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Mannix J, Duke H, Almajnooni A, Ongkeko M. Imaging the Male Breast: Gynecomastia, Male Breast Cancer, and Beyond. Radiographics 2024; 44:e230181. [PMID: 38752766 DOI: 10.1148/rg.230181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
The number of men undergoing breast imaging has increased in recent years, according to some reports. Most male breast concerns are related to benign causes, most commonly gynecomastia. The range of abnormalities typically encountered in the male breast is less broad than that encountered in women, given that lobule formation rarely occurs in men. Other benign causes of male breast palpable abnormalities with characteristic imaging findings include lipomas, sebaceous or epidermal inclusion cysts, and intramammary lymph nodes. Male breast cancer (MBC) is rare, representing up to 1% of breast cancer cases, but some data indicate that its incidence is increasing. MBC demonstrates some clinical features that overlap with those of gynecomastia, including a propensity for the subareolar breast. Men with breast cancer tend to present at a later stage than do women. MBC typically has similar imaging features to those of female breast cancer, often characterized by an irregular mass that may have associated calcifications. Occasionally, however, MBC has a benign-appearing imaging phenotype, with an oval shape and circumscribed margins, and therefore most solid breast masses in men require tissue diagnosis. Histopathologic evaluation may alternatively reveal other benign breast masses found in men, including papillomas, myofibroblastomas, and hemangiomas. Radiologists must be familiar with the breadth of male breast abnormalities to meet the rising challenge of caring for these patients. ©RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Jaimee Mannix
- From the Department of Radiology, Breast Imaging Section, Mallinckrodt Institute of Radiology (J.M., H.D.) and Department of Pathology (A.A., M.O.), Washington University in St. Louis School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110
| | - Heather Duke
- From the Department of Radiology, Breast Imaging Section, Mallinckrodt Institute of Radiology (J.M., H.D.) and Department of Pathology (A.A., M.O.), Washington University in St. Louis School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110
| | - Abdullah Almajnooni
- From the Department of Radiology, Breast Imaging Section, Mallinckrodt Institute of Radiology (J.M., H.D.) and Department of Pathology (A.A., M.O.), Washington University in St. Louis School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110
| | - Martin Ongkeko
- From the Department of Radiology, Breast Imaging Section, Mallinckrodt Institute of Radiology (J.M., H.D.) and Department of Pathology (A.A., M.O.), Washington University in St. Louis School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110
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2
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Alzayyat R, Bokhari D, Almuhanna A, Al-Maghrebi D. Male breast abscess: A rare entity. Radiol Case Rep 2024; 19:1122-1127. [PMID: 38259713 PMCID: PMC10801142 DOI: 10.1016/j.radcr.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/04/2023] [Accepted: 12/09/2023] [Indexed: 01/24/2024] Open
Abstract
Breast abscess in males is a rare condition, which accounts for 1%-3% of all documented breast diseases. Males with certain risk factors may develop a breast abscess. The ultrasonographic, mammographic, and pathological characteristics of this case will be highlighted in the report. A 51-year-old morbidly obese Saudi male who is a 160-pack-years smoker presented to our surgical clinic complaining of a right breast mass that presented a long time ago and was changing in size. The mass was painless until 5 days prior to presentation. On physical examination, a firm nonmobile 3 × 4 cm mass was felt at 10-12-o'clock, 1 cm away from the nipple. A bilateral X-ray mammogram and ultrasound were performed with fine needle aspiration and culture. The mammogram of the right breast showed a well-circumscribed subareolar mass with equal density, and it was also associated with overlying skin thickening and relative breast parenchymal edema. The fine needle aspiration grossly showed yellowish-green turbid content followed by turbid blood. The anaerobic culture results showed the gram-positive cocci, Finegoldia Magna. The patient was then instructed to take an antibiotic accordingly and return after 1 week. Fine needle aspiration and culture were performed again after antibiotics and grossly showed 2-3 cc of pus without any growth in culture. Male breast disorders are typically benign, with gynecomastia being the most prevalent, and malignancy being the most serious despite its rarity. Breast abscesses are a challenging clinical condition, and radiologists have a pivotal role in evaluation and follow-up of these lesions.
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Affiliation(s)
- Remah Alzayyat
- College of Medicine, Imam Abdulrahman Bin Faisal University, Eastern Province, Dammam, P.O Box:1982, 31441, Saudi Arabia
| | - Danah Bokhari
- College of Medicine, Imam Abdulrahman Bin Faisal University, Eastern Province, Dammam, P.O Box:1982, 31441, Saudi Arabia
| | - Afnan Almuhanna
- Department of Radiology, King Fahd Hospital of The University, Bashar Ibn Burd St, Al Aqrabiyah, Al Khobar 34445, Saudi Arabia
| | - Deena Al-Maghrebi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Eastern Province, Dammam, P.O Box:1982, 31441, Saudi Arabia
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3
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Ammann AM, Pratt CG, Lewis JD, Ahmad SA, Shaughnessy E, Heelan AA. Breast infections: A review of current literature. Am J Surg 2024; 228:78-82. [PMID: 37949727 DOI: 10.1016/j.amjsurg.2023.10.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023]
Abstract
Breast infections are common, affect women of all ages, and are associated with significant morbidity. Despite overall prevalence, treatment varies significantly based on provider or institution and no central treatment guidelines exist to direct the management of breast infections. This article provides a summary of the current trends in management of breast infections. The etiology, epidemiology, risk factors, presentation, diagnosis, and treatment of mastitis and breast abscesses (and their relative subdivisions) are explored based on the current literature. Trends in microbiology are reviewed and an approach to antibiotic coverage is proposed. Overall, there is a lack of randomized-controlled trials focused on the treatment of breast infections. This has resulted in an absence of clinical practice guidelines for the management of breast abscesses and variable practice patterns. The development of best-care protocols or pathways could provide more uniformity in care of breast infections.
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Affiliation(s)
- Allison M Ammann
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA.
| | - Catherine G Pratt
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA.
| | - Jaime D Lewis
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA.
| | - Syed A Ahmad
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA.
| | - Elizabeth Shaughnessy
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA.
| | - Alicia A Heelan
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA.
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4
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Pictorial Review of Male Breast Disease. CURRENT BREAST CANCER REPORTS 2023. [DOI: 10.1007/s12609-023-00482-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
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5
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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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6
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Stevenson DR, Das S, Lambourne J, Ledwidge SFC, Johnson L, Rosmarin C. Corynebacterium kroppenstedtii breast abscesses in context, a retrospective cohort study. J Med Microbiol 2022; 71. [PMID: 36748506 DOI: 10.1099/jmm.0.001616] [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] [Indexed: 12/23/2022] Open
Abstract
Corynebacterium kroppenstedtii breast abscesses and granulomatous mastitis have gained increased recognition in the 20 years since their association was first described. No studies to date have described this organism in the context of all breast abscess pathogens. We retrospectively reviewed 160 community-acquired breast abscess samples from 135 patients in a 3 year period, describing the organisms isolated along with risk factors, site of infection and outcomes. We compared patient subgroups with acute and chronic abscesses, the latter defined as having a requirement for repeat aspiration more than 1 month apart. The prevalence of C. kroppenstedtii breast abscesses was 8 % in all patients (11/135), rising to 32 % in chronic abscesses (10/31), but only 1 % in acute abscesses (1/104; P<0.01). Only 10 % (1/10) of patients with C. kroppenstedtii chronic abscesses were smokers, whereas 75 % of patients (15/20) with non-C. kroppenstedtii chronic abscesses were smokers (P=0.01). C. kroppenstedtii should be considered in recurrent and prolonged infections, especially in non-smokers, and diagnostic methods altered accordingly. Identifying C. kroppenstedtii provides diagnostic clarity and alters management with recommendations for longer courses of treatment using non-beta-lactam antibiotics.
