BACKGROUND

Granulomatous mastitis (GM) of the breast has long posed a clinical dilemma in terms of diagnosis and management. GM can range from acute to chronic inflammations, which will have treatment implications. Inflammation of the breast may clinically mimic breast carcinomas and pyogenic abscesses. Thus, in the absence of known etiology, such as trauma or breastfeeding, GM may be difficult to diagnose. Currently, the incidence of GM is 2.4 per 100,000 women and 0.37% of the total population in the US. The rarity of GM contributes to it being a poorly understood disease. It has no definite clinical features and is often confused with a neoplasm or infection clinically and radiologically.

The study aimed to describe the clinical characteristics of GM seen in the Breast Care Clinic in the Philippine General Hospital (PGH) from January 2015 to June 2019. This study would initially provide institutional data on GM that is relevant in the Philippines.

This is a retrospective observational study of patients with GM seen in the Philippine General Hospital, a national tertiary referral hospital, from January 2015 to June 2019.

A total of 43 patients with pathological findings of GM from January 1, 2015 to June 15, 2019 were recorded. Among these 43 patients, 98% were female. The median age was 38.9 ± 11.3 years old. In 60.5% (26 out of 43) of patients, the initial impression was breast malignancy. The most common clinical presentation in 69.8% (30 out of 43) of the subjects was a breast mass. In more than 50% of the patients, breast ultrasonography was the initial imaging performed. The histopathologic profile of the patients showed inflammation, of which, the greatest were that of chronic granulomatous inflammation (46.5%, n-20). Treatment options performed were tended more medical (53.5%, n-23) than surgical (16.3%, n-7).Among those who received medical treatment, the therapeutics given were antitubercular medications (34.9%, n-15) and antibiotics (16.3%, n-7), while the others had a combination of antitubercular and antibiotic regimen medications (2.3%, n-1); unknown treatment (25.6%, n-11) and none (11.6%, n-5). For patient outcomes, no mortalities were recorded during the study period. However, most patients had inconsistent followups. Approximately 7%-23% of the patients who had followed up within the six months showed improvement or resolution of symptoms.

This study assessed the clinical profiles of patients with GM in a national tertiary referral hospital. Internationally, there is still no consensus on the algorithm and management of GM patients. However, the authors recommend a close follow-up every two weeks to re-evaluate patient response to the medical regimen being administered. The authors recommend a prospective study with a longer follow-up period to gain a deeper understanding of GM in Filipinos.

Objective To systematically analyze the current status of outcomes reporting in clinical trials on treating stasis acute mastitis with Traditional Chinese Medicine breast massage.Methods We searched CNKI, Wanfang, VIP, SinoMed, PubMed, Web of Science, Embase, Cochrane library, JBI, CINAHL, PsycINFO, Clinical Trials Registry Platform portal, Clinical Trials Registry, Australian New Zealand Clinical Trials Registry, Center Watch Registry from inception to May 15, 2022 to find randomized controlled trials, non-randomized controlled trials, case series and cohort studies which reported the outcomes of stasis acute mastitis managed with Traditional Chinese Medicine breast massage, with search terms of mastitis, acute mastitis, lactation mastitis, puerperal mastitis, breast problem, breast engorgement, milk stasis, blocked ducked, breast pain, breast massage, and acupoint massage. Outcomes and the measurement schemes (measurement methods, timing of assessing outcome, frequency of assessing outcome, measurers) were extracted from the included studies. We used the Management of Otitis Media with Effusion in Children with Cleft Palate (MOMENT) to assess the quality of each study, then categorized outcomes derived from the included studies into different domains according to the Outcome Measures in Rheumatology Arthritis Clinic Trials (OMERACT) Filter 2.1 framework.Results We identified 85 clinical trials, in which 54 different outcomes were reported. A total of 81.2% (69/85) of studies were assessed as medium quality with a mean score of 2.6, and 18.8% (16/85) as low quality with a mean score of 0.9. These outcomes were organized in three core areas. Lump size (89.4%, 76/85) was the most frequently reported outcome, followed by breast pain (69.4%, 59/85) and milk excretion (68.2%, 58/85). Five methods were used to assess lump size and four methods to assess breast pain.Conclusions The outcomes reported in clinical trials regarding stasis acute mastitis treated by Traditional Chinese Medicine breast massage are heterogeneous. Developing a core outcome set to achieve consistent standards for reporting outcomes and modalities for validation of the outcomes is clearly warranted.
Child ; Female ; Humans ; Australia ; Massage ; Mastitis/therapy* ; Mastodynia ; Medicine, Chinese Traditional

Diagnosis, Differential ; Female ; Granulomatous Mastitis/drug therapy* ; Humans ; Mammography

