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Zhou F, Liu L, Wang F, Yu L, Xiang Y, Zheng C, Huang S, Yang Z, Yu Z. Periductal Mastitis, a Disease with Distinct Clinicopathological Features from Granulomatous Lobular Mastitis. J Inflamm Res 2024; 17:3815-3823. [PMID: 38895142 PMCID: PMC11185250 DOI: 10.2147/jir.s464585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
Purpose Periductal mastitis (PDM) is a chronic inflammatory lesion of the breast with an unknown etiology, and it is difficult for clinicians to differentiate it from granulomatous lobular mastitis (GLM), although they have different treatment strategies and prognosis. This study aimed to investigate the differences in their clinicopathologic features to inform treatment strategies. Patients and Methods Between 2011 and 2020, 121 patients diagnosed with PDM and 57 patients with GLM were retrospective analysis. Patient data were extracted on demographics, clinical presentation, pathologic characteristics, treatments and clinical response. Histopathological evaluations were performed on core needle biopsy specimens. Immunohistochemical stains using antibodies against CD3, CD4, CD8, CD20, and CD138 was performed to define immune cell infiltration. Results PDM patients had a higher median age compared to GLM patients (38 vs 32, p<0.001). PDM was primarily located in the areolar area, while GLM predominantly affected the peripheral quadrant of the breast (56.20% vs 75.44%, p<0.001). Histopathologically, more ductal dilatation (90.08% vs 3.51%, p<0.001), ductal wall thickening (47.93% vs 1.75%, p<0.001), and ductal rupture (44.63% vs 5.26%, p<0.001) were observed in PDM. GLM presented with significantly more granuloma (94.74% vs 10.74%, p<0.001), microabscess (68.42% vs 28.93%, p<0.001), and lipid vacuole (40.35% vs 8.26%, p<0.001) formation than PDM. Immunohistochemical analysis revealed a significant presence of CD20+ B lymphocytes in PDM and a higher prevalence of CD8+ T lymphocytes in GLM, indicating differing immune responses. Treatment outcomes varied, with PDM patients responding well to surgery and anti-mycobacterial therapy, while GLM patients showed favorable responses to steroid therapy. Conclusion PDM is a specific entity with a similar clinical presentation but distinct histopathological features and immune profiles to GLM. Further research is needed to elucidate the pathogenesis and optimize therapeutic approaches for these breast inflammatory conditions.
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Affiliation(s)
- Fei Zhou
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, 250033, People’s Republic of China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, 250033, People’s Republic of China
| | - Liyuan Liu
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, 250033, People’s Republic of China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, 250033, People’s Republic of China
| | - Fei Wang
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, 250033, People’s Republic of China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, 250033, People’s Republic of China
| | - Lixiang Yu
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, 250033, People’s Republic of China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, 250033, People’s Republic of China
| | - Yujuan Xiang
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, 250033, People’s Republic of China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, 250033, People’s Republic of China
| | - Chao Zheng
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, 250033, People’s Republic of China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, 250033, People’s Republic of China
| | - Shuya Huang
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, 250033, People’s Republic of China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, 250033, People’s Republic of China
| | - Zhen Yang
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, 250033, People’s Republic of China
| | - Zhigang Yu
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, 250033, People’s Republic of China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, Shandong, 250033, People’s Republic of China
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Wang Z, Hua L, Liu X, Chen X, Xue G. A hematological parameter-based model for distinguishing non-puerperal mastitis from invasive ductal carcinoma. Front Oncol 2023; 13:1295656. [PMID: 38152369 PMCID: PMC10751305 DOI: 10.3389/fonc.2023.1295656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/29/2023] [Indexed: 12/29/2023] Open
Abstract
Purpose Non-puerperal mastitis (NPM) accounts for approximately 4-5% of all benign breast lesions. Ultrasound is the preferred method for screening breast diseases; however, similarities in imaging results can make it challenging to distinguish NPM from invasive ductal carcinoma (IDC). Our objective was to identify convenient and objective hematological markers to distinguish NPM from IDC. Methods We recruited 89 patients with NPM, 88 with IDC, and 86 with fibroadenoma (FA), and compared their laboratory data at the time of admission. LASSO regression, univariate logistic regression, and multivariate logistic regression were used to screen the parameters for construction of diagnostic models. Receiver operating characteristic curves, calibration curves, and decision curves were constructed to evaluate the accuracy of this model. Results We found significant differences in routine laboratory data between patients with NPM and IDC, and these indicators were candidate biomarkers for distinguishing between the two diseases. Additionally, we evaluated the ability of some classic hematological markers reported in previous studies to differentiate between NPM and IDC, and the results showed that these indicators are not ideal biomarkers. Furthermore, through rigorous LASSO and logistic regression, we selected age, white blood cell count, and thrombin time to construct a differential diagnostic model that exhibited a high level of discrimination, with an area under the curve of 0.912 in the training set and with 0.851 in the validation set. Furthermore, using the same selection method, we constructed a differential diagnostic model for NPM and FA, which also demonstrated good performance with an area under the curve of 0.862 in the training set and with 0.854 in the validation set. Both of these two models achieved AUCs higher than the AUCs of models built using machine learning methods such as random forest, decision tree, and SVM in both the training and validation sets. Conclusion Certain laboratory parameters on admission differed significantly between the NPM and IDC groups, and the constructed model was designated as a differential diagnostic marker. Our analysis showed that it has acceptable efficiency in distinguishing NPM from IDC and may be employed as an auxiliary diagnostic tool.
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Affiliation(s)
- Zhichun Wang
- Department of Breast Surgery, Jiujiang NO.1 People’s Hospital, Jiujiang, Jiangxi, China
| | - Lin Hua
- Department of Clinical Laboratory, Jiujiang NO.1 People’s Hospital, Jiujiang, Jiangxi, China
| | - Xiaofeng Liu
- Department of Clinical Laboratory, Jiujiang NO.1 People’s Hospital, Jiujiang, Jiangxi, China
| | - Xueli Chen
- Department of Clinical Laboratory, Jiujiang NO.1 People’s Hospital, Jiujiang, Jiangxi, China
| | - Guohui Xue
- Department of Clinical Laboratory, Jiujiang NO.1 People’s Hospital, Jiujiang, Jiangxi, China
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Snider HC. Management of Mastitis, Abscess, and Fistula. Surg Clin North Am 2022; 102:1103-1116. [DOI: 10.1016/j.suc.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Biomedical Indicators of Patients with Non-Puerperal Mastitis: A Retrospective Study. Nutrients 2022; 14:nu14224816. [PMID: 36432503 PMCID: PMC9695051 DOI: 10.3390/nu14224816] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Non-puerperal mastitis (NPM), a recurrent chronic inflammation of non-lactating breast, often proves tremendous difficulty in treatment, and it may give rise to its complicated symptoms and unclear etiology. Furthermore, the clinical morbidity rate of NPM has been increasing in recent years. METHODS Overall, 284 patients diagnosed with NPM were consecutively recruited as cases in this study, and patients with benign breast disease (n = 1128) were enrolled as control. The clinical, biomedical, and pathological indicators were analyzed. Univariate and multivariate logistic analysis were used to distinguish risks between NPM and benign breast mass patients. Furthermore, according to the pathological characteristics, the patients of NPM were classified into two subgroups: mammary duct ectasia (MDE) and granulomatous lobular mastitis (GLM). The differences of biomedical indicators between MDE and GLM groups were also analyzed. RESULTS Compared with benign breast mass group, the level of high-density lipoprotein (HDL-C) significantly decreased, while lipoprotein(a) (Lp(a)) and blood glucose (GLU) both increased in NPM group. According to univariate and multivariate logistic analysis, the onset age and HDL-C were generally decreased, while Lp(a) and GLU were increased in NPM group. The onset age, HDL-C, Lp(a), and GLU were modeled to distinguish NPM and benign breast mass. Significant differences were also observed between MDE and GLM patients in biomedical indicators, such as lipoprotein(a) (Lp(a)), lactate dehydrogenase (LDH), creatine kinase (CK), total cholesterol (TC), and so on. CONCLUSIONS Our results indicated for the first time that biomarkers were associated with NPM. The biomedical indicators involved in lipid metabolism might be important factors in the development and treatment of NPM. In addition, MDE and GLM are two diseases with different inflammatory states of NPM. These findings would be helpful for a better understanding of NPM and give us some insights to develop new diagnostic and therapeutic strategies.
