Idiopathic granulomatous mastitis (IGM) is a breast non-systemic and chronic inflammatory disease that mimics abscesses, mastitis or breast cancer of low incidence, with much controversy on its diagnosis and successful treatment. The aim of this study is to retrospectively associate in an integral manner, the clinical characteristics, and the radiologic findings in order to develop an algorithm to make diagnosis and treatment of this entity easy. A retrospective analysis was performed with 16 patients for whom histologically IGM diagnoses were confirmed and were treated in our center between January 2011 and December 2016. Clinical characteristics, radiological, and histological reports, as well as treatment regime and outcome were included in the analysis.Idiopathic granulomatous mastitis is a breast-limited entity, with a chronic and generally benign course, with unknown etiology; but if not treated correctly there is a possibility of recurrence. Radiologic protocols are not sufficiently precise to establish a differential diagnosis, and while histopathological diagnosis is obligatory.Clinical treatment guides must be developed for which we strongly recommend the following diagnosis and treatment algorithm for patients with granulomatous mastitis.
Sentinel lymph node biopsy has been one of the most important advances in oncologic surgery, especially in breast cancer, since it decreases the high morbidity associated with radical axillary dissection, and allows treatment personalization. The staging of axillary nodes in breast cancer is fundamental as it is a prognostic indicator and determines the need for adjuvant therapy. Sentinel lymph node is detected by injecting a radioisotope and dye through the periareolar area that consequently travels through mammary glands to axillary lymph nodes. We conducted a retrospective study that included 57 women with a histopathological diagnosis of breast cancer, and underwent sentinel node biopsy. Transoperative pathology analysis reported metastases in 24% of the patients, requiring radical axillary dissection. Sensitivity was 97%, and specificity was 85%, reflecting high efficacy of the sentinel lymph node biopsy, and thus benefitting patients by decreasing morbidity. Sentinel node biopsy is the standard procedure for correct staging of patients with early breast cancer, and no clinical evidence of lymph node involvement. Further, it decreases morbidity in these patients by preventing radical axillary dissection, a previously standard approach, without compromising the diagnosis and hence, the prognosis of the patients. We demonstrated that with the correct technique for sentinel lymph node biopsy, the prognosis for patients is much better than for those patients that undergo radical axillary dissection.
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare neoplasm responsible for 0.04% to 0.5% of all cases of breast disease. It occurs in patients with a previous history of breast implants that generally progress without complications during the first years of post-operatory and is mainly associated with macro-textured implants. Due to its low incidence, it does not represent the first probable diagnosis in patients with a breast tumor. This article reports the case of a patient with BIA-ALCL initially treated as a Hodgkin's lymphoma. We emphasize the importance of a correct and complete diagnosis by immunohistochemistry before imaging in patients that develop a breast tumor associated with the prosthetic capsule after breast implant surgery and its adequate treatment, including surgery.
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