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Affiliation(s)
- Daniel R Stevenson
- Department of Medical Microbiology, Division of Infection, Barts Health NHS Trust, London, UK
| | - Satya Das
- Department of Medical Microbiology, Division of Infection, Barts Health NHS Trust, London, UK.,Queen Mary University of London, London E1 4NS, UK
| | - Jonathan Lambourne
- Department of Medical Microbiology, Division of Infection, Barts Health NHS Trust, London, UK
| | - Serena F C Ledwidge
- Department of Breast Surgery, Division of Surgery, Barts Health NHS Trust, London, UK
| | - Laura Johnson
- Department of Breast Surgery, Division of Surgery, Barts Health NHS Trust, London, UK
| | - Caryn Rosmarin
- Department of Medical Microbiology, Division of Infection, Barts Health NHS Trust, London, UK
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7
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Beaumont AL, Peiffer-Smadja N. Antibiothérapie dans la prise en charge des abcès du sein. IMAGERIE DE LA FEMME 2022. [DOI: 10.1016/j.femme.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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8
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Bartolomé-Álvarez J, Solves-Ferriz V. Microbiology of breast abscesses. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:479-482. [PMID: 35729052 DOI: 10.1016/j.eimce.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/24/2020] [Accepted: 01/05/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Treatment of breast abscesses is based on drainage and antibiotic therapy directed at the bacteria causing the infection. The aim of this study was to know the etiological agents of breast abscesses. METHODS Patients who had a culture-positive breast abscess between September 2015 and January 2020 were included in the study. Culture results were consulted in the laboratory database. It was collected from medical records if the patients presented the following risk factors: breastfeeding, diabetes or smoking. Abscesses secondary to surgical wound infection were excluded. RESULTS Sixty patients were included, 58 women and 2 men. Staphylococcus aureus was the most frequent agent in lactating women. Anaerobic bacteria were isolated in 28 (61%) of 46 abscesses in non-lactating patients. In non-lactating patients, the frequency of anaerobes in abscesses was lower in diabetics than in the rest (0/5 vs 26/38; P = .013). In non-lactating and non-diabetic patients, the proportion of abscesses with anaerobes was higher in smokers than in non-smokers (21/24 vs 5/14; P = .003). Aerobic gram-positive cocci were the most frequent agents in diabetics. CONCLUSION Anaerobes were the most frequent agents, followed by S. aureus. The etiology of breast abscesses varied with the risk factors studied.
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Affiliation(s)
| | - Verónica Solves-Ferriz
- Servicio de Microbiología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
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9
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Aboud A, Smith A, Gumbs S, Ramcharan A. Prevotella bivia: A Rare Cause of Zuska’s Breast Disease. Cureus 2022; 14:e28904. [PMID: 36225524 PMCID: PMC9541477 DOI: 10.7759/cureus.28904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 11/05/2022] Open
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10
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Dalci K, Gumus S, Saritas AG, Gul MO, Rencuzogullari A, Akcam AT, Ulku A, Ergin M, Sakman G. Modified techniques versus Hadfield's procedure in patients with periductal mastitis. BMC Surg 2022; 22:40. [PMID: 35120473 PMCID: PMC8817489 DOI: 10.1186/s12893-022-01496-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 01/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Periductal mastitis (PM) is a rare disease characterized by chronic inflammation of the terminal mammary ducts. Complete removal of terminal lactiferous ducts with Hadfield procedure is a previously defined technique in treatment but carries various complications risks. This study aims to evaluate the effectiveness of modified techniques in the treatment of PM. METHODS Twenty women who underwent surgery due to PM between January 2012 and December 2019 were retrospectively analyzed. Types of PM were determined. All patients were operated on with three different incisions [Hadfield's operation with periareolar incision (n:11), periareolar combined radial incision (n:7), and round block incision (n:2)]. RESULTS The mean age was 37.5 ± 6.5 years (range: 24-49). Sixty percent of patients had type 3 PM. In Hadfield's procedure, NAC retraction (n:2), seroma (n:1), and hematoma (n:1) were seen. In the periareolar incision combined radial incision group only one patient had complications (seroma) and none in the round block method. Follow-up was 12 ± 1.5 months and disease relapse occurred in two patients in the Hadfield group. Patients who underwent round block were more satisfied with the appearance of the nipple. CONCLUSIONS In the treatment of PM, the main principle of surgical treatment is the excision of the affected canal with a clear margin. Apart from the classical Hadfield procedure, the round block method and periareolar combined radial incision techniques can be performed in the treatment of PM.
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Affiliation(s)
- Kubilay Dalci
- Department of General Surgery, Cukurova University, Sarıcam, 01330, Adana, Turkey
| | - Serdar Gumus
- Department of Surgical Oncology, Cukurova University, Sarıcam, 01330, Adana, Turkey.
