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Huang J, Sin TH, Nie L, Zhou Y, Zhang F, Ma J, Shi X, Chen L, Niu K, Zhang X, Sun Q, Huang H. Dermis-retained breast dermo-glandular flap: a new surgical approach for granulomatous lobular mastitis. Front Surg 2023; 10:1187811. [PMID: 37396291 PMCID: PMC10311996 DOI: 10.3389/fsurg.2023.1187811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/24/2023] [Indexed: 07/04/2023] Open
Abstract
Background Granulomatous lobular mastitis (GLM) is characterized by nonspecific chronic inflammation concentrated in breast lobules. Surgical resection is one of the most common treatment options for GLM. On the basis of our previous use of Breast Dermo-Glandular Flap (BDGF), we designed a new surgical approach for GLM, especially for cases where the focus is close to the nipple. Here we describe this new treatment approach. Methods In Peking Union Medical College Hospital (PUMCH) and Beijing Dangdai Hospital during January 2020-June 2021, we enrolled all 18 GLM patients who underwent surgery with the use of Dermis-Retained BDGF. All patients were women; most of the patients were 18-50 years old (88%); and the most common clinical manifestation of GLM was breast mass (60%). Then, we collected and analyzed data about the surgery and outcomes (drainage tubes moving time, relapse, patients' shape satisfaction). We regarded GLM recurrence on the same side as relapse. If there was no complication and the patient's satisfaction was excellent or good, we rated the surgery as successful. We recorded the occurrence of all common postsurgical complications of the breast. Results The debridement area was 3-5.5 (4.3 ± 0.7) cm; surgery time was 78-119 (95.6 ± 11.6) min; and mean debridement time (27.8 ± 8.9 min) was shorter than the time to obtain and transplant the flap (47.5 ± 12.9 min). Blood loss was less than 139 ml. As for bacterial culture, two patients had positive results, but they had no symptoms. No surgery-related complications happened. In terms of the outcomes, all of the drainage tubes were removed in less than 5 days, and only one patient experienced relapse after 1 year of surgery during the follow-up. The patients' satisfaction with the breast shape was as follows: excellent (50%), good (22%), acceptable (22%), and poor (6%). Conclusion For GLM patients refractory to conservative therapy or former unsatisfactory surgical management whose lesion is in the vicinity of the nipple and larger than 3 cm, Dermis-Retained BDGF is a suitable approach to fill the after-debridement defect below the nipple-areola and achieve a relatively satisfactory cosmetic outcome.
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Affiliation(s)
- Junying Huang
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Tat-Hang Sin
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Longzhu Nie
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yidong Zhou
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fan Zhang
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jia Ma
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaoguang Shi
- Department of Breast Surgery, Beijing Dangdai Hospital, Beijing, China
| | - Linlin Chen
- Department of Breast Surgery, Beijing Dangdai Hospital, Beijing, China
| | - Kunying Niu
- Department of Breast Surgery, Beijing Dangdai Hospital, Beijing, China
| | - Xiaohui Zhang
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hanyuan Huang
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Li Y, Chen L, Zhang C, Wang Y, Hu J, Zhou M, Zhang X. Clinicopathologic Features and Pathogens of Granulomatous Lobular Mastitis. Breast Care (Basel) 2023; 18:130-140. [PMID: 37261131 PMCID: PMC10228255 DOI: 10.1159/000529391] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 01/24/2023] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND Granulomatous lobular mastitis (GLM) is a rare, benign, and complex breast disease that can be easily misdiagnosed as breast cancer. The etiology of GLM is unclear, and optimal treatment has not been established. METHODS Medical records for 333 patients with GLM in recent 5 years at Longhua Hospital, Shanghai, China, were analyzed. Potential pathogens in 33 fresh tissue specimens were also analyzed using 16S rDNA sequencing technology, matrix-assisted laser desorption ionization time of flight mass spectrometry, and bacterial cultures. RESULTS The median age of patients was 32 years (range 22-47 years). Among 333 patients, 38.7% displayed elevated prolactin, while 23.7% displayed high interleukin-2. In the granulomatous lesion, CD3-positive T lymphocytes were significantly more than CD20-positive B lymphocytes around the vacuoles or microabscesses. Gram-positive organisms were observed in 82 cases, including in 22 cases from fresh tissue specimens. Thirty-three cases yielded associated pathogens and all displayed multiple pathogenic infections, as identified using 16S rDNA sequencing technology. Pathogenic infections were further identified as belonging to 16 main genera and 8 main pathogenic species. CONCLUSIONS GLM displays distinct histological and clinical features similar to those that have been previously reported in the literature. Using 16S rDNA sequencing technology, all of our cases demonstrated multiple pathogenic infections, which provided more useful information for clinical treatment.
