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Wang X, He X, Liu J, Zhang H, Wan H, Luo J, Yang J. Immune pathogenesis of idiopathic granulomatous mastitis: from etiology toward therapeutic approaches. Front Immunol 2024; 15:1295759. [PMID: 38529282 PMCID: PMC10961981 DOI: 10.3389/fimmu.2024.1295759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 02/22/2024] [Indexed: 03/27/2024] Open
Abstract
Idiopathic granulomatous mastitis (IGM) is a noncancerous, chronic inflammatory disorder of breast with unknown causes, posing significant challenges to the quality of life due to its high refractoriness and local aggressiveness. The typical symptoms of this disease involve skin redness, a firm and tender breast mass and mastalgia; others may include swelling, fistula, abscess (often without fever), nipple retraction, and peau d'orange appearance. IGM often mimics breast abscesses or malignancies, particularly inflammatory breast cancer, and is characterized by absent standardized treatment options, inconsistent patient response and unknown mechanism. Definite diagnosis of this disease relies on core needle biopsy and histopathological examination. The prevailing etiological theory suggests that IGM is an autoimmune disease, as some patients respond well to steroid treatment. Additionally, the presence of concurrent erythema nodosum or other autoimmune conditions supports the autoimmune nature of the disease. Based on current knowledge, this review aims to elucidate the autoimmune-favored features of IGM and explore its potential etiologies. Furthermore, we discuss the immune-mediated pathogenesis of IGM using existing research and propose immunotherapeutic strategies for managing this condition.
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Affiliation(s)
- Xiaoli Wang
- Breast Center, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiujing He
- Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Tumor Targeted and Immune Therapy, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Junzhi Liu
- West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Haiyan Zhang
- Department of Breast Surgery, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, China
| | - Hangyu Wan
- Department of Breast Surgery, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, China
| | - Jing Luo
- Department of Breast Surgery, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, China
| | - Jiqiao Yang
- Breast Center, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
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Esmaeil NK, Salih AM, Hammood ZD, Pshtiwan LR, Abdullah AM, Kakamad FH, Abdullah HO, Ahmed GS, Abdalla BA, Salih RQ. Clinical, microbiological, immunological and hormonal profiles of patients with granulomatous mastitis. Biomed Rep 2023; 18:41. [PMID: 37325183 PMCID: PMC10265128 DOI: 10.3892/br.2023.1624] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/24/2023] [Indexed: 06/17/2023] Open
Abstract
Various studies on the etiology and other aspects of granulomatous mastitis (GM) have been performed; however, a lot of controversies have arisen. The present study aimed to present the clinicopathological findings and identify the sensitivity and resistance of isolated bacteria in patients with GM. In this cross-sectional study 63 female patients with a confirmed histopathological diagnosis of GM were included. A core needle biopsy was conducted for the patients to obtain a sample for histopathological examination and bacterial culture. In total, 46 types of antibiotics were used to determine the sensitivity and resistance of each isolated bacterial species. All the medical and clinical records of the patients were acquired through the completion of a questionnaire form in person or, if necessary, through the evaluation of their medical records in the database of the relevant center. The majority of the patients were in the premenopausal or perimenopausal period. GM was unilateral in 58.7% of the patients. The most common symptom was pain, followed by fever and chills. The mean ranges of the erythrocyte sedimentation rate, C-reactive protein, IL-6, IL-17, C5a, white blood count, neutrophil-to-lymphocyte ratio, and prolactin tests were significantly elevated in comparison to the normal ranges. In total, nine different bacterial species were isolated from the bacterial culture of the core biopsy samples, and 50% of the isolated bacterial species were sensitive to trimethoprim-sulfamethoxazole. Since there is no consensus on the etiology of GM, any additional studies related to this aspect expand the current understanding of this puzzling condition.