| | - Ahmet Gokhan Saritas
- Department of General Surgery, Cukurova University, Sarıcam, 01330, Adana, Turkey
| | - Mehmet Onur Gul
- Department of Surgical Oncology, Cukurova University, Sarıcam, 01330, Adana, Turkey
| | - Ahmet Rencuzogullari
- Department of General Surgery, Cukurova University, Sarıcam, 01330, Adana, Turkey
| | - Atilgan Tolga Akcam
- Department of General Surgery, Cukurova University, Sarıcam, 01330, Adana, Turkey
| | - Abdullah Ulku
- Department of General Surgery, Cukurova University, Sarıcam, 01330, Adana, Turkey
| | - Melek Ergin
- Department of Pathology, Cukurova University Adana, Sarıcam, 01330, Adana, Turkey
| | - Gurhan Sakman
- Department of General Surgery, Cukurova University, Sarıcam, 01330, Adana, Turkey
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11
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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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12
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Sunil krishna, Shenoy PA, Priyanka KS, Vishwanath S. “Breast abscess in a male patient due to Finegoldia magna and Bifidobacterium scardovii: An unusual entity”. Anaerobe 2022; 75:102536. [DOI: 10.1016/j.anaerobe.2022.102536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/12/2022] [Accepted: 02/17/2022] [Indexed: 11/16/2022]
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13
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Radiology–Pathology Correlation: Inflammatory Conditions of the Breast. CURRENT BREAST CANCER REPORTS 2021. [DOI: 10.1007/s12609-021-00432-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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Costa Morais Oliveira V, Cubas-Vega N, López Del-Tejo P, Baía-da-Silva DC, Araújo Tavares M, Picinin Safe I, Cordeiro-Santos M, Lacerda MVG, Val F. Non-lactational Infectious Mastitis in the Americas: A Systematic Review. Front Med (Lausanne) 2021; 8:672513. [PMID: 34422853 PMCID: PMC8378399 DOI: 10.3389/fmed.2021.672513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/05/2021] [Indexed: 10/29/2022] Open
Abstract
Background: Non-lactational infectious mastitis (NLIM) is an inflammatory breast disease with broad clinical presentation. Inadequate treatment can lead to chronic infections that cause breast deformities. NLIM information is limited, especially in the Americas. A systematic review and meta-analysis have been conducted here. Methods: Literature search was conducted in three databases (Lilacs, PubMed, and Scielo) on NLIM cases in the Americas. Demographic, epidemiological, clinical, radiological, and laboratory data were extracted. The main characteristics and results were also compared according to the country's gross national income. Results: A total of 47 articles were included, resulting in 93 cases. The etiological agent was described in 86 (92.5%) patients. Bacteria were the most prevalent etiology (73; 84.8%). Amongst bacterial diagnoses, more frequent cases were Mycobacterium tuberculosis (28; 38.4%); Corynebacterium spp. (15; 20.5%); non-tuberculous mycobacteria (13; 17.8%). The cases were reported in eight different countries, with the USA being the country with the highest number of cases (35; 37.6%). Patients from high-income countries group presented a shorter diagnostic time when compared to low, low-middle, and upper-middle-income countries. A greater number of radiographic studies with pathological findings were described in high-income countries. Conclusion: Non-lactational infectious mastitis is a complex public health problem with diagnostic and treatment challenges. Hence, multi-professional approach-based additional studies are recommended on its epidemiology, diagnosis, treatment, and control.
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Affiliation(s)
- Victor Costa Morais Oliveira
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Fundação Hospital Adriano Jorge, Manaus, Brazil.,Programa de Pós-graduação em Medicina Tropical, Universidade Do Estado Do Amazonas, Manaus, Brazil
| | - Nadia Cubas-Vega
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-graduação em Medicina Tropical, Universidade Do Estado Do Amazonas, Manaus, Brazil
| | - Paola López Del-Tejo
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-graduação em Medicina Tropical, Universidade Do Estado Do Amazonas, Manaus, Brazil
| | - Djane C Baía-da-Silva
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-graduação em Medicina Tropical, Universidade Do Estado Do Amazonas, Manaus, Brazil
| | | | | | - Marcelo Cordeiro-Santos
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-graduação em Medicina Tropical, Universidade Do Estado Do Amazonas, Manaus, Brazil.,Departamento de Ensino e Pesquisa, Universidade Nilton Lins, Manaus, Brazil
| | - Marcus Vinícius Guimarães Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-graduação em Medicina Tropical, Universidade Do Estado Do Amazonas, Manaus, Brazil.,Rede de Pesquisa em Malária, Instituto Leônidas and Maria Deane, Fiocruz-Amazonas, Manaus, Brazil
| | - Fernando Val
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-graduação em Medicina Tropical, Universidade Do Estado Do Amazonas, Manaus, Brazil
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Abstract
Patients may present to the emergency department with breast complaints due to traumatic or nontraumatic changes in the breast. Benign and malignant breast pathologies may mimic each other both in clinical presentation and imaging appearance. A complex cystic and solid mass seen on ultrasound in a patient with a palpable mass can represent breast cancer, abscess, or hematoma. A unilateral swollen breast may result from inflammatory breast cancer, mastitis, or other benign etiologies; correlation with clinical history, physical exam, and close follow-up are required to ensure complete resolution of symptoms. Uncommon breast entities such as granulomatous mastitis and breast implant-associated anaplastic large-cell lymphoma may cause changes in the appearance of the breast that prompt a patient to seek initial evaluation in the emergency department. Imaging evaluation of the breast in the emergency department is limited, and it is important that patients with a breast complaint be referred to a dedicated breast center for complete evaluation at an appropriate time interval after their discharge from the emergency department.
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Affiliation(s)
- Deanna L Lane
- University of Texas MD Anderson Cancer Center, Department of Breast Imaging, Houston, TX,USA
| | - Jay R Parikh
- University of Texas MD Anderson Cancer Center, Department of Breast Imaging, Houston, TX,USA
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16
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Bartolomé-Álvarez J, Solves-Ferriz V. Microbiology of breast abscesses. Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(21)00024-0. [PMID: 33640150 DOI: 10.1016/j.eimc.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/24/2020] [Accepted: 01/05/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Treatment of breast abscesses is based on drainage and antibiotic therapy directed at the bacteria causing the infection. The aim of this study was to know the etiological agents of breast abscesses. METHODS Patients who had a culture-positive breast abscess between September 2015 and January 2020 were included in the study. Culture results were consulted in the laboratory database. It was collected from medical records if the patients presented the following risk factors: breastfeeding, diabetes or smoking. Abscesses secondary to surgical wound infection were excluded. RESULTS Sixty patients were included: 58 women and 2 men. Staphylococcus aureus was the most frequent agent in lactating women. Anaerobic bacteria were isolated in 28 (61%) of 46 abscesses in non-lactating patients. In non-lactating patients, the frequency of anaerobes in abscesses was lower in diabetics than in the rest (0/5 vs 26/38; P=.013). In non-lactating and non-diabetic patients, the proportion of abscesses with anaerobes was higher in smokers than in non-smokers (21/24 vs 5/14; P=.003). Aerobic gram-positive cocci were the most frequent agents in diabetics. CONCLUSION Anaerobes were the most frequent agents, followed by S.aureus. The etiology of breast abscesses varied with the risk factors studied.
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Affiliation(s)
| | - Verónica Solves-Ferriz
- Servicio de Microbiología, Complejo Hospitalario Universitario de Albacete, Albacete, España
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17
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Ofri A, Dona E, O'Toole S. Squamous metaplasia of lactiferous ducts (SMOLD): an under-recognised entity. BMJ Case Rep 2020; 13:13/12/e237568. [PMID: 33298489 DOI: 10.1136/bcr-2020-237568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Breast abscesses are a common surgical problem, typically occurring secondary to lactation mastitis. Recurrent subareolar abscesses are rarely reported and may be poorly recognised as a presentation of squamous metaplasia of lactiferous ducts, known eponymously as 'Zuska's disease'. Other synonyms include subareolar breast abscess and lactiferous or mammary fistulas. Recognition of this painful entity is crucial for optimal outcomes since typical breast abscess management of recurrent aspiration or incision and drainage can lead to recurrence and chronic complications, such as fistula formation.