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Zheng Y, Bai L, Sun J, Zhu L, Huang R, Duan S, Dong F, Tang Z, Li Y. Diagnostic value of radiomics model based on gray-scale and contrast-enhanced ultrasound for inflammatory mass stage periductal mastitis/duct ectasia. Front Oncol 2022; 12:981106. [PMID: 36203455 PMCID: PMC9530941 DOI: 10.3389/fonc.2022.981106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/29/2022] [Indexed: 12/24/2022] Open
Abstract
ObjectiveThe present study aimed to investigate the clinical application value of the radiomics model based on gray-scale ultrasound (GSUS) and contrast-enhanced ultrasound (CEUS) images in the differentiation of inflammatory mass stage periductal mastitis/duct ectasia (IMSPDM/DE) and invasive ductal carcinoma (IDC).MethodsIn this retrospective study, 254 patients (IMSPDM/DE: 129; IDC:125) were enrolled between January 2018 and December 2020 as a training cohort to develop the classification models. The radiomics features were extracted from the GSUS and CEUS images. The least absolute shrinkage and selection operator (LASSO) regression model was employed to select the corresponding features. Based on these selected features, logistic regression analysis was used to aid the construction of these three radiomics signatures (GSUS, CEUS and GSCEUS radiomics signature). In addition, 80 patients (IMSPDM/DE:40; IDC:40) were recruited between January 2021 and November 2021 and were used as the validation cohort. The best radiomics signature was selected. Based on the clinical parameters and the radiomics signature, a classification model was built. Finally, the classification model was assessed using nomogram and decision curve analyses.ResultsThree radiomics signatures were able to differentiate IMSPDM/DE from IDC. The GSCEUS radiomics signature outperformed the other two radiomics signatures and the AUC, sensitivity, specificity, and accuracy were estimated to be 0.876, 0.756, 0.804, and 0.798 in the training cohort and 0.796, 0.675, 0.838 and 0.763 in the validation cohort, respectively. The lower patient age (p<0.001), higher neutrophil count (p<0.001), lack of pausimenia (p=0.023) and GSCEUS radiomics features (p<0.001) were independent risk factors of IMSPDM/DE. The classification model that included the clinical factors and the GSCEUS radiomics signature outperformed the GSCEUS radiomics signature alone (the AUC values of the training and validation cohorts were 0.962 and 0.891, respectively). The nomogram was applied to the validation cohort, reaching optimal discrimination, with an AUC value of 0.891, a sensitivity of 0.888, and a specificity of 0.750.ConclusionsThe present study combined the clinical parameters with the GSCEUS radiomics signature and developed a nomogram. This GSCEUS radiomics-based classification model could be used to differentiate IMSPDM/DE from IDC in a non-invasive manner.
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Affiliation(s)
- Yan Zheng
- Department of Ultrasound, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Lu Bai
- Department of Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, China
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Jie Sun
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Lin Zhu
- Department of Ultrasound, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Renjun Huang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shaofeng Duan
- Precision Health Institution, GE Healthcare, Shanghai, China
| | - Fenglin Dong
- Department of Ultrasound, The First Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Fenglin Dong, ; Zaixiang Tang, ; Yonggang Li,
| | - Zaixiang Tang
- Department of Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, China
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
- *Correspondence: Fenglin Dong, ; Zaixiang Tang, ; Yonggang Li,
| | - Yonggang Li
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Medical Imaging, Soochow University, Suzhou, China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
- Suzhou Key Laboratory of Intelligent Medicine and Equipment, Soochow University, Suzhou, China
- *Correspondence: Fenglin Dong, ; Zaixiang Tang, ; Yonggang Li,
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Xing M, Zhang S, Zha X, Zhang J. Current Understanding and Management of Plasma Cell Mastitis: Can We Benefit from What We Know? Breast Care (Basel) 2022; 17:321-329. [PMID: 35949416 PMCID: PMC9247483 DOI: 10.1159/000517572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/20/2021] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Plasma cell mastitis (PCM), also known as mammary duct ectasia, is a chronic nonbacterial breast inflammation characterized by duct expansion and plasma cell infiltration. The severe and intense clinical manifestations profoundly affect the quality of life of female patients. Although the pathological process of PCM is known to include four stages (duct dilatation, inflammation, abscess and fistula), there is still lack of imaging techniques and serum markers with high specificity in clinical practice. Due to recurrent acute attacks and the prolonged healing process of the disease, most patients choose to accept mastectomy. SUMMARY We searched for studies, reports and reviews referring to PCM in the past 20 years; more than half of the results were related to animal studies, and little attention has been paid to human beings, which may explain the frequent misdiagnosis of PCM as breast cancer and the limited treatment options. This review focuses on the current diagnostic methods and markers for PCM and hierarchically discusses the typical clinical features, etiological causes and relevant molecular mechanisms of PCM. KEY MESSAGES We herein highlight the urgent need to develop more specific and sensitive biomarkers in the clinical laboratory. It will help to establish a standardized flowchart for the diagnosis and treatment of PCM in order to improve recovery for female patients.
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Affiliation(s)
- Mengying Xing
- Department of Laboratory Medicine, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shichang Zhang
- Department of Laboratory Medicine, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoming Zha
- Department of Breast Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiexin Zhang
- Department of Laboratory Medicine, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Xu H, Liu R, Lv Y, Fan Z, Mu W, Yang Q, Fu H, Li Y. Treatments for Periductal Mastitis: Systematic Review and Meta-Analysis. Breast Care (Basel) 2022; 17:55-62. [PMID: 35355704 PMCID: PMC8914206 DOI: 10.1159/000514419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 01/13/2021] [Indexed: 02/03/2023] Open
Abstract
Introduction Periductal mastitis (PDM) is a complex benign breast disease with a prolonged course and a high risk of recurrence after treatment. There are many available treatments for PDM, but none is widely accepted. This study aims to evaluate the various treatment failure rates (TFR) of different invasive treatment measures by looking at recurrence and persistence after treatment. In this way, it sets out to inform better clinical decisions in the treatment of PDM. Methods We searched PubMed, Embase, and Cochrane Library databases for eligible studies about different treatment regimens provided to PDM patients that had been published before October 1, 2019. We included original studies written in English that reported the recurrence and/or persistence rates of each therapy. Outcomes were presented as pooled TFR and 95% CI for the TFR. Results We included 27 eligible studies involving 1,066 patients in this study. We summarized 4 groups and 10 subgroups of PDM treatments, according to the published studies. Patients treated minimally invasively (group 1) were subdivided into 3 subgroups and pooled TFR were calculated as follows: incision and drainage (n = 73; TFR = 75.6%; 95% CI 27.3-100%), incision alone (n = 74; TFR = 20.1%; 95% CI 0-59.9%), and breast duct irrigation (n = 123; TFR = 19.4%; 95% CI 0-65.0%). Patients treated with a minor excision (excision of the infected tissue and related duct; group 2) were divided into 4 subgroups and pooled TFR were calculated as follows: wound packing alone (n = 127; TFR = 2.1%; 95% CI 0-5.2%), primary closure alone (n = 66; TFR = 37.1%; 95% CI 9.5-64.8%), primary closure under antibiotic treatment cover (n = 55; TFR = 4.8%; 95% CI 0-11.4%), and additional nipple part removal (n = 232; TFR = 9.6%; 95% CI 5.8-13.4%). Patients treated with a major excision (excision of the infected tissue and the major duct; group 3) included the following 2 subgroups: patients treated with a circumareolar incision (n = 142; TFR = 7.5%; 95% CI 0.4-14.7%) and patients treated with a radial incision of the breast (n = 78; TFR = 0.6%; 95% CI 0-3.6%). Group 4 contained patients receiving different major plastic surgeries. The pooled TFR of this group (n = 86) was 3.4% (95% CI 0-7.5%). Conclusion Breast duct irrigation, which is the most minimally invasive of all of the treatment options, seemed to yield good outcomes and may be the first-line treatment for PDM patients. Minor excision methods, except for primary closure alone, might be enough for most PDM patients. Major excision, especially with radial incision, was a highly effective salvage therapy. The major plastic surgery technique was also acceptable as an alternative treatment for patients with large lesions and concerns about breast appearance. Incision and drainage and minor excision with primary closure alone should be avoided for PDM patients. Further research is still needed to better understand the etiology and pathogenesis of PDM and explore more effective treatments for this disease.