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Affiliation(s)
- Nawzad K. Esmaeil
- Department of Medical Laboratory Technology, Kalar Technical College, Sulaimani Polytechnic University, Sulaymaniyah, Kurdistan 46000, Iraq
| | - Abdulwahid M. Salih
- Department of Scientific Affairs, Smart Health Tower, Sulaymaniyah, Kurdistan 46000, Iraq
- College of Medicine, University of Sulaimani, Sulaymaniyah, Kurdistan 46000, Iraq
| | - Zuhair D. Hammood
- Department of Scientific Affairs, Smart Health Tower, Sulaymaniyah, Kurdistan 46000, Iraq
| | - Lana R.A. Pshtiwan
- Department of Scientific Affairs, Smart Health Tower, Sulaymaniyah, Kurdistan 46000, Iraq
| | - Ari M. Abdullah
- Department of Scientific Affairs, Smart Health Tower, Sulaymaniyah, Kurdistan 46000, Iraq
| | - Fahmi H. Kakamad
- Department of Scientific Affairs, Smart Health Tower, Sulaymaniyah, Kurdistan 46000, Iraq
- College of Medicine, University of Sulaimani, Sulaymaniyah, Kurdistan 46000, Iraq
- Kscien Organization, Sulaymaniyah, Kurdistan 46000, Iraq
| | - Hiwa O. Abdullah
- Department of Scientific Affairs, Smart Health Tower, Sulaymaniyah, Kurdistan 46000, Iraq
- Kscien Organization, Sulaymaniyah, Kurdistan 46000, Iraq
| | - Gasha S. Ahmed
- Kscien Organization, Sulaymaniyah, Kurdistan 46000, Iraq
| | - Berun A. Abdalla
- Department of Scientific Affairs, Smart Health Tower, Sulaymaniyah, Kurdistan 46000, Iraq
- Kscien Organization, Sulaymaniyah, Kurdistan 46000, Iraq
| | - Rawezh Q. Salih
- Department of Scientific Affairs, Smart Health Tower, Sulaymaniyah, Kurdistan 46000, Iraq
- Kscien Organization, Sulaymaniyah, Kurdistan 46000, Iraq
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Arnott W, Leong G, Davis A, Diab J, Clement Z. Eosinophilic mastitis: a rare benign inflammatory condition and review of the literature. J Surg Case Rep 2022; 2022:rjac456. [PMID: 36245561 PMCID: PMC9556265 DOI: 10.1093/jscr/rjac456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/07/2022] [Indexed: 11/12/2022] Open
Abstract
We report the case of a 53-year-old nulliparous female presenting with a 9-month history of recurrent mastitis and a retro-areolar lesion. Histological assessment showed an inflammatory infiltrate predominantly composed of eosinophils without evidence of malignant changes. The patient was diagnosed with eosinophilic mastitis and commenced on a course of oral steroids with good effect. This case will outline the pathology, clinical manifestations and diagnosis of eosinophilic mastitis alongside a review of the literature.
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Affiliation(s)
- William Arnott
- Correspondence address. The Tweed Hospital, Powell St, NSW, Australia. E-mail: ; Tel: +61297228000
| | - Gregory Leong
- The Tweed Hospital, Department of General Surgery, Tweed Heads, New South Wales, Australia,Bond University, School of Medicine, Robina, Queensland, Australia
| | - Arie Davis
- The Tweed Hospital, Department of General Surgery, Tweed Heads, New South Wales, Australia,University of New South Wales, School of Medicine, Kensington, New South Wales, Australia
| | - Jason Diab
- The Tweed Hospital, Department of General Surgery, Tweed Heads, New South Wales, Australia,John Flynn Private Hospital, Departmemnt of General Surgery, Tugun, Queensland, Australia,University of Notre Dame, School of Medicine, Darlinghurst, NSW, Australia,University of New South Wales, School of Medicine, Kensington, New South Wales, Australia
| | - Zackariah Clement
- The Tweed Hospital, Department of General Surgery, Tweed Heads, New South Wales, Australia,John Flynn Private Hospital, Departmemnt of General Surgery, Tugun, Queensland, Australia
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Lalonde KM, Black C, Lam JC. Principles of empiric antimicrobial usage and dosing: Lessons learned. Clin Case Rep 2022; 10:e05594. [PMID: 35340652 PMCID: PMC8929268 DOI: 10.1002/ccr3.5594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/01/2022] [Accepted: 03/06/2022] [Indexed: 11/16/2022] Open
Abstract
A lack of clinical response to empiric antimicrobials behooves the clinician to reflect further on diagnostic considerations. When prescribing antibiotics, determining the correct dose, most optimal route of administration, and considering the pharmacokinetic properties of the drug with respect to clinical and patient factors are crucial. Improving antibiotic usage is paramount. Antibiotic prescribing is a purposeful process, requiring a clinical indication, determination of the optimal drug dosage/route of administration, and consideration of clinical pharmacokinetics in a patient.
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Affiliation(s)
| | - Cameron Black
- Faculty of Pharmacy & Pharmaceutical Sciences University of Alberta Edmonton Alberta Canada
| | - John C. Lam
- Department of Medicine University of Calgary Calgary Alberta Canada
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