Management of idiopathic granulomatous mastitis with observation

Bouton, Marcia E.; Jayaram, Lakshmi; O’Neill, Patrick J.; Hsu, Chiu Hsieh; Komenaka, Ian K.

doi:10.1016/j.amjsurg.2014.08.044

Cited by 75 publications

(65 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, awareness of this histopathological entity is lacking, and it is imperative that clinical microbiologists work to educate their colleagues and residents about novel disease associations, such as C. kroppenstedtii mastitis, with characteristic histopathological findings (27). Consistent with data from several recent reports, 7 of 9 patients in our study were of Hispanic descent (11,12,(28)(29)(30)(31)(32)(33). This association may be due to multiparity, breastfeeding, low socioeconomic status, or birth outside the United States with geographic variation in skin flora (1).…”

Section: Discussionsupporting

confidence: 81%

Clinical Significance of Commensal Gram-Positive Rods Routinely Isolated from Patient Samples

2016

View full text Add to dashboard Cite

Commensal bacteria from the skin and mucosal surfaces are routinely isolated from patient samples and considered contaminants. The majority of these isolates are catalase-positive Gram-positive rods from multiple genera routinely classified as diphtheroids. These organisms can be seen upon Gram staining of clinical specimens or can be isolated as the predominant or pure species in culture, raising a priori suspicion of a possible involvement in infection. With the development and adoption of matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), suspicious isolates are now routinely identified to the species level. In this study, we performed a retrospective data review (2012 to 2015) and utilized site-specific laboratory criteria and chart reviews to identify species within the diphtheroid classification representative of true infection versus contamination. Our data set included 762 isolates from 13 genera constituting 41 bacterial species. Only 18% represented true infection, and 82% were deemed contaminants. Clinically significant isolates were identified in anaerobic wounds (18%), aerobic wounds (30%), blood (5.5%), urine (22%), cerebrospinal fluid (24%), ophthalmologic cultures (8%), and sterile sites (20%). Organisms deemed clinically significant included multiple Actinomyces species in wounds, Propionibacterium species in joints and cerebrospinal fluid associated with central nervous system hardware, Corynebacterium kroppenstedtii (100%) in breast, and Corynebacterium striatum in multiple sites. Novel findings include clinically significant urinary tract infections by Actinomyces neuii (21%) and Corynebacterium aurimucosum (21%). Taken together, these findings indicate that species-level identification of diphtheroids isolated with a priori suspicion of infection is essential to accurately determine whether an isolate belongs to a species associated with specific types of infection. C linical microbiology specimens frequently grow variable levels of commensal bacteria from the skin and mucosal surfaces in addition to true pathogens (1). The majority of these isolates are aerobic, asporogenic, irregularly shaped, non-partially-acid-fast, catalase-positive, Gram-positive rods from multiple genera with nondistinct colony morphology, routinely classified as diphtheroids (2). The term diphtheroid and coryneform are interchangeable, and for a comprehensive review of bacterial genera classified as coryneform bacteria, see two excellent reviews by Bernard et al. (2,3). In brief, the medically relevant genera whose morphological and biochemical descriptions fit in the diphtheroid classification include Arcanobacterium, Arthrobacter, Brevibacterium, Cellulomonas, Cellulosimicrobium, Corynebacterium (non-diphtheriae), Curtobacterium, Dermabacter, Exiguobacterium, Helcobacillus, Janibacter, Knoellia, Leifsonia, Microbacterium, Pseudoclavibacter, and Trueperella (2-4).Additionally, certain species within other genera share some but not all features of diphtheroids, are part of t...

show abstract

Section: Discussionsupporting

confidence: 81%

Clinical Significance of Commensal Gram-Positive Rods Routinely Isolated from Patient Samples

2016

View full text Add to dashboard Cite

show abstract

“…Bouton et al [3] considered GLM as a self-limiting benign condition, and they found the average time to resolution to be 7.4 months, albeit with a recurrence rate of 11%.…”

Section: Discussionmentioning

confidence: 99%

“…It usually affects women of child-bearing age, with the average age being 35 years [2]. Patients with GLM have a great diversity of symptoms but most commonly present with a breast mass with or without pain and sometimes skin ulcerations and sinus or fistula formation [3]. The etiology of GLM is still unknown.…”