INTRODUCTION: Idiopathic granulomatous mastitis (IGM) is a rare, benign, chronic breast condition that can cause repeated abscesses or mass formation in bilateral breasts. The condition can severely impact the quality of life of affected women. This study aims to evaluate effective treatment modalities, as well as understand the demographics and clinical presentation of patients with IGM. METHODS: An 11-year retrospective review was performed of patients diagnosed with IGM from 1 January 2008 to 31 December 2018 at a tertiary breast unit. RESULTS: A total of 77 patients were included in the study. The median age at presentation was 36 years old. IGM presented most commonly as a breast lump (98.1%). The median number of flares was 2 (1-12). Of the 77 patients, 68.8% (53) were treated with antibiotics, 50.6% (39) with steroids, and 44.2% (34) underwent surgery, in the course of their IGM treatment. Forty-five (59.2%) of the 76 patients with IGM required a multimodal treatment approach to achieve remission. There was no significant difference in the number of flares no matter the initial treatment ( CONCLUSION IGM is a clinical diagnosis. It is a rare, relapsing breast inflammatory condition that affects young females with no superior treatment modality. Smoking is associated with higher number of flares of IGM and should be discouraged in IGM patients.
Adult ; Anti-Bacterial Agents/therapeutic use* ; Female ; Granulomatous Mastitis/therapy* ; Humans ; Quality of Life ; Retrospective Studies ; Treatment Outcome

Mammary lesions in sows can prevent suckling piglets from consuming colostrum that provides fundamental nutrients and protective immunity. Although mammary gross lesions are frequently found in sows at farms or slaughterhouses, with the exception of mastitis, they have received little research attention. In this study, we investigated mammary lesions observed in South Korean sows between 2015 and 2016. Mammary tissue samples of 82 sows showing gross lesions during meat inspection were histologically classified and immunohistochemical analysis was conducted to assess the expression of estrogen receptor (ER)-α, ER-β, and progesterone receptor (PR) for mammary hyperplastic lesions as well as that of cluster of differentiation (CD) 3, CD79a, interleukin (IL)-1α, IL-1β, IL-6, and IL-8 for mastitis. Furthermore, 20 swab samples were cultured, and the isolated bacteria were identified using polymerase chain reactions for 16S ribosomal RNA genes. The lesions were classified as hyperplasia, mastitis, or hyperplasia with mastitis. Immunohistochemistry results revealed that there was neither expression of ER-α nor of ER-β, but all examined hyperplastic samples expressed PR. In addition, there was a significant correlation between CD3 and IL-1β expressions, as well as between IL-1β and IL-6 expressions. Regarding the identity of the isolated bacteria, Pseudomonas spp. were most frequently detected. The results of this study have revealed the incidence and characteristics of porcine mammary lesions.
Abattoirs ; Agriculture ; Bacteria ; Bacterial Infections ; Classification ; Colostrum ; Cytokines ; Estrogens ; Female ; Hyperplasia ; Immunohistochemistry ; Incidence ; Interleukin-6 ; Interleukin-8 ; Interleukins ; Mammary Glands, Human ; Mastitis ; Meat ; Polymerase Chain Reaction ; Pseudomonas ; Receptors, Progesterone ; RNA, Ribosomal, 16S ; Swine

Buffalo mastitis is an important economic problem in southern Italy, causing qualitative/quantitative alterations in milk and resulting in economic losses due to the sub-clinical course and chronic evolution. We investigated 50 udders of slaughtered buffaloes and subjected them to effectual microbiological screening to evaluate macro and microscopic mammary gland changes, immune-characterize the cell infiltrates, and compare the degree of tissue inflammation with somatic cell counts. Numerous Gram-positive and Gram-negative bacteria were isolated from all samples, majority of which were environmental mastitis pathogens. Histological features referable to chronic mastitis were observed in 92% udders. Lymphocytes, plasma cells and macrophages were found to evolve into aggregates in 48% udders, which often organized to form tertiary lymphoid structures (TLSs). A predominance of interstitial CD8+ over CD4+ lymphocytes and, in TLSs, scattered CD8+ lymphocytes in the mantle cells and CD79+ lymphocytes in germinal centers, were evidenced. Environmental pathogens are known to persist and cause chronic inflammatory changes in buffaloes, where CD8+ lymphocytes play an important role by controlling the local immune response. Moreover, the TLSs evidenced here for the first time in buffalo mastitis, could play a role in maintaining immune responses against persistent antigens, thereby contributing in determining the chronic course of mastitis.
Animals ; Buffaloes ; Cell Count ; Female ; Germinal Center ; Gram-Negative Bacteria ; Inflammation ; Italy ; Lymphocytes ; Macrophages ; Mammary Glands, Animal ; Mammary Glands, Human ; Mass Screening ; Mastitis ; Milk ; Plasma Cells