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Affiliation(s)
- Adam Ofri
- Department of General Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Eddy Dona
- Work of Art, Bella Vista, New South Wales, Australia
| | - Sandra O'Toole
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
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18
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Xu H, Jiang Y, Liao M, Li D, Zhu C. Continuous postoperative negative pressure irrigation assisted mammaplasty in treating chronic refractory plasma cell mastitis. Gland Surg 2020; 9:2071-2078. [PMID: 33447558 DOI: 10.21037/gs-20-795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Chronic refractory plasma cell mastitis (CRPCM) is an aseptic inflammation of the breast with a chronic course of the disease, extended treatment cycle (months to years), with a high recurrence rate. The objective of this study was to evaluate the efficacy of continuous postoperative negative pressure irrigation assisted mammaplasty (CPNPIAM) in treating CRPCM. Methods Between 2016 and 2018, 36 CRPCM patients receiving CPNPIAM were enrolled in this study. CPNPIAM mainly involved complete lesion removal, immediate breast mammaplasty, and continuous postoperative negative pressure irrigation. The age of the patients, local symptoms, history of treatment, the duration of the disease before surgery, hospitalization period, related risk factors, the success rate, the recurrence rate and patients' overall satisfaction ratings were analyzed in the article. Results Patients were aged between 22 and 53 years (mean 34.64 years). All patients had a history of conservative treatment or simple drainage. Local symptoms included inflammatory mass (n=36, 100%), abscess (n=33, 92%), nipple discharge (n=7, 19%), inflammatory plaque (n=34, 94%), and sinus tract formation (n=19, 53%). The lesion sizes ranged from 3 to 10 cm (mean 5.13 cm) in diameter. The mean hospitalization period was 8.42 days. The success rate was 100% (36/36) and the recurrence rate was 0% (0/36) at a 3-month follow-up. The patients' overall satisfaction ratings were "very good" (n=22, 61%), "good" (n=12, 33%), and "moderate" (n=2, 6%) with no poor or unsatisfactory ratings. Conclusions CPNPIAM is an effective way of treating CRPCM, and showed a high success rate, a low recurrence rate, and high patient satisfaction.
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Affiliation(s)
- Hua Xu
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Mingjuan Liao
- Department of Traditional Chinese Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Dongliang Li
- Department of Thoracic Surgery, Shanxi Provincial Tumor Hospital, Taiyuan, China
| | - Chenfang Zhu
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
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Alqahtani SM. A subareolar breast abscess in a man: A case report and literature review. J Taibah Univ Med Sci 2020; 15:557-560. [PMID: 33318748 PMCID: PMC7715457 DOI: 10.1016/j.jtumed.2020.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/02/2020] [Accepted: 07/06/2020] [Indexed: 10/31/2022] Open
Abstract
Subareolar breast abscesses (SBAs) in men are extremely rare. To date, only 15 men with SBA have been reported in the English literature. We present a case of SBA in a 28-year-old man who visited our surgical clinic with a painful swelling in his right breast for 10 days. Physical examination showed a tender, hot mass in the right subareolar area with erythema. Ultrasound of the right breast showed radiological features of a breast abscess. Fine-needle aspiration yielded brownish yellow pus. Based on these findings, a diagnosis of right SBA was established. This is the first documented case of SBA in men from the KSA. Additionally, this case report sheds light on the current clinical and therapeutic approaches to managing cases of SBA in men.
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Affiliation(s)
- Saad M. Alqahtani
- Department of Surgery, College of Medicine, Majmaah University, Majmaah, KSA
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20
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Geffroy D. La peau des seins, première frontière anatomique. IMAGERIE DE LA FEMME 2020. [DOI: 10.1016/j.femme.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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21
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Valente I, Garlaschi A, Ruff de Conti M, De Giorgis S, Montrucchio E, Menella S, Calabrese M. A rare occupational disease of hairdressers: A case of breast pilonidal abscess and a review of the literature. Breast J 2020; 26:1828-1830. [DOI: 10.1111/tbj.13885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 04/26/2020] [Accepted: 04/28/2020] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | - Sara De Giorgis
- Department of Health, Sciences (DISSAL) University of GenoaOspedale Policlinico San Martino Genova Italy
| | | | - Simone Menella
- Department of Health, Sciences (DISSAL) University of GenoaOspedale Policlinico San Martino Genova Italy
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22
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Treatment Efficacy of Chuang Ling Ye, a Traditional Chinese Herbal Medicine Compound, on Idiopathic Granulomatous Mastitis: A Randomized Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:6964801. [PMID: 32714413 PMCID: PMC7341429 DOI: 10.1155/2020/6964801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/26/2020] [Indexed: 12/17/2022]
Abstract
Objective To explore whether Chuang Ling Ye (CLY), a traditional Chinese herbal medicine compound, could improve the treatment of idiopathic granulomatous mastitis (IGM) via decreasing inflammatory response. Methods Herein, 40 patients with IGM who had wounds requiring dressing change were enrolled and randomly divided into two groups: the CLY group and the control group. The size of the neoplasm and pain score of patients were followed-up for 4 weeks. Local tissues were taken during dressing change and examined by commercial enzyme-linked immunosorbent assay (ELISA) kits. The levels of inflammatory markers, including interleukin-1β (IL-1β), IL-2, IL-6, interferon gamma (IFN-γ), and tumor necrosis factor-α (TNF-α) were measured. Results After treatment, the size of the neoplasm in the CLY group was significantly smaller than that in the control group (14.28 cm ± 8.96 cm vs. 21.14 cm ± 0.12 cm, P=0.038), and the pain scores were markedly reduced (P=0.004). Besides, CLY downregulated the expression levels of IL-1β, IFN-γ, and TNF-α. Conclusion External use of CLY could reduce the neoplasm of IGM by inhibiting local inflammation. This trial is registered with ChiCTR1800017744.
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23
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Cobo F, Guillot V, Navarro-Marí JM. Breast Abscesses Caused by Anaerobic Microorganisms: Clinical and Microbiological Characteristics. Antibiotics (Basel) 2020; 9:antibiotics9060341. [PMID: 32570867 PMCID: PMC7345347 DOI: 10.3390/antibiotics9060341] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/04/2020] [Accepted: 06/16/2020] [Indexed: 11/16/2022] Open
Abstract
The objectives of this study were to report the antimicrobial susceptibility of 35 clinically significant anaerobic bacteria isolated from breast abscesses between March 2017 and February 2020 in a tertiary hospital in Granada (Spain) and to describe key clinical features of the patients. Species identification was performed mainly by MALDI-TOF MS. Antimicrobial susceptibility tests were carried out against benzylpenicillin, amoxicillin-clavulanic acid, imipenem, moxifloxacin, clindamycin, metronidazole, and piperacillin-tazobactam using the gradient diffusion technique and European Committee on Antimicrobial Susceptibility Testing EUCAST breakpoints (except for moxifloxacin). The most frequent anaerobes were Finegoldia magna (31.4%; n = 11), Actinomyces spp. (17.1%; n = 6), Propionibacterium spp. (17.1%; n = 6), and Prevotella spp. (14.2%; n = 5). Imipenem, amoxicillin-clavulanic acid, and piperacillin-tazobactam were universally active against all genera tested. High overall resistance rates to clindamycin were observed, especially for Gram-positive anaerobic cocci (56.2%) and Gram-positive anaerobic bacilli (38.4%). High resistance rates to metronidazole were also observed for Gram-positive (76.9%) and Gram-negative anaerobic bacilli (50%). High resistance rates to moxifloxacin were found for Gram-negative anaerobic bacilli (50%) and Gram-positive anaerobic cocci (31.2%). No breast abscess cases of Bacteroides spp. were detected. Routine antimicrobial susceptibility testing for anaerobes in breast abscesses may contribute to allow empirical therapies to be selected in accordance with local data on resistant strains.