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Affiliation(s)
- Huiying Xu
- Breast Center, Shunyi Maternal and Children's Hospital of Beijing Children's Hospital, Beijing, China
| | - Ruidong Liu
- Breast Surgery, The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Yanli Lv
- Breast Center, Shunyi Maternal and Children's Hospital of Beijing Children's Hospital, Beijing, China
| | - Zhenhua Fan
- Department of Breast Disease, Peking University Shougang Hospital, Beijing, China
| | - Weimin Mu
- Breast Center, Shunyi Maternal and Children's Hospital of Beijing Children's Hospital, Beijing, China
| | - Qingzhong Yang
- Breast Center, Shunyi Maternal and Children's Hospital of Beijing Children's Hospital, Beijing, China
| | - Hui Fu
- Breast Center, Shunyi Maternal and Children's Hospital of Beijing Children's Hospital, Beijing, China
| | - Yi Li
- Breast Center, Shunyi Maternal and Children's Hospital of Beijing Children's Hospital, Beijing, China,*Yi Li, Breast Center, Shunyi Maternal and Children's Hospital of Beijing Children's Hospital, 1 Shunkang Rd., Beijing 101300 (China),
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Del Riego J, Pitarch M, Codina C, Nebot L, Andreu FJ, Aparicio O, Medina A, Martín A. Multimodality approach to the nipple-areolar complex: a pictorial review and diagnostic algorithm. Insights Imaging 2020; 11:89. [PMID: 32757082 PMCID: PMC7406635 DOI: 10.1186/s13244-020-00896-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/16/2020] [Indexed: 12/29/2022] Open
Abstract
The anatomic and histologic characteristics of the nipple-areolar complex make this breast region special. The nipple-areolar complex can be affected by abnormal development and a wide spectrum of pathological conditions, many of which have unspecific clinical and radiological presentations that can present a challenge for radiologists. The nipple-areolar complex requires a specific imaging workup in which a multimodal approach is essential. Radiologists need to know the different imaging modalities used to study the nipple-areolar complex, as well as their advantages and limitations. It is essential to get acquainted with the acquisition technique for each modality and the spectrum of findings for the different conditions. This review describes and illustrates a combined clinical and radiological approach to evaluate the nipple-areolar complex, emphasizing the findings for the normal morphology, developmental abnormalities, and the most common benign and malignant diseases that can affect this region. We also present a diagnostic algorithm that enables a rapid, practical approach to diagnosing condition involving the nipple-areolar complex.
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Affiliation(s)
- Javier Del Riego
- Department of Radiology, Women's Imaging, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, 1 Parc Tauli, Sabadell, Barcelona, Spain. .,Women's Imaging, Grup Duran Diagnòstic per la Imatge, Sabadell, Barcelona, Spain.
| | - Mireia Pitarch
- Department of Radiology, Women's Imaging, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, 1 Parc Tauli, Sabadell, Barcelona, Spain
| | - Clara Codina
- Department of Radiology, Women's Imaging, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, 1 Parc Tauli, Sabadell, Barcelona, Spain
| | - Laura Nebot
- Department of Pathology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Oscar Aparicio
- Department of Surgery, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, Barcelona, Spain
| | - Alexandra Medina
- Department of Gynecology and Obstetrics, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, Barcelona, Spain
| | - Amaya Martín
- Department of Radiology, Women's Imaging, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, 1 Parc Tauli, Sabadell, Barcelona, Spain.,Women's Imaging, Grup Duran Diagnòstic per la Imatge, Sabadell, Barcelona, Spain
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Ming J, Meng G, Yuan Q, Zhong L, Tang P, Zhang K, Chen Q, Fan L, Jiang J. Clinical Characteristics and Surgical Modality of Plasma Cell Mastitis: Analysis of 91 Cases. Am Surg 2020. [DOI: 10.1177/000313481307900130] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to investigate the clinical characteristics and surgical modality of plasma cell mastitis (PCM). A total of 93 breasts of 91 female patients with PCM from June 2003 to June 2010 (unilateral in 89 patients and bilateral in two patients) were investigated in this study. All breasts were divided into two groups: the direct excision group (DE group) received focused excision and nipple retraction correction; and the incision drainage group (ID group) received these procedures only in the event of failing at least two incision drainages. Clinical characteristics, extent of excision, and prognosis were compared between two groups. There were 53 breasts in the DE group and 40 breasts in the ID group. No significant differences were noted in the number of retracted nipples and abscesses in the first visit or extent of disease between two groups ( P > 0.05). However, during surgery, 3.85 ± 0.97 abscesses per breast were detectable in the ID group, which was significantly higher than 1.21 ± 0.06 abscesses per breast in the DE group. The ID group had significantly higher inflammation and excised extent compared with the DE group ( P < 0.05). Hospitalization time was 179.60 ± 14.8 days in the ID group, which was significantly higher than 22.49 ± 1.93 days in the DE group ( P < 0.05). Bacterial culture was negative for pus of 39 non-rupturing abscesses. Congenital nipple retraction may be the primary cause of PCM. Early and complete focused excision and nipple retraction correction are effective treatment methods.
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Affiliation(s)
- Jia Ming
- Breast Disease Center, Southwest Hospital affiliated with The Third Military Medical University, Chongqing, China
| | - Gang Meng
- Department of Pathology, Southwest Hospital affiliated with The Third Military Medical University, Chongqing, China
| | - Qiaoying Yuan
- Department of Pathology, Southwest Hospital affiliated with The Third Military Medical University, Chongqing, China
| | - Ling Zhong
- Breast Disease Center, Southwest Hospital affiliated with The Third Military Medical University, Chongqing, China
| | - Peng Tang
- Breast Disease Center, Southwest Hospital affiliated with The Third Military Medical University, Chongqing, China
| | - Kongyong Zhang
- Breast Disease Center, Southwest Hospital affiliated with The Third Military Medical University, Chongqing, China
| | - Qingqiu Chen
- Breast Disease Center, Southwest Hospital affiliated with The Third Military Medical University, Chongqing, China
| | - Linjun Fan
- Breast Disease Center, Southwest Hospital affiliated with The Third Military Medical University, Chongqing, China
| | - Jun Jiang
- Breast Disease Center, Southwest Hospital affiliated with The Third Military Medical University, Chongqing, China
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Abstract
BACKGROUND The aim of this study was to present several cases of benign and malignant nipple lesions and contribute to diagnosis and differential diagnosis. METHODS A retrospective study was conducted on 13 patients. All of the patients were evaluated by ultrasonography, and 11 of them had pathological results. We analyzed the clinical and sonographic features. RESULTS There were 3 malignant lesions, 7 benign lesions, and 3 congenital nipple dysplasia, listed as follows:Malignant lesions (n = 3, 23%): Paget's disease (PD, n = 3, 23%). All of the patients with PD showed unilateral nipple erosion, discharge, and pain. The ultrasound showed abundant blood flow (n = 3, 23%); 2 patients (n = 2, 15%) had microcalcifications.Benign lesions (n = 7, 54%): Adenoma of the nipple (n = 2, 15%). One patient (n = 1, 8%) had nipple erosion and discharge. Two patients (n = 2, 15%) had a palpable nodule in the nipple. The ultrasound of both patients (n = 2, 15%) showed regular-shaped, clear border nodule with abundant blood flow (n = 2, 15%).Leiomyoma of the nipple (n = 1, 8%): This male patient was characterized by unilateral nipple enlargement and pain. The ultrasound showed a regular nodule with absent blood flow.Plasma cell mastitis (n = 2, 15%): Two patients showed unilateral nipple inversion and pain. One patient (n = 1, 8%) showed swollen and redness. The 2 patients showed a lesion in the gland around the nipple present as an irregular shape and unclear boundary hypoechoic mass.Nipple wart (n = 2, 15%): Two patients showed a unilateral soft exogenous neoplasm. Both of the patients showed a hypoechoic wart; the echo was similar to the nipple, the border was clear, and had no blood flow in the wart.Nipple Dysplasia (n = 3, 23%): Accessory nipple (n = 3, 23%). Two patients (n = 2, 15%) had accessory nipples in the subcoastal area, 1 patient (n = 1, 8%) in the areolar. All of the patients' sonographic features were the same as the nipple.The positive predict value (PPV) of the clinical symptoms: Erosion and discharge are both 75% (P < 0.05). The PPV of the US manifestations: irregular shape, indictinct margin, abundant blood flow, microcalcification, thicken skin in diagnosing malignant lesions are 60%,60%,60%,100%,100%, respectively (P < 0.05). CONCLUSIONS The characteristic sonographic features together with clinical symptoms contribute to the diagnosis of nipple lesions.