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Affiliation(s)
- Yunyuan Li
- Department of Pathology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ling Chen
- Department of Pathology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chunyan Zhang
- Department of Acupuncture and Moxibustion, Yueyang Hospital of Intergrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yanwen Wang
- Department of Pathology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jun Hu
- Department of Clinical Lab, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mengyun Zhou
- Department of Pathology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaoyun Zhang
- Department of Pathology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Prokop J, Maršálek P, Sengul I, Pelikán A, Janoutová J, Horyl P, Roman J, Sengul D, Junior JMS. Evaluation of breast stiffness pathology based on breast compression during mammography: Proposal for novel breast stiffness scale classification. Clinics (Sao Paulo) 2022; 77:100100. [PMID: 36137345 PMCID: PMC9493386 DOI: 10.1016/j.clinsp.2022.100100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/27/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022] Open
Abstract
Breast cancer is diagnosed through a patient's Breast Self-Examination (BSE), Clinical Breast Examination (CBE), or para-clinical methods. False negativity of PCM in breast cancer diagnostics leads to a persisting problem associated with breast tumors diagnosed only in advanced stages. As the tumor volume/size at which it becomes invasive is not clear, BSE and CBE play an exceedingly important role in the early diagnosis of breast cancer. The quality and effectiveness of BSE and CBE depend on several factors, among which breast stiffness is the most important one. In this study, the authors present four methods for evaluating breast stiffness pathology during mammography examination based on the outputs obtained during the breast compression process, id est, without exposing the patient to X-Ray radiation. Based on the subjective assessment of breast stiffness by experienced medical examiners, a novel breast stiffness classification was designed, and the best method of its objective measurement was calibrated to fit the scale. Hence, this study provides an objective tool for the identification of patients who, being unable to perform valid BSE, could benefit from an increased frequency of mammography screening. Dum vivimus servimus.
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Affiliation(s)
- Jiří Prokop
- Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, Czechia; Department of Surgery, University Hospital Ostrava, Czechia; Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Czechia
| | - Pavel Maršálek
- Department of Applied Mechanics, Faculty of Mechanical Engineering, VŠB-Technical University of Ostrava, Czechia
| | - Ilker Sengul
- Division of Endocrine Surgery, Faculty of Medicine, Giresun University, Turkey; Department of General Surgery, Faculty of Medicine, Giresun University, Turkey.
| | - Anton Pelikán
- Department of Surgery, University Hospital Ostrava, Czechia; Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Czechia; Department of Health Care Sciences, Faculty of Humanities, Tomas Bata University in Zlin, Czechia
| | - Jana Janoutová
- Department of Public Health, Faculty of Medicine and Dentistry, Palacký University Olomouc, Czechia
| | - Petr Horyl
- Department of Applied Mechanics, Faculty of Mechanical Engineering, VŠB-Technical University of Ostrava, Czechia
| | - Jan Roman
- Department of Surgery, University Hospital Ostrava, Czechia; Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Czechia
| | - Demet Sengul
- Department of Pathology, Faculty of Medicine, Giresun University, Turkey
| | - José Maria Soares Junior
- Universidade Federal de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Obstetrícia e Ginecologia, Disciplina de Ginecologia São Paulo (SP), Brasil
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Bacon DR, Ngeve SM, Jordan SG. Granulomatous mastitis: An underdiagnosed inflammatory disease afflicting minority women. Radiol Case Rep 2021; 16:3990-3994. [PMID: 34745405 PMCID: PMC8554342 DOI: 10.1016/j.radcr.2021.09.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/16/2021] [Accepted: 09/18/2021] [Indexed: 11/29/2022] Open
Abstract
Granulomatous mastitis (GM) is an underdiagnosed and understudied benign inflammatory disease of the breast whose accurate diagnosis is confounded by mimicry of other breast pathologies (infectious mastitis and abscess, malignancy) and limited clinician knowledge of the disease. GM disproportionately affects minority women, furthering health disparities for a demographic already disadvantaged in the care of breast diseases. The first step in diagnosis is ultrasound followed by core needle biopsy yielding granulomatous inflammation. To far lesser degree, mammography, and MRI may play a role in narrowing the differential. A high index of clinical suspicion and multidisciplinary approach is required. The presence of Corynebacterium kroppensteddti may indicate one subtype of granulomatous mastitis called cystic neutrophilic granulomatous mastitis; disease stratification, and individualized therapy are on the horizon.
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Affiliation(s)
- Daniel R Bacon
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Smith M Ngeve
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Sheryl G Jordan
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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