As an important zoonotic pathogen, Staphylococcus aureus has led to serious mastitis and endometritis in infected dairy cows. In this study, a total of 164 strains of S. aureus were isolated from dairy cows in Xinjiang Province, China, and subjected to assays to determine drug susceptibility and biofilm (BF) formation ability. Enterotoxin-related genes were detected, and the transcription levels of genes related to BF formation were determined by using reverse transcription-quantitative polymerase chain reaction. Moreover, the pathogenicity of isolates with different BF formation abilities was determined by measuring their hemolysis activity, half lethal dose (LD₅₀) and organ bacterial load. The results showed that 86.0% of S. aureus isolates could form BF. Among them, 42.1% of the strains had weak BF formation ability, and most strains with a strong BF formation ability were ica gene carriers. The S. aureus isolates displayed multidrug resistance and their drug resistance was positively correlated with their BF formation ability. Moreover, 96.3% of the S. aureus isolates carried enterotoxin genes. Among them, the detection rates of the novel enterotoxin genes were higher than those of conventional enterotoxin genes. Furthermore, isolates with a strong BF formation ability had higher LD50 but lower hemolysis ability and organ bacterial load than those of the isolates with weak or no BF ability. However, isolates without BF ability produced more severe pathological changes than those of isolates with strong BF formation ability. These findings suggest that higher BF ability and presence of novel enterotoxin genes are important characteristics of S. aureus isolates from dairy cows in Xinjiang Province, China, and such isolates may pose potential threats to food safety.
Bacterial Load ; Biofilms ; China ; Drug Resistance ; Drug Resistance, Microbial ; Drug Resistance, Multiple ; Endometritis ; Enterotoxins ; Female ; Food Safety ; Hemolysis ; Lethal Dose 50 ; Mastitis ; Polymerase Chain Reaction ; Staphylococcus aureus ; Staphylococcus ; Virulence

Trypanosomiasis is caused by a pathogenic protozoan of the genus Trypanosoma, being Trypanosoma vivax the most important agent for cattle. The aim of the present study was to demonstrate the expansion of T. vivax infection in different mesoregions of Minas Gerais, Brazil, and describe the clinicopathological findings of trypanosomiasis in cattle. The diagnosis was based on visualization of the parasite in blood smears and DNA detection of T. vivax in the blood of live cows and tissues of necropsied animals by the polymerase chain reaction (PCR). Thirty suspected herds were tested, of which 11 were positive for T. vivax. The most frequent clinical signs were anemia, apathy, drop in milk production, weight loss, reproductive disorders, and nervous signs. Concomitant diseases, such as malignant edema, pneumonia and increased cases of mastitis were associated with T. vivax infection. Three cows were necropsied and the most significant findings were low body condition score, pale mucous and spleen with white pulp hyperplasia. The results demonstrated the expansion of T. vivax infection in Minas Gerais, that PCR-associated blood smears are promising for diagnosis, and that other diseases often occur concomitantly to T. vivax infection in regions with trypanosomiasis in cattle.
Anemia ; Animals ; Apathy ; Brazil ; Cattle ; Diagnosis ; DNA ; Edema ; Female ; Hyperplasia ; Mastitis ; Milk ; Parasites ; Parasitic Diseases ; Pneumonia ; Polymerase Chain Reaction ; Ruminants ; Spleen ; Trypanosoma vivax ; Trypanosoma ; Trypanosomiasis ; Weight Loss

Central venous stenosis is a rare cause of unilateral breast edema occurring in hemodialysis patients that needs to be differentiated from other differential diagnoses, including, but not limited to, inflammatory breast carcinoma, mastitis, lymphedema, and congestive heart failure. All reports of similar cases in the available literature have described improvement or resolution of the edema after treatment. Herein, we report and discuss the pathophysiology of breast edema formation in a patient who presented with massive left-sided breast edema 7 years after being diagnosed with central venous stenosis. Medical and minimally invasive therapy had not been successful, so she underwent reduction mammoplasty to relieve the symptoms.
Axillary Vein ; Breast ; Constriction, Pathologic* ; Diagnosis, Differential ; Edema ; Female ; Heart Failure ; Humans ; Inflammatory Breast Neoplasms ; Lymphedema ; Mammaplasty* ; Mastitis ; Renal Dialysis ; Upper Extremity Deep Vein Thrombosis

Atopic dermatitis (AD) is a chronic inflammatory skin disease in children. Patients with AD experience a high rate of colonization of the skin surface by Staphylococcus aureus. Because of a skin barrier defect, there is a potential risk of staphylococcal invasive infection in patients with AD. Here, we present 2 cases of breast abscess caused by S. aureus in 2 adolescent girls with severe AD. Methicillin-sensitive S. aureus was identified from the breast abscess material. They were treated with appropriate antibiotics, however surgical drainage of the abscess was needed in case 1. Identical strains were found from the breast abscess material as well as the lesional and the nonlesional skin of the patients through matrixassisted laser desorption/ionization time-of-flight analysis. We characterized the differential abundance of Firmicutes phylum in patients' skin in microbiota analysis. In particular, S. aureus, a member of Firmicutes, differed significantly between the lesional and the normal-appearing skin. Our cases demonstrate the potential severity of bacterial deep tissue infection in AD and the dysbiosis of skin microbiota may be involved in inflammation in AD.
Abscess* ; Adolescent* ; Anti-Bacterial Agents ; Breast* ; Child ; Colon ; Dermatitis, Atopic* ; Drainage ; Dysbiosis ; Female* ; Firmicutes ; Humans ; Inflammation ; Mastitis ; Microbiota ; Skin ; Skin Diseases ; Staphylococcus aureus* ; Staphylococcus*