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Affiliation(s)
| | | | | | | | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Singh N, Kushwaha P, Gupta A, Prakash O. Recent Advances of Novel Therapeutic Agents from Botanicals for Prevention and Therapy of Breast Cancer: An Updated Review. CURRENT CANCER THERAPY REVIEWS 2020. [DOI: 10.2174/1573394715666181129101502] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Breast cancer is among the foremost common malignancies and the second leading
cause for cancer-related deaths in females. Varied treatment approaches are projected to cause a
subject matter reduction in the fatality rate. Carcinoma treatment is highly challenging due to
therapeutic resistance and reoccurrence. Several studies have revealed that bioactive compounds
isolated from natural products such as plants, vegetables, and marine origins have a therapeutic
and preventive role in breast carcinoma. Utilization of these bioactive agents in amelioration of
cancer as complementary and alternative therapy increases day by day due to growing scientific
shreds of evidence of the biomedical innovation and clinical trials. Due to the safe nature of these
photochemical investigators are focusing on the investigation of lead compounds from traditional
herbal medicine to discover new lead anticancer agents in the single pure compound. This review
highlights the mechanism of action and future prospects of novel medicinal agents from botanical
sources that have chemoprevention activity against breast carcinoma together with other types of
body cancer. The major bioactive, which are used as a remedy for the prevention and treatment of
breast cancer, is summarized and explored here.
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Affiliation(s)
- Namrata Singh
- Faculty of Pharmacy, Integral University, Dasauli, Kursi Road, Lucknow, Uttar Pradesh 226026, India
| | - Poonam Kushwaha
- Faculty of Pharmacy, Integral University, Dasauli, Kursi Road, Lucknow, Uttar Pradesh 226026, India
| | - Amresh Gupta
- Goel Institute of Pharmacy and Sciences, Near Indira Canal, Faizabad Road, Lucknow, Uttar Pradesh, India
| | - Om Prakash
- Faculty of Pharmacy, Integral University, Dasauli, Kursi Road, Lucknow, Uttar Pradesh 226026, India
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12
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Chen C, Luo L, Gao D, Qu R, Guo Y, Huo J, Su Y. Surgical drainage of lactational breast abscess with ultrasound-guided Encor vacuum-assisted breast biopsy system. Breast J 2019; 25:889-897. [PMID: 31148346 PMCID: PMC6851758 DOI: 10.1111/tbj.13350] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 11/20/2018] [Accepted: 11/20/2018] [Indexed: 12/03/2022]
Abstract
Lactational breast abscess is a serious complication of mastitis and commonly diagnosed in breast-feeding women. The traditional drainage of breast abscess was often performed with incisive technique which may result in prolonged healing time, regular dressings, dressing pain, interfering with breastfeeding and unsatisfactory cosmetic outcome. As minimal invasive alternatives to incisive drainage, needle aspiration or percutaneous catheter placement cannot completely replace incisive drainage for the inability to treat large, multiloculated or chronic abscess. Vacuum-assisted breast biopsy system (VABB) has been successfully applied in the treatment of benign breast diseases with satisfactory cosmetic outcomes. Among VABB devices, EnCor system has some distinctive features that make it an appropriate candidate for the treatment of lactational breast abscesses. In this study, for the first time, we investigated the feasibility, efficacy, and cosmetic results of surgical drainage of lactational breast abscess with US-guided Encor VABB system. Our data suggests this procedure could serve as a promising alternative for women with lactational breast abscess who require incisive intervention with high cure rate, relatively short healing time, low recurrence rate, few complications, satisfactory cosmetics outcome and without interfering with breastfeeding.
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Affiliation(s)
- Chen Chen
- Breast and Thyroid CenterThe First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University)ZunyiChina
| | - Li‐bo Luo
- Breast and Thyroid CenterThe First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University)ZunyiChina
| | - Dan Gao
- Department of UltrasoundThe First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University)ZunyiChina
| | - Rui Qu
- Breast and Thyroid CenterThe First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University)ZunyiChina
| | - You‐ming Guo
- Breast and Thyroid CenterThe First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University)ZunyiChina
| | - Jin‐long Huo
- Breast and Thyroid CenterThe First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University)ZunyiChina
| | - Ying‐ying Su
- Breast and Thyroid CenterThe First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University)ZunyiChina
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13
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Febery A, Bennett I. Sonographic features of inflammatory conditions of the breast. Australas J Ultrasound Med 2019; 22:165-173. [PMID: 34760553 DOI: 10.1002/ajum.12170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Inflammatory conditions of the breast can be a diagnostic challenge, and ultrasound is a proven valuable tool in this setting. In acute infective conditions, ultrasound is often a superior tool to mammography due to the impracticality of applying compression to the breast and the increased parenchymal density of these often younger patients. Although infective processes comprise the majority of inflammatory conditions in the breast, not infrequently other various disease processes can masquerade as infections. In particular, inflammatory breast cancer can be easily misdiagnosed as an infective process and sonography can play an important role in expediting the correct diagnosis. Furthermore, aspiration, drainage and biopsy are frequently required in managing breast inflammation and breast disease generally, and ultrasound is the most practical imaging modality facilitating such interventions. This article provides a review of the ultrasound characteristics of some of the more frequently encountered inflammatory disorders of the breast which span a spectrum of acute to chronic conditions. The various conditions in this report are described in terms of their specific sonographic imaging features as well as pathogenesis, common clinical presentations, and aspects of management are outlined where appropriate.
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Affiliation(s)
- Alice Febery
- Department of Surgery, University of Queensland Princess Alexandra Hospital 199 Ipswich Road Woolloongabba, Brisbane Queensland Australia
| | - Ian Bennett
- Department of Surgery, University of Queensland Princess Alexandra Hospital 199 Ipswich Road Woolloongabba, Brisbane Queensland Australia
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Boakes E, Woods A, Johnson N, Kadoglou N. Breast Infection: A Review of Diagnosis and Management Practices. Eur J Breast Health 2018; 14:136-143. [PMID: 30123878 DOI: 10.5152/ejbh.2018.3871] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 03/08/2018] [Indexed: 11/22/2022]
Abstract
Mastitis is a common condition that predominates during the puerperium. Breast abscesses are less common, however when they do develop, delays in specialist referral may occur due to lack of clear protocols. In secondary care abscesses can be diagnosed by ultrasound scan and in the past the management has been dependent on the receiving surgeon. Management options include aspiration under local anesthetic or more invasive incision and drainage (I&D). Over recent years the availability of bedside/clinic based ultrasound scan has made diagnosis easier and minimally invasive procedures have become the cornerstone of breast abscess management. We review the diagnosis and management of breast infection in the primary and secondary care setting, highlighting the importance of early referral for severe infection/breast abscesses. As a clear guideline on the management of breast infection is lacking, this review provides useful guidance for those who rarely see breast infection to help avoid long-term morbidity.