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Affiliation(s)
- Fernando Cobo
- Correspondence: ; Tel.: +34-958-020-364; Fax: +34-958-241-245
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24
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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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A New Treatment for Mammillary Fistulas Using Ultrasound-Guided Percutaneous Needle Electrolysis. J Clin Med 2020; 9:jcm9030649. [PMID: 32121204 PMCID: PMC7141207 DOI: 10.3390/jcm9030649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 02/21/2020] [Accepted: 02/24/2020] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to investigate the efficacy of ultrasound-guided percutaneous needle electrolysis (PNE) in mammillary fistulas (MFs). A prospective study was performed in 18 patients with MF who were treated with the PNE technique. The technique was repeated in the case of no response or recurrence. The results obtained show that MFs revealing an elongated appearance with the ultrasound (US) are generally resolved with two sessions of PNE, whereas ovoid MFs require several sessions of PNE for complete resolution and they tend to recur. Success of the treatment with PNE was observed in 88.8% of the patients (16/18), and failure, after five or six sessions in two cases (11.2%), which were referred for surgery. Conclusions: To the best of our knowledge this is the first study to reveal that the PNE technique is safe, effective, quick, and well-tolerated by patients.
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26
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Wu JM, Turashvili G. Cystic neutrophilic granulomatous mastitis: an update. J Clin Pathol 2020; 73:445-453. [PMID: 32094275 DOI: 10.1136/jclinpath-2019-206180] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 02/07/2023]
Abstract
Cystic neutrophilic granulomatous mastitis (CNGM) is a rare subtype of granulomatous mastitis with a highly distinct histological pattern often associated with Corynebacterium species. CNGM is characterised by suppurative lipogranulomas that are composed of central lipid vacuoles rimmed by neutrophils and an outer cuff of epithelioid histiocytes. Some of the lipid vacuoles may contain sparse, rod-shaped, gram-positive bacilli that can be easily missed or dismissed. The surrounding mixed inflammatory infiltrate contains Langhans-type giant cells, lymphocytes and neutrophils. CNGM occurs in reproductive age women with a history of pregnancy and typically presents as a palpable mass that can be painful. CNGM has many mimickers, most significantly breast carcinoma. In many cases, CNGM has significant pathological and clinical overlap with other forms of granulomatous mastitis. Given the association with Corynebacterium species, early diagnosis of CNGM is essential in offering patients the most appropriate treatment. Prolonged antibiotic therapy specifically directed to corynebacteria is required, sometimes even beyond resolution of clinical symptoms. This comprehensive review of the existing literature on CNGM describes clinical-pathological features, microbiological findings, challenges associated with the microscopic differential diagnosis, clinical implications of this diagnosis and emerging treatment options. Morphological criteria and suggested comments to convey the degree of diagnostic certainty are also proposed for standard pathology reporting.
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Affiliation(s)
- Jessie M Wu
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Gulisa Turashvili
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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27
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[Idiopathic granulomatous mastitis associated with erythema nodosum]. Ann Dermatol Venereol 2020; 146:571-576. [PMID: 31151772 DOI: 10.1016/j.annder.2019.04.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 12/24/2018] [Accepted: 04/08/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) is a rare, chronic, granulomatous, inflammatory disorder with potentially misleading clinical and radiological features. IGM is diagnosed after exclusion of infectious or tumoral diseases. Herein we report a case of erythema nodosum associated with IGM, which serves as a reminder that erythema nodosum may constitute an extra-mammary sign of IGM. PATIENTS AND METHODS A 36-year-old nulliparous woman presented with fever and skin rash at our dermatology clinic at the North Franche-Comté hospital in July 2017. Symptoms had occurred 2 days previously. The patient had a fever of 38.8°C and typical erythema nodosum on the limbs. Physical examination showed an irregular, inflammatory, abscessed mass measuring 20cm with multiple shrinkage zones that had been developing for 4 weeks and for which breast examinations were being performed. Laboratory tests showed an inflammatory state (CRP 155mg/mL, WBC 14.6×109/L), other tests (serum electrolytes and calcium, hepatic and renal tests, Streptotest, T-spot, HIV, HBV, HCV serology, anti-streptolysin, anti-streptodornase, local microbiology samples, antinuclear antibodies, soluble antigens antibodies, hemocultures, angiotensin-converting-enzyme and chest x-rays) were normal. Microbiology investigations were negative. Mammography revealed invasive mastitis. Breast sample biopsies showed giant cell granulomas without caseous necrosis or tumor cells, and histochemical staining (PAS, Ziehl, Grocott, Gram) was negative. The final diagnosis was of IGM associated with erythema nodosum. Symptoms rapidly improved with oral steroids. DISCUSSION As reported herein, erythema nodosum may be associated with IGM and support the diagnosis thereof. This association is rare, with fewer than 30 case reports described in the literature. IGM is an uncommon benign disorder of the breast that can mimic two frequent breast disorders: breast carcinoma and breast abscess. It usually occurs in young sexually active women. It appears as a tumor with an inflammatory solid painful mass, with nipple and skin retraction, occasionally with abscesses and accompanied by homolateral axillary lymphadenopathies. Radiologic findings are usually not specific for or suggestive of cancer. The histopathological picture of IGM is characterized by the presence of multinucleated giant cells and epithelioid histiocytes forming non-caseating granulomas around lobules. Minor ductal and periductal inflammation is usually present. IGM is rarely associated with autoimmune system manifestations, especially erythema nodosum, arthritis, episcleritis or hidradenitis suppurativa. Although the physiopathology of IGM remains unclear, this case serves as additional evidence that the etiology of IGM is of autoimmune origin. While there is no recommendation for the treatment of IGM, oral steroids remain the cornerstone of therapy. CONCLUSION We report a case of IGM associated with erythema nodosum. Dermatologists must be aware of this association.