Section: Introductionmentioning

confidence: 99%

Granulomatous Lobular Mastitis: Antituberculous Treatment and Outcome in 22 Patients

et al. 2018

View full text Add to dashboard Cite

Background: Granulomatous lobular mastitis (GLM) is a rare chronic inflammatory condition of the breast. The purpose of this study was to describe antituberculous treatment of GLM and the long-term follow-up outcome. Methods: This retrospective study included 22 patients who had been histopathologically diagnosed with GLM at the Second Hospital of Shandong University from January 2011 to March 2015. Clinical characteristics, ultrasonography and mammography findings, laboratory tests, treatment regimens, follow-up information, and recurrences were recorded. Results: All patients were female with a median age of 29 (range 23-44) years. The most common symptom was a breast mass with or without pain. Large irregular hypoechoic masses could be found in the breast ultrasounds of 13 patients. All patients received triple antituberculous therapy. During a median follow-up period of 40 months, 3 patients were lost to follow-up; of the remaining 19 patients, 18 achieved clinical complete remission and no recurrences were observed. Conclusion: GLM is an unusual benign breast condition that mimics breast carcinoma in its clinical and imaging presentation. Antituberculous therapy seems to be an effective alternative option in the treatment of GLM.

show abstract

“…They mention that surgical treatments should be restricted to biopsies, by draining the abscess and excising fistulae 14 . They believe that surgical intervention can cause physiological distress, scars, disease exacerbation, fistula formation, and other surgical complications 9,14 . A retrospective study in Phoenix demonstrates that clinical observation can be an effective strategy for this nonmalignant disease, thus avoiding the costs and side effects of surgical and medical treatment 9 .…”

Section: Discussionmentioning

confidence: 99%

Idiopathic granulomatous mastitis: diagnosis and follow-up with magnetic resonance imaging

Andrade¹,

Heinzen²,

Pincerato³

et al. 2017

Rev. Bras. Mastol. (Impr.)

View full text Add to dashboard Cite

A mastite granulomatosa é uma condição rara e benigna da mama que, em alguns casos, possui etiologia desconhecida de doença inflamatória benigna, a mastite idiopática. Seu diagnóstico normalmente é feito por exclusão. Os exames de imagens têm demonstrado achados inespecíficos que podem sugerir uma doença inflamatória, um carcinoma ou não apresentar alterações. Deve ser realizado um diagnóstico diferencial com outras causas de mastites, sempre alertando para o risco de carcinoma inflamatório. Os exames de imagem servem mais para descartar uma malignidade do que para confirmar a mastite granulomatosa idiopática. Em função de tanto os exames de imagem como o exame físico poderem simular uma lesão maligna da mama, o laudo histopatológico é fundamental para estabelecer o diagnóstico. A sua etiologia permanece desconhecida, portanto, o tratamento é controverso na literatura, com alguns autores recomendando cirurgia, outros a imunossupressão e, por fim, alguns antibióticos. É apresentado o caso de uma paciente de 21 anos com uma lesão suspeita na mama associada à descarga papilar. Durante a investigação, houve um realce de 12 x 6 x 8,5 cm na ressonância magnética associado a sinais inflamatórios na pele e nos linfonodos. O exame anatomopatológico evidenciou um quadro de mastite granulomatosa idiopática. O realce desapareceu completamente após o tratamento conservador com corticoterapia. A mamografia e o ultrassom também podem demonstrar alterações inespecíficas, tais como assimetria focal, massa indefinida ou distorção. Apesar das limitações dos exames de imagem, demonstrou-se, neste relato, que a ressonância magnética pode ser utilizada para monitorar a resposta clínica ao tratamento conservador e o acompanhamento pelo risco de recorrência. PALAVRAS-CHAVE:Diagnóstico por imagem; mastite; mastite granulomatosa. RESUMO ABSTRACTGranulomatous mastitis is a rare and benign condition of the breast that, in some cases, has an unknown etiology of benign inflammatory disease know as idiopathic mastitis. Your diagnosis is usually made by exclusion. Imaging tests have shown nonspecific findings that may suggest an inflammatory disease, a carcinoma, or no changes. A differential diagnosis should be made with other causes of mastitis, always alerting to the risk of inflammatory carcinoma. Imaging tests are more useful to rule out malignancy than to confirm idiopathic granulomatous mastitis. Because both imaging and physical examination can mimic a malignant lesion of the breast, the histopathological report is fundamental to establish the diagnosis. Its etiology remains unknown, so the treatment is controversial in the literature, with some authors recommending surgery, others immunosuppression, and, finally, some antibiotics. We report the case of a 21-year-old woman with a suspected lesion in the breast associated with papillary discharge. During the investigation, there was a 12 x 6 x 8.5 cm enhancement on magnetic resonance imaging associated with inflammatory signs on the skin and lymph nodes. Anatomopathological examination ...

show abstract

Management of idiopathic granulomatous mastitis with observation

Cited by 75 publications

References 23 publications

Clinical Significance of Commensal Gram-Positive Rods Routinely Isolated from Patient Samples

Clinical Significance of Commensal Gram-Positive Rods Routinely Isolated from Patient Samples

Granulomatous Lobular Mastitis: Antituberculous Treatment and Outcome in 22 Patients

Idiopathic granulomatous mastitis: diagnosis and follow-up with magnetic resonance imaging

Contact Info

Product

Resources

About