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Affiliation(s)
- Eve Boakes
- Department of General Surgery, London North West Healthcare NHS Trust, Northwick Park Hospital, Middlesex, London
| | - Amy Woods
- Department of Medicine, Croydon University Hospital, Croydon, London
| | - Natalie Johnson
- Department of General Surgery, London North West Healthcare NHS Trust, Northwick Park Hospital, Middlesex, London
| | - Naim Kadoglou
- Department of General Surgery, London North West Healthcare NHS Trust, Northwick Park Hospital, Middlesex, London
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Clinicodiagnostic management and bacteriological etiology of non-puerperal mastitis in the population of Southern China. JOURNAL OF BIO-X RESEARCH 2018. [DOI: 10.1097/jbr.0000000000000004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Zhang Y, Zhou Y, Mao F, Guan J, Sun Q. Clinical characteristics, classification and surgical treatment of periductal mastitis. J Thorac Dis 2018; 10:2420-2427. [PMID: 29850148 DOI: 10.21037/jtd.2018.04.22] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study aimed to describe the clinical characteristics of periductal mastitis (PDM), propose the practical clinical classification system and evaluate the results of different surgical treatments in different type of PDM patients. Methods A retrospective study was carried out at department of breast surgery, Peking Union Medical College Hospital, Beijing, China. A total of 152 patients with the diagnosis of PDM were reviewed from March 2012 to December 2016. All of the patients underwent surgery. Data were collected regarding clinical manifestation, treatment, and outcomes. Results The median age was 36 years. A subareolar breast mass was the most frequent symptom. The most common clinical manifestations were mass (98.0%), rubefaction (41.1%), nipple retraction (36.8%), abscess (36.8%), skin ulceration (25.7%), and mammary duct fistula (19.1%). Fourteen (9.2%) patients were recurrent PDM at first hospitalization. Eight (5.3%) patients had prolactinoma. Five (3.3%) patients were taking antipsychotic medications. Only four (2.6%) patients were smokers. Eight patients were highly suspected to be breast cancer before surgery. A four-type classification system was first proposed according to clinical manifestations. The different surgeries in each category were evaluated. After 3 years median follow-up, 11 (7.2%) patients got recurrence including two initial recurrent PDM. Conclusions Periductal mastitis is a distinct benign breast condition of unknown etiology. Mass, abscess and fistula are most common manifestations of the disease. Wide surgical excision, fistulectomy and extended excision with transfer of a random breast dermo-glandular flap (BDGF) are effective surgical modalities for different type of PDM.
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Affiliation(s)
- Yanna Zhang
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Yidong Zhou
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Feng Mao
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Jinghong Guan
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
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Zhang X, Grobmyer SR, Wang Y, Sun Q, Huang H. Duct ectasia in an accessory breast successfully treated with a flap technique: a case report. J Thorac Dis 2017; 8:E1585-E1588. [PMID: 28149587 DOI: 10.21037/jtd.2016.12.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Herein, we report a case of duct ectasia in an accessory breast. A 39-year-old, non-lactating Chinese female presented with a recurrent lesion in the right axillary accessory breast. Physical examination and ultrasound revealed an extensive multifocal inflammatory lesion with a size of 10 cm × 7 cm. Antibiotic therapy and a drainage procedure were unsuccessful during the past year. Because of the patient's severe recurrent lesion, we performed an accessory breast excision and then developed an additional flap to achieve primary suture and healing. The outcome was satisfactory. To our knowledge, this is the first case of duct ectasia in an accessory breast reported in China thus far and the first time that a flap technique was used in duct ectasia for complete excision, defect covering and primary healing.
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Affiliation(s)
- Xiaohui Zhang
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China
| | | | | | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China
| | - Hanyuan Huang
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China
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Periductal Mastitis: An Inflammatory Disease Related to Bacterial Infection and Consequent Immune Responses? Mediators Inflamm 2017; 2017:5309081. [PMID: 28182101 PMCID: PMC5274658 DOI: 10.1155/2017/5309081] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 11/20/2016] [Accepted: 12/06/2016] [Indexed: 11/17/2022] Open
Abstract
Periductal mastitis (PDM) is a prolonged inflammatory disease, but the cause of PDM is poorly understood. In the present case control study, 87 PDM and 87 healthy controls were enrolled and the results were evaluated to identify the significant risk factors for PDM. To investigate the roles of bacterial infection and critical cytokines expression, 16S rRNA gene sequencing and bacterial culturing were conducted. We also measured the levels of interferon-γ, interleukin-12A, and interleukin-17A by semiquantitative immunohistochemistry method. In a multivariable logistic regression model, we identified overweight/obesity and late onset of menarche as independent risk factors for PDM. In contrast, age of first birth >27 years had a protective effect. With 16S rRNA gene sequencing, we confirmed bacterial infections were found in all PDM patients, but none of the control patients was positive on the gene expression of 16S rRNA. Our results also demonstrated significant increases of the IFN-γ and IL-12A expression in PDM, but there was no difference in IL-17A expression in these two groups. Taken together, this study suggests that reproductive factors and overweight/obesity are possible predisposing risk factors for PDM. Bacterial infection and the increased expression of some proinflammatory cytokines are associated with the pathogenesis of this disease.
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19
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Recurrent periductal mastitis: Surgical treatment. Surgery 2016; 160:1689-1692. [PMID: 27616631 DOI: 10.1016/j.surg.2016.06.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/20/2016] [Accepted: 06/24/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Recurrent periductal mastitis is a benign breast disorder that often features a mammary fistula that runs between periareolar skin and the ductal mammary system. Due to the high recurrence rate of this disease, its management is controversial. This study was designed to assess the efficacy of fistulectomy (Hadfield operation), particularly with regard to its long-term outcome. METHODS We reviewed all women with recurrent periductal mastitis who underwent the Hadfield operation in the Breast Center in S.Orsola-Malpighi Hospital (Bologna University) from 2005 to 2015. All but one of the patients were heavy smokers and presented with a recurrent periareolar abscess and a periareolar mammary fistula. RESULTS Eighteen women underwent the Hadfield surgical treatment. Mean age at the time of presentation was 42 years; 17 of 18 women smoked >10 cigarettes/d. All patients had a breast ultrasonography or mammography. Half of the patients had undergone antibiotic therapy with one or more prior abscess drainages or another form of operative treatment. All patients who underwent operative treatment had no postoperative events and were satisfied with the cosmetic results. Squamous metaplasia was always present in the specimens. After a median follow-up of 36 months, 2 patients developed a recurrence after a few months; neither had stopped smoking. CONCLUSION Based on our review of the literature and taking into account the results of this study, it seems clear that the best treatment involves a combined total excision of the affected duct and the fistulous tract. Due to the important role of smoking in this disease, it is important to encourage patients to stop smoking.
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20
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Touboul C, Laas E, Rafii A. [Exploration of breast inflammation excluding pregnancy and breastfeeding: Guidelines]. ACTA ACUST UNITED AC 2015; 44:913-20. [PMID: 26527011 DOI: 10.1016/j.jgyn.2015.09.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 09/18/2015] [Indexed: 01/04/2023]
Abstract
Breast inflammation, excluding breast-feeding and pregnancy, is a rare breast pathology. We conducted a PubMed database search of all studies focusing on mastitis or breast inflammation exploration. While the most frequent aetiologies are infectious and inflammatory, inflammatory breast cancer can be diagnosed (LE2). Aetiologic diagnostic is difficult due to the absence of any clinical and imaging specific signs (LE3). The presence of mass, suspect lymph nodes or skin thickening in a woman older than 40 years old should orient toward inflammatory breast cancer (LE3). A suspect lesion must lead to perform a biopsy under sonography (grade A). In the absence of evidence for a malignant pathology after initial evaluation, we recommend starting an antibiotic treatment (grade C) with a clinical follow-up at the end of the treatment (grade B). If the symptoms persist, we recommend a new imaging (± MRI) (grade C) and a biopsy (grade C). Benign inflammatory pathologies may require a biopsy to exclude an inflammatory breast cancer and precise the diagnosis. Their specific management and treatment are presented in detail in the following chapters and may involve steroids.