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28
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Luo J, Long T, Cai Y, Teng Y, Fan Z, Liang Z, Zhu C, Ma H, Li G. Abscess Drainage with or Without Antibiotics in Lactational Breast Abscess: Study Protocol for a Randomized Controlled Trial. Infect Drug Resist 2020; 13:183-190. [PMID: 32021332 PMCID: PMC6983478 DOI: 10.2147/idr.s221037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 12/24/2019] [Indexed: 11/23/2022] Open
Abstract
Background Lactational breast abscess, a complication from lactational mastitis, is a common cause of breastfeeding discontinuation. No consensus has been reached regarding the necessity of antibiotics in this disease. The purpose of this trial is to determine if surgical drainage is non-inferior to drainage together with a standard course of antibiotics, in the treatment of lactational breast abscess. Methods Breastfeeding females with breast abscess from 18 to 50 years old are eligible for study inclusion. An expected number of 306 patients will be randomly allocated in parallel to the intervention arm (simple drainage without antibiotics) or the control arm (abscess drainage with standard 5-day-course of antibiotics). The primary outcomes include the time to resolution of breast abscess and disease recurrence rate. Secondary outcomes of interests are 3-day-improvement proportion, rate of continuing breastfeeding, treatment failure rate, procedural-related complications, and length of hospital stay. An expected non-inferiority margin for the difference in the primary outcome of interest is set at 1 day, on the basis of a one-sided 97.5% confidence interval. Discussion This trial will provide first-hand evidence on whether simple abscess drainage is non-inferior to drainage together with a standard course of antibiotics, in lactational mothers with breast abscess. The indication of antibiotic prophylaxis could be revised if non-inferiority is set up, and guidelines for lactational breast abscess require amendments correspondingly. Trial Registration This study has been registered in the Chinese Clinical Trial Registry, and the trial registration number is ChiCTR1900024008.
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Affiliation(s)
- Jiayue Luo
- Department of Breast Surgery, Guangzhou Women and Children`s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, People's Republic of China
| | - Tianzhu Long
- Department of Breast Surgery, Guangzhou Women and Children`s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, People's Republic of China
| | - Yuanxuan Cai
- Department of Breast Surgery, Guangzhou Women and Children`s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, People's Republic of China
| | - Yuan Teng
- Department of Breast Surgery, Guangzhou Women and Children`s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, People's Republic of China
| | - Zhe Fan
- Department of Breast Surgery, Guangzhou Women and Children`s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, People's Republic of China
| | - Zhen Liang
- Department of Breast Surgery, Guangzhou Women and Children`s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, People's Republic of China
| | - Cairong Zhu
- Department of Breast Surgery, Guangzhou Women and Children`s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, People's Republic of China
| | - Hongmin Ma
- Department of Breast Surgery, Guangzhou Women and Children`s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, People's Republic of China
| | - Guanhua Li
- Department of Breast Surgery, Guangzhou Women and Children`s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, People's Republic of China
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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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30
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Ceniceros A, Galen B, Madaline T. Gonococcal breast abscess. IDCases 2019; 18:e00620. [PMID: 31463197 PMCID: PMC6706344 DOI: 10.1016/j.idcr.2019.e00620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/07/2019] [Accepted: 08/07/2019] [Indexed: 12/03/2022] Open
Abstract
A 32-year-old nonlactational women with a nipple piercing and previous oral-to-breast contact presented with findings consistent with mastitis and abscess, however, the patient failed multiple courses of empiric antimicrobials. Needle aspiration was performed and the culture was positive for N. gonorrhoeae. She was successfully treated with intravenous ceftriaxone and transitioned to oral ciprofloxacin once susceptibilities were known. N. gonorrhoeae is an uncommon cause of nonlactational mastitis and abscess. A few cases have been reported in the context of sexual contact and nipple piercings. In an era of increasing antimicrobial resistance and with the risk of disseminated gonococcal infection, a high index of suspicion should be maintained within this clinical context.
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Affiliation(s)
- Ashley Ceniceros
- Department of Internal Medicine, Division of Infectious Diseases, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, United States
| | - Benjamin Galen
- Department of Internal Medicine, Division of Hospital Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, United States
| | - Theresa Madaline
- Department of Internal Medicine, Division of Infectious Diseases, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, United States
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31
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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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David M, Handa P, Castaldi M. Predictors of outcomes in managing breast abscesses-A large retrospective single-center analysis. Breast J 2018; 24:755-763. [PMID: 29781232 DOI: 10.1111/tbj.13053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 10/31/2017] [Accepted: 11/07/2017] [Indexed: 11/28/2022]
Abstract
We have retrospectively examined a wide range of clinical characteristics, sonographic features, microbiology, and antibiotic regimens in patients with breast abscesses to seek predictive features related to outcome. Because consensus for optimal treatment of breast abscesses has moved toward minimally invasive management using single or repeated needle aspiration (ASP) coupled with adjuvant antibiotics, we assessed whether any factors correlate with the need for repeat procedures by analyzing the number of ASPs and/or surgical incision and drainage (I&D) per abscess. We examined 127 abscesses in 114 patients from a single urban public hospital, and among clinical characteristics, we found that only smoking history (P = .021) and the presence of nipple rings (P = .005) were associated with greater likelihood of necessitating repeat for abscess resolution procedures. Neither diabetes, lactational status, and HIV nor ultrasound features imaging of an abscess including size >3 cm, multiloculation, rind thickness, or central vs peripheral location were correlated with the need for a repeat procedure. Likewise, no specific micro-organisms predicted a greater likelihood of requiring repeat procedures, and no specific initial antibiotic regimen (gram-positive and/or gram-negative or multiresistance coverage) impacted clinical outcomes. Our data indicate that no specific imaging abscess characteristics, type of micro-organism, or initial choice of antibiotics affect outcomes, and therefore, these features should not preclude attempts at conventional therapy by repeated aspiration and antibiotic treatment. While a smoking history and presence of a nipple ring may increase the risk of a prolonged course, the decision to change antibiotics or repeat aspiration should rely instead on clinical evaluation and judgment by experienced physicians.
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Affiliation(s)
- Miriam David
- Department of Radiology, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Priyanka Handa
- Department of Radiology, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Maria Castaldi
- Department of Surgery, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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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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Berná-Serna JD, García-Vidal JA, Escolar-Reina P, Berná-Mestre JD. Ultrasound-guided percutaneous electrolysis: A new therapeutic option for mammary fistulas. Med Hypotheses 2018; 112:35-36. [PMID: 29447933 DOI: 10.1016/j.mehy.2018.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/24/2017] [Accepted: 01/19/2018] [Indexed: 11/19/2022]
Abstract
Mammary fistula (MF) is a recurrent condition characterised by the draining of abscesses around the areola. The best management for MF remains challenging. Moreover, the main problem is the high recurrence rate of this disease. MF is considered a chronic process. The percutaneous electrolysis (PE) technique involves the application of a galvanic current with an ultrasound-guided needle to induce ablation and repair of the affected tissue. Good results have been obtained with PE in chronic tendinopathies. Below we present a hypothesis that PE may be a new therapeutic option for MF.
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Affiliation(s)
- Juan D Berná-Serna
- Department of Radiology, Virgen de la Arrixaca University Clinical Hospital, IMIB, Ctra. Madrid-Cartagena, 30120 El Palmar (Murcia), Spain.
| | | | | | - Juan D Berná-Mestre
- Department of Radiology, Virgen de la Arrixaca University Clinical Hospital, IMIB, Ctra. Madrid-Cartagena, 30120 El Palmar (Murcia), Spain
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Subareolar breast abscess in male patients: a report of two patients with a literature review. Surg Case Rep 2017; 3:128. [PMID: 29260424 PMCID: PMC5736504 DOI: 10.1186/s40792-017-0402-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 12/03/2017] [Indexed: 11/23/2022] Open
Abstract
Background Subareolar breast abscess (SBA) is a rare infectious disease of the breast in male patients. Case presentation Herein, we report two male patients with SBA. Patient 1 was initially diagnosed with a malignant tumor based on imaging findings; ultrasonography revealed a hypoechoic mass with blood flow. Patient 2 was diagnosed with inflammatory changes to his nipple; ultrasonography findings supported the diagnosis with an irregular hypoechoic mass with blood flow. Both patients received a cytological or histological biopsy preoperatively, which showed an abscess without malignant cells. Conclusion These cases serve as an important reminder to consider complete resection of the tumor including the responsible mammary duct (tumor and duct resection (TDR)) for curative therapy of SBA.
