel. Under therapy with antibiotics or Bromocriptine, these parameters were equalized in both breasts. The model of nonpuerperal mastitis shows, that Colour and Pulsed Wave Doppler Sonography makes it possible to differentiate tumours of the breast on the basis of an analysis of their vascularity and the comparison with the parameters of the vessels in the contralateral breast. The effects of a pharmacological therapy on the vascularity of breast tumours can also be measured with this method.

[Inflammatory and infectious lesions of the breast. Contribution of ultrasonography]

Non puerperal abscess associated with periductal mastitis assumes increasing importance. US is an excellent tool for detection of an abscess cavity, which many have a variety of scanographic findings. Mammography may be difficult to perform properly because of pain and edema of the breast.

[Inflammatory and infectious lesions of the breast. Contribution of ultrasonography]

Non puerperal abscess associated with periductal mastitis assumes increasing importance. US is an excellent tool for detection of an abscess cavity, which many have a variety of scanographic findings. Mammography may be difficult to perform properly because of pain and edema of the breast.

[The study of ultrasonographic diagnosis on breast diseases]

15 sonomammographic findings of 341 histologically proved breast masses were reviewed to improve and objectify the current diagnostic criteria of sonomammography. The author proposed the renewed plan of the diagnostic criteria and the judgement method of benign or malignant breast masses on an electronic linear scanner, offering the author's original diagnostic concept particularly about the shape and the internal echo. This diagnostic approach demonstrated a sensitivity of 93.2%, specificity of 85.9%, and accuracy of 89.7%, which sufficiently showed to raise differential diagnostic capability for breast masses.

Acute inflammation of the breast--the role of breast ultrasound in diagnosis and management

Twenty female patients aged between 24 and 69 years were referred for breast ultrasound (US) examination between June 1989 and June 1990, with clinical suspicion of a breast abscess. Six were currently lactating. Initial US examination confirmed the presence of an abscess collection in nine out of 20 patients. Seven of these subsequently had surgical incision and drainage. Two settled on medical treatment. No abscess was detected on initial US examination in the remaining 11 patients who were treated conservatively with oral antibiotics. One patient, who had markedly dilated ducts on her initial US examination, remained symptomatic. Follow-up US demonstrated a small fluid collection, which within 7 days developed into a large multiloculated abscess requiring surgical drainage. We feel that US is very useful in accurately demonstrating the presence or absence of an abscess collection in the acutely inflamed breast.

[Galactography in the study of the secreting breast]

Sixty cases of mammary secretion were studied using cytological examinations of the mammary secretion, traditional mammography, galactography and histological examination of bioptic samples. Comparison of the results produced by the different techniques highlighted the importance of galactography for the description of the various pictures presented by duct pathologies as well as its outstanding prognostic accuracy. Galactography also offers the major advantage of precisely locating the topographic location of the mammary lesion, thus enabling the surgeon to adopt an appropriate procedure that removes all diseased tissue and structures as is essential for histological success. Quick and easy to perform, practically exempt from complications or side effects, this examination therefore appears to be an irreplaceable addition to the battery of breast cancer diagnosis techniques.

[Tuberculosis of the breast. Report of a clinical case and review of the literature]

Tuberculosis of the breast is an uncommon disease and the correct diagnosis may be established only by histologic demonstration of granulomatous inflammatory infiltrates with central caseation. In fact, preoperative examination and mammography suggest carcinoma or sometimes bacterial abscess in most instances. Tuberculous mastitis was diagnosed in a 74-year-old woman. The case history and a review of the literature are presented. The Authors emphasize the role of excision of necrotic tissue and drainage, in combination with antimicrobial therapy, in the treatment of this pathology.

Inflammatory breast disease: mammographic spectrum

We reviewed 27 biopsy-proven cases of inflammatory disease of the breast. Mammographic features of acute and chronic breast inflammation and abscess included focal increased density (68%), a spiculated mass (56%), skin thickening (48%), skin retraction (28%), and microcalcification (8%). We found considerable similarity between inflammation and malignancy.

[Tuberculosis of the female breast: diagnostic clarification]

Modern therapeutic possibilities made tuberculosis of the breast a rare entity which, however, still exists and usually mimicks a malignancy. It represents a secondary organ manifestation and should be considered in differential diagnosis in all cases of primary lung tuberculosis and when fine needle biopsy fails to yield the expected tumour cells. We demonstrate such a case of breast tuberculosis and stress the cytologist's option to restain any cytological slide according to Ziehl-Neelsen. In our case, this renewed staining established the correct diagnosis.

Tuberculosis of the breast: rare but still extant. Review of the literature and report of an additional case

Tuberculosis of the breast is a rare malady that is usually manifested by a unilateral mass suggestive of carcinoma or sometimes of abscess. Mammography also suggests carcinoma in most instances. However, at operation, the discovery of necrotic tissue or abscess may lead to the suspicion of infectious or inflammatory disease rather than neoplasm. The diagnosis of tuberculosis may be established by the demonstration of acid-fast bacilli in excised tissue, by culture studies, or by guinea pig inoculation; however, the diagnosis is usually not suspected. In the past, mastectomy was the usual treatment. Today, successful treatment combines antituberculous drug therapy with the removal of infected breast tissue. The prognosis for complete cure is excellent. One case of secondary tuberculous mastitis has been reported herein. The patient, an Egyptian woman residing in the United States since 1973, was treated in Egypt for pulmonary tuberculosis at age 17. She presented in 1982 with a breast mass that mimicked carcinoma on physical examination and mammograms, but excisional biopsy and histologic examination revealed a breast abscess that contained caseous material and a solitary acid-fast bacillus. The patient was cured of her disease after appropriate operation and a course of antituberculous drugs. This has been the only documented case of mammary tuberculosis at our institution. Despite its rarity, tuberculosis of the breast should not be forgotten in this age of world travel.

[Roentgenodiagnosis of the suppurative-inflammatory process in acute lactation mastitis]

The analysis of roentgen-diagnostics of pyo-inflammatory processes in the mammary glands in 365 patients with acute lactation mastitis has been made. Simple mammography is recommended as a simple and safe method for patients with acute lactation mastitis.