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Affiliation(s)
- C Touboul
- Service de gynécologie-obstétrique et médecine de la reproduction, centre hospitalier intercommunal de Créteil, faculté de médecine de Créteil UPEC - Paris XII, 40, avenue de Verdun, 94000 Créteil, France; UMR Inserm U965, angiogenèse et recherche translationnelle, 75010 Paris, France.
| | - E Laas
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - A Rafii
- Stem Cell and Microenvironment Laboratory, Weill Cornell Medical College in Qatar (WCMC-Q), Education City, Qatar Foundation, Doha, Qatar
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D’Alfonso TM, Ginter PS, Shin SJ. A Review of Inflammatory Processes of the Breast with a Focus on Diagnosis in Core Biopsy Samples. J Pathol Transl Med 2015; 49:279-87. [PMID: 26095437 PMCID: PMC4508565 DOI: 10.4132/jptm.2015.06.11] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 06/10/2015] [Accepted: 06/11/2015] [Indexed: 12/28/2022] Open
Abstract
Inflammatory and reactive lesions of the breast are relatively uncommon among benign breast lesions and can be the source of an abnormality on imaging. Such lesions can simulate a malignant process, based on both clinical and radiographic findings, and core biopsy is often performed to rule out malignancy. Furthermore, some inflammatory processes can mimic carcinoma or other malignancy microscopically, and vice versa. Diagnostic difficulty may arise due to the small and fragmented sample of a core biopsy. This review will focus on the pertinent clinical, radiographic, and histopathologic features of the more commonly encountered inflammatory lesions of the breast that can be characterized in a core biopsy sample. These include fat necrosis, mammary duct ectasia, granulomatous lobular mastitis, diabetic mastopathy, and abscess. The microscopic differential diagnoses for these lesions when seen in a core biopsy sample will be discussed.
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Affiliation(s)
- Timothy M. D’Alfonso
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Paula S. Ginter
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Sandra J. Shin
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
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Zhang X, Lin Y, Sun Q, Huang H. Dermo-glandular flap for treatment of recurrent periductal mastitis. J Surg Res 2014; 193:738-44. [PMID: 25199569 DOI: 10.1016/j.jss.2014.07.067] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 07/23/2014] [Accepted: 07/31/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Recurrent periductal mastitis (PDM) is usually refractory to medical treatment and normally requires surgical intervention or even mastectomy. This study aimed to evaluate the effectiveness and safety of extended excision with transferring a random breast dermo-glandular flap (BDGF) in the treatment of severe PDM. MATERIALS AND METHODS Between January 2010 and December 2011, 47 patients with recurrent PDM were consecutively and prospectively hospitalized for elective extended excision. A random BDGF was harvested from the ipsilateral breast tissue overlying the pectoralis major muscle and transferred to resurface the breast tissue defect. The donor site wound was closed using interrupted sutures. Main outcome measures included flap survivability, surgical morbidities, and follow-up cosmetic outcome. RESULTS All flaps survived uneventfully and all wounds healed by primary intention. PDM recurred in two patients (2/47, 4.3%) and required second-look surgery. The cosmetic outcome was self-evaluated to be excellent in 31.9% (15/47) of patients, good in 36.2% (17/47), acceptable in 21.3% (10/47), and poor in 10.6% (5/47), respectively. The donor site wounds healed uneventfully with minimal scarring. CONCLUSIONS Extended excision with transferring BDGF is an effective, safe treatment modality for recurrent PDM with a low-risk morbidity and favorable cosmesis.
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Affiliation(s)
- Xiaohui Zhang
- Department of Breast Surgery, Peking Union Medical College Hospital and Chinese Academy of Medical Science, Beijing, China
| | - Yan Lin
- Department of Breast Surgery, Peking Union Medical College Hospital and Chinese Academy of Medical Science, Beijing, China
| | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital and Chinese Academy of Medical Science, Beijing, China.
| | - Hanyuan Huang
- Department of Breast Surgery, Peking Union Medical College Hospital and Chinese Academy of Medical Science, Beijing, China.
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Abstract
Nodular fasciitis is a benign proliferation of myofibroblasts which presents clinically as a rapidly growing mass with nonspecific features on imaging and high cellular activity on histopathology. Nodular fasciitis can be mistaken for malignant fibrous lesions such as soft tissue sarcoma or breast carcinoma when located within breast tissue. This presents a problem for appropriate treatment planning as the natural history of nodular fasciitis is spontaneous regression. We present the mammographic, sonographic, computed tomography, and histopathologic characteristics of nodular fasciitis in a 68 year female initially presenting with a rapidly enlarging right axillary mass.
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Affiliation(s)
- Dejan Samardzic
- Department of Radiology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Alison Chetlen
- Department of Radiology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jozef Malysz
- Department of Pathology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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Kim BS, Lee JH, Kim WJ, Kim DC, Shin S, Kwon HJ, Park JS, Park YM. Periductal mastitis mimicking breast cancer in a male breast. Clin Imaging 2012; 37:574-6. [PMID: 23116730 DOI: 10.1016/j.clinimag.2012.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 09/04/2012] [Indexed: 11/19/2022]
Abstract
Periductal mastitis in a male patient rarely has been reported in the English literature. Herein, we now present a rare case of periductal mastitis mimicking breast cancer, both clinically and radiologically, in a 37-year-old man. Mammogram and sonogram showed a mass with irregular shape, spiculated margin and a nipple retraction, mimicking a male breast cancer. Radiologic and pathologic correlation is provided.
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Affiliation(s)
- Bo Sung Kim
- Department of Radiology, Dong-A University College of Medicine, Busan, Republic of Korea
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Berná-Serna JD, Berná-Mestre JD, Piñero A, Carrascosa MC. Sonographically guided percutaneous intralesional triamcinolone injection: a new treatment for mammillary fistulas: preliminary results. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:617-621. [PMID: 22441919 DOI: 10.7863/jum.2012.31.4.617] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We describe a new procedure, sonographically guided intralesional triamcinolone injection, for the treatment of mammillary fistulas. Six patients with mammillary fistulas were enrolled in this prospective study. Clinical improvement was rapid after the first triamcinolone injection. The initial response to treatment was assessed as complete in 4 cases, and the remaining 2 cases resolved successfully with additional injections. On the basis of the excellent results obtained in this study, it is thought that intralesional triamcinolone injection may be a good alternative to surgery.
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Affiliation(s)
- Juan D Berná-Serna
- Department of Radiology, Virgen de la Arrixaca University Hospital, 30120 El Palmar, Murcia, Spain.
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Sabel MS, Helvie MA, Breslin T, Curry A, Diehl KM, Cimmino VM, Chang AE, Newman LA. Is Duct Excision Still Necessary for All Cases of Suspicious Nipple Discharge? Breast J 2011; 18:157-62. [DOI: 10.1111/j.1524-4741.2011.01207.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gupta N, Agrawal P, Saikia UN, Das A, Srinivasan R, Rajwanshi A, Singh G. Periductal mastitis in a male breast masquerading as lobular carcinoma on fine needle aspiration cytology. Diagn Cytopathol 2011; 40:455-8. [PMID: 21618711 DOI: 10.1002/dc.21707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 02/25/2011] [Indexed: 11/09/2022]
Abstract
Fine needle aspiration cytology (FNAC) is quite successful in identifying specific benign and malignant breast lesions, but its role in the categorization of proliferative breast lesions has not been well defined. Mastitis/ breast abscess can lead to intense inflammatory response; however, its association with epithelial hyperplasia is rarely reported. At times, it may be difficult to differentiate dense lymphoplasmacytic infiltrate from non-Hodgkin's lymphoma. We present a case of periductal mastitis associated with epithelial hyperplasia, presenting as a subaerolar swelling in a male breast, which was misinterpreted as lobular carcinoma on FNAC.