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Saboo A, Bennett I. Trends in non-lactation breast abscesses in a tertiary hospital setting. ANZ J Surg 2017; 88:739-744. [PMID: 29045009 DOI: 10.1111/ans.14146] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 05/22/2017] [Accepted: 06/20/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND The aim of this paper was to retrospectively review non-lactation breast abscesses treated in Princess Alexandra Hospital over a 10-year period and to illustrate the trends in size, risk factors, microbiological profile and management. METHODS A computerized search of the medical records was undertaken to identify all adult patients with a diagnosis of breast abscesses during June 2005-June 2015. Patients concurrently breastfeeding were excluded. A retrospectively review of the clinical records was performed. RESULTS Eighty-five abscesses were identified in 77 patients. The median patient age was 45 years and 93.7% were females. Smoking and diabetes mellitus were associated with a longer inpatient hospital stay. There was a significant difference in microbiology of abscesses in relation to size. Smaller abscesses (≤3.0 cm) predominantly had mixed anaerobes (54%), whereas larger abscesses had a dominance of Staphylococcus aureus (29%) and other aerobic microbes (33%) (P < 0.05). Seven percent of all abscesses had methicillin-resistant S. aureus. Flucloxacillin was prescribed solely in majority of the cases (45%) with addition of suitable mixed anaerobic cover in 12% cases. Of the 85 abscesses, 58.8% were managed non-operatively with antibiotics ± percutaneous drainage. Percutaneous aspiration had a shorter inpatient stay compared with patients who underwent operative management. CONCLUSION This represents the first Australian study solely analysing non-lactation breast abscess. Size was correlated significantly to characteristic bacteriology and empiric therapy should include both aerobic and anaerobic cover. The majority of non-lactation breast abscesses can be managed non-operatively with a combination of antibiotics and percutaneous aspiration.
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Affiliation(s)
- Apoorva Saboo
- Department of Surgery, The University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Ian Bennett
- Department of Surgery, The University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Zhang L, Hu J, Guys N, Meng J, Chu J, Zhang W, Liu A, Wang S, Song Q. Diffusion-weighted imaging in relation to morphology on dynamic contrast enhancement MRI: the diagnostic value of characterizing non-puerperal mastitis. Eur Radiol 2017; 28:992-999. [PMID: 28956122 PMCID: PMC5811586 DOI: 10.1007/s00330-017-5051-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 08/10/2017] [Accepted: 08/22/2017] [Indexed: 02/05/2023]
Abstract
Objectives To demonstrate the value of diffusion-weighted imaging (DWI) in the characterisation of mastitis lesions. Methods Sixty-one non-puerperal patients with pathologically confirmed single benign mastitis lesions underwent preoperative examinations with conventional MRI and axial DWI. Patients were categorised into three groups: (1) periductal mastitis (PDM), (2) granulomatous lobular mastitis (GLM), and (3) infectious abscess (IAB). Apparent diffusion coefficient (ADC) values of each lesion were recorded. A one-way ANOVA with logistic analysis was performed to compare ADC values and other parameters. Discriminative abilities of DWI modalities were compared using the area under the receiver operating characteristic curve (AUC). P < 0.05 was considered statistically significant. Results ADC values differed significantly among the three groups (P = 0.003) as well as between PDM and IAB and between PDM and GLM. The distribution of non-mass enhancement on dynamic contrast-enhanced (DCE) MRI differed significantly among the three groups (P = 0.03) but not between any two groups specifically. There were no differences in lesion location, patient age, T2WI or DWI signal intensity, enhancement type, non-mass internal enhancement, or mass enhancement characteristics among the three groups. Conclusions ADC values and the distribution of non-mass enhancement are valuable in classifying mastitis subtypes. Key points • Mastitis subtypes exhibit different characteristics on DWI and DCE MRI. • ADC values are helpful in isolating PDM from other mastitis lesions. • Distribution of non-mass enhancement also has value in comparing mastitis subtypes.
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Affiliation(s)
- Lina Zhang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang, Dalian, Liaoning, 116011, China
| | - Jiani Hu
- Department of Radiology, Wayne State University, 540 East Canfield Street, Detroit, MI, 48201, USA
| | - Nicholas Guys
- Department of Radiology, Wayne State University, 540 East Canfield Street, Detroit, MI, 48201, USA
| | - Jinli Meng
- Department of Radiology, Chengban Branch of West China Hospital, 37 Guoxue Alley, Wuhou, Chengdu, Sichuan, 610041, China
| | - Jianguo Chu
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang, Dalian, Liaoning, 116011, China
| | - Weisheng Zhang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang, Dalian, Liaoning, 116011, China
| | - Ailian Liu
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang, Dalian, Liaoning, 116011, China.
| | - Shaowu Wang
- Department of Radiology, Second Affiliated Hospital of Dalian Medical University, 467 Zhongshan Road, Shahekou, Dalian, Liaoning, 116023, China.
| | - Qingwei Song
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang, Dalian, Liaoning, 116011, China
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Radiologic-Pathologic Correlation for Benign Results After MRI-Guided Breast Biopsy. AJR Am J Roentgenol 2017; 209:442-453. [PMID: 28537753 DOI: 10.2214/ajr.16.17048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The majority of MRI-guided breast biopsies yield benign pathology. The purpose of this article is to provide a comprehensive overview of benign pathologic entities commonly encountered at MRI-guided breast biopsy. CONCLUSION Proper radiologic-pathologic correlation is an integral component of MRI-guided breast biopsy. Familiarity with the spectrum of MRI findings and key histopathologic features of common benign entities will enhance the radiologist's confidence in determining concordance and lead to improved patient management recommendations.