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Affiliation(s)
- Nalini Gupta
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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31
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Berná-Serna JD, Berná-Mestre JD. Follicular occlusion due to hyperkeratosis: A new hypothesis on the pathogenesis of mammillary fistula. Med Hypotheses 2010; 75:553-4. [PMID: 20708341 DOI: 10.1016/j.mehy.2010.07.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 07/17/2010] [Indexed: 11/19/2022]
Affiliation(s)
- Juan D Berná-Serna
- Department of Radiology, Virgen de la Arrixaca University Hospital, 30120-El Palmar (Murcia), Spain.
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32
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Gu B, Miao J, Fa Y, Lu J, Zou S. Retinoic acid attenuates lipopolysaccharide-induced inflammatory responses by suppressing TLR4/NF-kappaB expression in rat mammary tissue. Int Immunopharmacol 2010; 10:799-805. [PMID: 20438866 DOI: 10.1016/j.intimp.2010.04.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 04/01/2010] [Accepted: 04/26/2010] [Indexed: 11/30/2022]
Abstract
The retinoids, a group of natural or synthetic derivatives of vitamin A, exert various anti-neoplastic and immunomodulatory actions. Recent studies have demonstrated that retinoic acid protects rats against lipopolysaccharide (LPS)-induced mastitis, but the mechanism of action is unclear. In the present study, an LPS-induced rat mastitis model and primary cultures of rat mammary epithelial cells were used to investigate the effect of retinoic acid on the TLR4/NF-kappaB signaling pathway. The data indicated that toll-like receptor 4 (TLR4) gene expression reached its peak value earlier in retinoic acid-treated rats than in the control group, and that retinoic acid significantly decreased NF-kappaB DNA binding activity and the level of IL-1beta in the mammary gland. The animal study result was confirmed by an in vitro cell culture system trial. TLR4 protein expression and NF-kappaB DNA binding activity were significantly decreased in primary rat mammary epithelial cells pretreated with 1mumol/l retinoic acid at 1h post-LPS stimulation. IL-1beta gene expression was also significantly decreased at 2, 4 and 8h post-LPS stimulation. These findings demonstrate that direct action by retinoic acid leads to attenuation of the LPS-induced inflammatory response by suppression of the TLR4/NF-kappaB signalling system, thereby providing a novel explanation for the underlying effect proposed for retinoic acid in the protection of mammary tissue during LPS-induced acute mastitis.
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Affiliation(s)
- Beibei Gu
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, Jiangsu Province 210095, China
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33
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Kamal RM, Hamed ST, Salem DS. Classification of Inflammatory Breast Disorders and Step by Step Diagnosis. Breast J 2009; 15:367-80. [DOI: 10.1111/j.1524-4741.2009.00740.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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34
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Croce S, Bretz-Grenier MF, Mathelin C. [Most common benign epithelial breast diseases: diagnosis, treatment and cancer risk]. ACTA ACUST UNITED AC 2008; 36:788-99. [PMID: 18650113 DOI: 10.1016/j.gyobfe.2008.02.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Accepted: 02/26/2008] [Indexed: 11/28/2022]
Abstract
As a consequence of breast imaging development and increased interventional radiology, benign epithelial breast diseases (BEBD) represent a growing percentage of breast pathology diagnoses. BEBD include numerous entities such as cysts, fibrosis, adenosis, duct ectasia, which require neither surgery nor follow-up. Some BEBD have to be individualized (radial scars, papillomas, complex sclerosing adenosis, lobular intraepithelial neoplasia, flat epithelial atypia, atypical hyperplasia), being preinvasive lesions or markers of increased breast cancer risk, or being associated with suspect radiological aspect. BEBD should be managed in a pluridisciplinar way and correctly diagnosed by percutaneous biopsies or surgical specimens. The goals of surgery vary according to lesions. It always allows a complete surgical specimen analysis and therefore a search for atypical or cancerous cells. Surgery can also have a preventive role by reducing the risk of potential malignant transformation. Finally, it enables in some cases the excision of a radiologically suspect mass. So the aim of this review is to give a clinical and morphological description of most common BEBD, underlying their cancer risk, specific diagnosis, therapeutic, follow-up and psychological repercussions.
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Affiliation(s)
- S Croce
- Département de pathologie, hôpital de Hautepierre, CHRU de Strasbourg, avenue Molière, 67200 Strasbourg cedex, France.
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35
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Witzel K, Riester U, Arps H, Kronsbein H, Benhidjeb T. [Mastitis with abscesses caused by esophageal fistula]. Wien Klin Wochenschr 2008; 120:118-20. [PMID: 18322774 DOI: 10.1007/s00508-007-0836-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Accepted: 06/20/2007] [Indexed: 12/01/2022]
Abstract
Mastitis originating from a fistula from intramediastinal esophago-jejunostomy following gastrectomy is an extremely rare event. We report on a 79-year old woman who had undergone repeated surgery due to recurrent breast abscesses for more than a year. The patient's history showed gastrectomy and esophago-jejunostomy two years earlier, with subsequent undetected insufficiency of the anastomosis and inflammation of the breast. The reason for the recurrent breast abscesses was found intraoperatively to be due to a fistula which could be followed to the anastomosis. Histologically, vegetable tissue (food particles) was detected in the fistula specimen. Detailed assessment of the patient's history could have helped detecting the circumstances when the first breast abscess appeared. Exact preoperative diagnosis and accurate wound débridement could have revealed the real cause of the recurrent abscess formation much earlier.
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Affiliation(s)
- Kai Witzel
- Chirurgische Universitätsklinik, PMU Salzburg, Austria.
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Abstract
Nipple discharge is the third most common breast complaint after breast pain and breast mass. It is most often a benign process. Up to 50% women in their reproductive years can express one or more drops of fluid from the breast. Nipple discharge can be of several types, including milky, multicolored and sticky, purulent, clear and watery, yellow or serous, pink or serosanguinous, bloody or sanguinous. The characteristics of the nipple discharge help in the early diagnosis and management of breast disease. The most common cause of pathologic nipple discharge is a benign papilloma followed by ductal ectasia, and the least likely is carcinoma. Most nipple discharges are the result of a clinically insignificant benign process; therefore, less invasive, nonsurgical diagnostic modalities have been explored to reduce the need for surgical intervention. The evaluation and diagnosis of nipple discharge is important for the early detection of carcinoma, when present; and, in the case of benign disease, it is necessary to stop the incommodious discharge.
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Affiliation(s)
- Aneela N Hussain
- Department of Family Medicine, State University of New York-Health Science Center, Brooklyn, New York 11203, USA.
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Abstract
Mammillary fistulas are uncommon, but when they occur they cause prolonged morbidity. The etiology and management strategies are less well established. The purpose of this study is to evaluate the etiologic factors and assess the results of surgical treatment. It is a retrospective study of all patients treated for mammillary fistula from 1990 to 2001. The clinical data, including complications of surgical treatment, were collected from medical records. Fistulas were segregated into simple and complex fistulas before analyzing the results of surgical treatment. Thirty-five patients were treated during this period. A history of either drainage of a subareolar abscess or spontaneous rupture of an inflammatory mass preceded the development of mammillary fistula in the majority of patients. Previous Hadfield's procedure for duct ectasia contributed to the development of fistula in seven patients. Seventeen patients presented with simple fistula. A large proportion of them were treated by total duct excision in recent years, with a higher rate of recurrence (4/6). Eighteen patients presented with complex fistulas; two of them had recurrences following surgical treatment. The overall recurrence rate was 23%. The majority of the patients showed features of periductal mastitis on histologic examination. Postoperative wound infection was positively associated with fistula recurrence. The best management of mammillary fistula remains a problem. Simple fistulas should be treated by fistulectomy and primary closure. Total duct excision should be reserved for complex fistulas. Postoperative wound infection is also a major factor in fistula recurrence. All patients should receive antibiotics. Surgery for duct ectasia has caused fistulas in 20% of cases in our study, raising the issue of restricting total duct excision to more severe forms of the disease. Mammillary fistulas should be treated more appropriately in a specialized breast unit with particular interest in benign breast disease.