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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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Laas E, Touboul C, Kerdraon O, Catteau-Jonard S. Mastites inflammatoires et infectieuses du sein en dehors de la grossesse et de la période d’allaitement : recommandations. ACTA ACUST UNITED AC 2015; 44:996-1016. [DOI: 10.1016/j.jgyn.2015.09.055] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 09/25/2015] [Accepted: 09/25/2015] [Indexed: 10/22/2022]
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Şafak KY. Mammography Findings of Male Breast Diseases. THE JOURNAL OF BREAST HEALTH 2015; 11:106-110. [PMID: 28331703 DOI: 10.5152/tjbh.2015.2565] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 05/01/2015] [Indexed: 12/21/2022]
Abstract
Over the past 2 decades, the percentage of men presenting with breast complaints has increased from 0.8% to 2.4%, and men now account for 1% of all breast cancer cases. The most common male breast mass is gynecomastia, followed by lipoma and epidermal inclusion cysts. Because there is a paucity of parenchyma as compared with the female breast, the malignancy rapidly progresses to the next stage, with the appearance of secondary signs like nipple retraction, fixation to deeper tissues, skin ulceration or adenopathy. Diagnostic evaluation is needed only when the palpable mass is unilateral, hard, fixed, peripheral to the nipple, or associated with nipple discharge, skin changes, or lymphadenopathy. Male breast cancer usually occurs in a subareolar location or is positioned eccentric to the nipple; occasionally, it occurs in a peripheral position. Secondary signs like skin thickening, nipple retraction, and axillary lymphadenopathy may be seen. Microcalcifications can occur. Mammography can accurately distinguish between malignant and benign male breast disease. Radiologists are generally less familiar with breast disease in males compared with females. In this article, we discuss the clinical, and mammographic features of a variety of benign and malignant diseases that can occur in the male breast.
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Affiliation(s)
- Kadihan Yalçın Şafak
- Clinic of Radiology, Kartal Dr. Lütfü Kırdar Training and Research Medicine, İstanbul, Turkey
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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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Giess CS, Golshan M, Flaherty K, Birdwell RL. Clinical experience with aspiration of breast abscesses based on size and etiology at an academic medical center. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:513-521. [PMID: 24975466 DOI: 10.1002/jcu.22191] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 02/26/2014] [Accepted: 06/03/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE Our purpose was to review needle aspiration of breast abscesses and identify factors associated with treatment by aspiration alone versus aspiration with surgical incision and drainage (I/D). METHODS This Institutional Review Board-approved, retrospective review of the breast ultrasound database from 2008 to 2010 identified 40 patients (41 abscesses) who underwent aspiration, with or without I/D. Demographics, imaging, number of aspirations, and microbiology were reviewed. RESULTS Twenty-two abscesses underwent aspiration only, 16 > 3 cm, 6 ≤ 3 cm (mean 4.3 cm, range 0.9-10 cm). Known risk factors included lactational (11), 3 weeks post partum (1), pregnancy (1), recent biopsy/lumpectomy (5). Nineteen abscesses underwent aspiration and I/D, 15 > 3 cm, 4 ≤ 3 cm (mean 4.1 cm, range 2.2-7.5 cm). Known risk factors included lactational (4), recurrent subareolar abscess (4), diabetes (3), hydradenitis suppuritiva (1), nipple piercing (2), smoking (1), pregnancy (1), HIV (1), and lumpectomy (1). Identified reasons for I/D included lack of improvement/recurrence (12), fistula (3), and one electively after clinical improvement of a recurrent subareolar abscess. CONCLUSIONS Abscesses associated with pregnancy and lactation or breast biopsy are effectively managed with aspiration, even when large. Recurrence, chronicity, or fistula may require surgical intervention.
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Affiliation(s)
- Catherine S Giess
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115
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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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Lam E, Chan T, Wiseman SM. Breast abscess: evidence based management recommendations. Expert Rev Anti Infect Ther 2014; 12:753-62. [PMID: 24791941 DOI: 10.1586/14787210.2014.913982] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Literature review was carried out and studies reporting on treatment of breast abscesses were critically appraised for quality and their level of evidence using the Strength of Recommendation Taxonomy guidelines, and key recommendations were summarized. Needle aspiration either with or without ultrasound guidance should be employed as first line treatment of breast abscesses. This approach has the potential benefits of: superior cosmesis, shorter healing time, and avoidance of general anaesthesia. Multiple aspiration sessions may be required for cure. Ultrasound-guided percutaneous catheter placement may be considered as an alternative approach for treatment of larger abscesses (>3 cm). Surgical incision and drainage should be considered for first line therapy in large (>5 cm), multiloculated, or long standing abscesses, or if percutaneous drainage is unsuccessful. All patients should be treated concurrently with antibiotics. Patients with recurrent subareolar abscesses and fistulas should be referred for consideration of surgical treatment.
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Affiliation(s)
- Elaine Lam
- Department of Surgery, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
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Nguyen C, Kettler MD, Swirsky ME, Miller VI, Scott C, Krause R, Hadro JA. Male breast disease: pictorial review with radiologic-pathologic correlation. Radiographics 2014; 33:763-79. [PMID: 23674773 DOI: 10.1148/rg.333125137] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The male breast is susceptible to many of the same pathologic processes as the female breast. Many of these conditions have mammographic, ultrasonographic (US), and magnetic resonance imaging findings that allow differentiation between clearly benign conditions and those that require biopsy. Gynecomastia is the most common abnormality of the male breast and has characteristic imaging features that usually allow differentiation from malignancy. Mammography is the initial imaging modality for a clinically suspicious mass. A palpable mass that is occult or incompletely imaged at mammography mandates targeted US. Suspicious or indeterminate masses require biopsy, which can usually be performed with US guidance. Approximately 0.7% of breast cancers occur in men. Men with breast cancer often present at a more advanced stage than do women owing to a delay in diagnosis. Benign breast neoplasms that may occur in men include angiolipoma, schwannoma, intraductal papilloma, and lipoma. Benign nonneoplastic entities that may occur in the male breast include intramammary lymph node, sebaceous cyst, diabetic mastopathy, hematoma, fat necrosis, subareolar abscess, breast augmentation, venous malformation, secondary syphilis, and nodular fasciitis. Familiarity with the salient features of the classic benign male breast conditions will allow accurate imaging interpretation and avoid unnecessary and often invasive treatment. © RSNA, 2013.
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Affiliation(s)
- Cheri Nguyen
- Department of Radiology, Baystate Medical Center, 759 Chestnut St, Springfield, MA 01199, USA.
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Wang K, Ye Y, Sun G, Xu Z. The Mammotome biopsy system is an effective treatment strategy for breast abscess. Am J Surg 2013; 205:35-8. [DOI: 10.1016/j.amjsurg.2012.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 05/31/2012] [Accepted: 05/31/2012] [Indexed: 10/27/2022]
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Bognar G, Ledniczky G, Lóderer Z. Aesthetic outcome as a goal using pectoral muscle-strip in recurrent subareolar abscess of the breast and for double subdermal flap in modelling of the inverted nipple. Arch Gynecol Obstet 2012; 287:395-7. [PMID: 22923129 DOI: 10.1007/s00404-012-2524-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Accepted: 08/06/2012] [Indexed: 01/18/2023]
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Abstract
Idiopathic granulomatous lobular mastitis (IGLM) is a rare breast condition with prominent skin findings. It is typically seen in young parous women. Painful breast masses, draining sinuses, scarring, and breast atrophy are the main clinical manifestations. IGLM can resemble a variety of other inflammatory and neoplastic processes of the breast. It is thought to result from obstruction and rupture of breast lobules. Extravasated breast secretions then induce an inflammatory reaction. Corynebacteria have also been implicated in the pathogenesis. Treatment is surgical, but systemic corticosteroids, methotrexate, and antibiotics also play a role.
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