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Affiliation(s)
- Satheesha Hanavadi
- Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom
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Versluijs-Ossewaarde FNL, Roumen RMH, Goris RJA. Subareolar Breast Abscesses: Characteristics and Results of Surgical Treatment. Breast J 2005; 11:179-82. [PMID: 15871702 DOI: 10.1111/j.1075-122x.2005.21524.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Our objective was to describe the characteristics of subareolar breast abscesses and to analyze the results of surgical treatment in relation to the prevention of recurrences. Almost 70% of patients smoked more than 10 cigarettes a day. The recurrence rate after excision of the lactiferous ducts was 28% and after management without excision of the lactiferous ducts was 79% (p < 0.001). Gram-positive bacteria were isolated more frequently in primary subareolar breast abscesses (not significant). Anaerobic microorganisms were more frequently cultured in recurring subareolar breast abscesses (p = 0.02). Definitive treatment of subareolar breast abscesses should consist of excision of the affected lactiferous ducts.
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Furuhira C, Ohshima A, Shimada K, Kuroki S, Nakano K, Ishikawa M, Yamamoto H, Tanaka M. A Case of Breast Cholesterol Granuloma Accompanied by Cancer. Breast Cancer 2004; 11:210-3. [PMID: 15550870 DOI: 10.1007/bf02968304] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cholesterol granuloma of the breast is a very rare benign disease with clinical and imaging features that are often indistinguishable from cancer preoperatively. We report a case of breast cholesterol granuloma accompanied by cancer. The patient was a 78-year-old woman who complained of a lump in her right breast. Mammography and ultrasonography showed a well-circumscribed mass. Fine needle aspiration cytology showed many cholesterol crystals and inflammatory cells without malignancy. With a diagnosis of cholesterol granuloma, tumor extirpation was performed. Histopathologic examination revealed cholesterol granuloma together with breast cancer, and additional partial mastectomy was subsequently performed. It is noted that breast cholesterol granuloma could be accompanied by cancer.
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Affiliation(s)
- Chizu Furuhira
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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40
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Berna-Serna JD, Madrigal M, Berna-Serna JD. Percutaneous management of breast abscesses. An experience of 39 cases. ULTRASOUND IN MEDICINE & BIOLOGY 2004; 30:1-6. [PMID: 14962601 DOI: 10.1016/j.ultrasmedbio.2003.10.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2003] [Revised: 09/17/2003] [Indexed: 05/24/2023]
Abstract
This is a review of our experience with percutaneous drainage by means of needle aspiration or catheter drainage of breast abscesses under ultrasound (US) guidance, and a suggested management algorithm. A retrospective study of the 39 patients (36 women, 3 men; mean age: 28.9 years) with breast abscesses who were treated by percutaneous US-guided procedures over a period of 13 years (1989 to 2002) was carried out. Of the 36 women, 34 were nonlactating and two lactating. Needle aspiration was used in the cases of fluid collections < or = 3 cm and catheter drainage in fluid collections of > 3 cm. Postdrainage care and US evolutive controls were carried out on an outpatient basis. Fine-needle aspiration cytology was performed in masses unresolved after postdrainage. Mammography was performed in patients over 30 years old. In all cases, US examination revealed images of fluid collection. A single needle aspiration was sufficient in 19 cases; 3 patients needed a second aspiration to resolve the breast abscess. A total of 15 cases were resolved by means of percutaneous catheter drainage. In 2 of the 17 patients who underwent catheter drainage, the mass persisted postdrainage; histologic findings showed a chronic abscess requiring surgical intervention in one and a breast carcinoma in the second. Mean follow-up was 8.4 months. Recurrence of breast abscess occurred in 4 patients, and these were resolved by surgical excision. Percutaneous drainage procedures in breast abscesses are a safe and effective alternative to incision and drainage. Needle aspiration is employed in cases of small abscesses and catheter drainage in abscesses larger than 3 cm. Although, in chronic abscesses, the treatment of choice is surgical excision, percutaneous drainage remains as an intermediate therapeutic option.
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41
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Berná JD, Sánchez J, Madrigal M, Ródenas J, Berná JD. An Alternative Approach to the Treatment of Mammary Duct Fistulas: A Combination of Microwave and Ultrasound. Am Surg 2002. [DOI: 10.1177/000313480206801014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Between 1994 and 1999, 11 women with recurrent mammary duct fistula underwent nonsurgical treatment with microwave and ultrasound. An initial ultrasonographic examination was performed during the recurrence of mammary duct fistula, and in ten cases it revealed a small superficial periareolar anechoic, hypoechoic, or heterogenic lesion with poorly defined edges and without posterior reinforcement (marked distal sound enhancement). Findings indicated an extraglandular inflammatory process; duct ectasia was not seen in any of the 11 patients. A combination of microwave and ultrasound was administered on an outpatient basis for 20 days. Clinical improvement was rapid after the first few sessions of treatment. In nine of the 11 patients there has been no recurrence during more than 2 years of follow-up. The two current episodes were resolved by a second application of the same treatment. In one of those patients (with recurrence at 6 months) an infiltration of steroids was also administered, and this patient is without recurrence after 23 months' follow-up.
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Affiliation(s)
- Juan D. Berná
- Departments of Radiology, University General Hospital, Murcia, Sapin
| | - Juan Sánchez
- Physiotherapy, University General Hospital, Murcia, Sapin
| | | | | | - Juan D. Berná
- Departments of Radiology, University General Hospital, Murcia, Sapin
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Abstract
The primary care physician usually is the first person to see patients complaining of breast pain or nipple discharge. The diagnosis of lactational mastitis is evident because of the history The major consideration is prompt and effective treatment and close follow-up evaluation. Failure to respond to appropriate therapy should suggest abscess formation, and prompt intervention is required. Any diagnosis of mastitis in a patient who is not lactating should be viewed with suspicion. Although several benign and non-life-threatening conditions have been discussed herein, inflammatory breast cancer must always be considered.
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Affiliation(s)
- Douglas J Marchant
- Department of Obstetrics and Gynecology, and the Breast Health Center, Women and Infants Hospital, Providence, Rhode Island 02905-2499, USA
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43
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Imperiale A, Zandrino F, Calabrese M, Parodi G, Massa T. ABSCESSES OF THE BREAST. US-guided serial percutaneous aspiration and local antibiotic therapy after unsuccessful systemic antibiotic therapy. Acta Radiol 2001. [DOI: 10.1034/j.1600-0455.2001.042002161.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Whitaker-Worth DL, Carlone V, Susser WS, Phelan N, Grant-Kels JM. Dermatologic diseases of the breast and nipple. J Am Acad Dermatol 2000; 43:733-51; quiz 752-4. [PMID: 11050577 DOI: 10.1067/mjd.2000.109303] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Breast and nipple skin is commonly affected by various inflammatory and neoplastic processes. Despite this fact, many physicians are unaware of the spectrum of diseases that can involve this area. Because breast and nipple skin represents a cosmetically, sexually, and functionally important entity to most patients, awareness of these disease entities is invaluable. This article reviews the normal anatomy of the breast, cutaneous manifestations of neoplastic processes that can present in these areas, and common inflammatory diseases of the breast and nipple skin.
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Affiliation(s)
- D L Whitaker-Worth
- University of Connecticut School of Medicine, Department of Dermatology, Farmington, USA.
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45
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46
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Al Gari M, Preece P. Sequelae of subareolar mammary duct excision. Breast 1998. [DOI: 10.1016/s0960-9776(98)90111-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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47
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48
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49
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50
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Abstract
The incidence of male duct ectasia (periductal mastitis) is extremely rare, only eight cases having been reported. The underlying cause (as in females) is uncertain. Two cases in HIV positive males of recurrent unilateral nipple lesions are reported with histology consistent with duct ectasia. At presentation neither patient had an AIDS defining illness. An impaired immunity secondary to HIV infection may result in an increased susceptibility to repeated nipple infections, and the clinical as well as histological features of duct ectasia. The consideration of HIV infection in future cases of male duct ectasia may be warranted.
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Affiliation(s)
- A M Downs
- Department GenitoUrinary Medicine, St Marys Hospital, London, UK
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