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Du NN, Feng JM, Shao SJ, Wan H, Wu XQ. Construction of a Multi-Indicator Model for Abscess Prediction in Granulomatous Lobular Mastitis Using Inflammatory Indicators. J Inflamm Res 2024; 17:553-564. [PMID: 38323114 PMCID: PMC10844011 DOI: 10.2147/jir.s443765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/20/2024] [Indexed: 02/08/2024] Open
Abstract
Background Granulomatous lobular mastitis (GLM) is a chronic inflammatory breast disease, and abscess formation is a common complication of GLM. The process of abscess formation is accompanied by changes in multiple inflammatory markers. The present study aimed to construct a diagnosis model for the early of GLM abscess formation based on multiple inflammatory parameters. Methods Based on the presence or absence of abscess formation on breast magnetic resonance imaging (MRI), 126 patients with GLM were categorised into an abscess group (85 patients) and a non-abscess group (41 patients). Demographic characteristics and the related laboratory results for the 9 inflammatory markers were collected. Logistics univariate analysis and collinearity test were used for selecting independent variables. A regression model to predict abscess formation was constructed using Logistics multivariate analysis. Results The univariate and multivariate analysis showed that the N, ESR, IL-4, IL-10 and INF-α were independent diagnostic factors of abscess formation in GLM (P<0. 05). The nomogram was drawn on the basis of the logistics regression model. The area under the curve (AUC) of the model was 0.890, which was significantly better than that of a single indicator and the sensitivity and specificity of the model were high (81.2% and 85.40%, respectively). These results predicted by the model were highly consistent with the actual diagnostic results. The results of this calibration curve indicated that the model had a good value and stability in predicting abscess formation in GLM. The decision curve analysis (DCA) demonstrated a satisfactory positive net benefit of the model. Conclusion A predictive model for abscess formation in GLM based on inflammatory markers was constructed in our study, which may provide a new strategy for early diagnosis and treatment of the abscess stage of GLM.
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Affiliation(s)
- Nan-Nan Du
- Breast Department, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200021, People’s Republic of China
| | - Jia-Mei Feng
- Breast Department, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200021, People’s Republic of China
| | - Shi-Jun Shao
- Breast Department, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200021, People’s Republic of China
| | - Hua Wan
- Breast Department, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200021, People’s Republic of China
| | - Xue-Qing Wu
- Breast Department, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200021, People’s Republic of China
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Rakotoarisaona MF, Razafimaharo TI, Razanakoto NH, Sendrasoa FA, Ducournau A, Devalland C, Dupond AS, Ranaivo IM, Ramarozatovo LS, Rapelanoro Rabenja F. Idiopathic Granulomatous Mastitis as an Unusual Cause of Erythema Nodosum in a Malagasy Woman. Int Med Case Rep J 2023; 16:159-165. [PMID: 36936184 PMCID: PMC10016364 DOI: 10.2147/imcrj.s403050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/28/2023] [Indexed: 03/16/2023] Open
Abstract
Introduction Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory disease. Neoplastic and infectious etiologies must be ruled out. IGM is a diagnostic challenge for countries with high tuberculosis endemicity like Madagascar since it may clinically and radiologically mimic breast tuberculosis. We report a case of IGM associated with erythema nodosum in a Malagasy. Case Report A 29-year-old primiparous woman came to a dermatological consultation for typical erythema nodosum lesions that appeared one month after a breast swelling. She had no particular medical history. Examination revealed typical erythema nodosum lesions on the legs, voluminous tender mass in the right breast. Bacteriological samples and tuberculosis test were negative. Imaging showed mastitis on the right breast with no evidence of malignancy. Histology revealed a non-caseating granulomas on the lobule of the right breast. As part of an etiological work-up, COVID-19 serology was performed with a positive IgG antibody. The diagnosis of IGM associated with erythema nodosum was evocated. The evolution was favorable under systemic corticosteroid therapy. Discussion The cause of this uncommon lesion remains obscure. The extramammary localizations such as erythema nodosum and arthralgia suggest an autoimmune origin. This pathogenesis is also reinforced by a good response to systemic immunosuppression. In our patient, the etiological assessment of the mastitis revealed a chronic infection with SARS-CoV-2. Histopathology is the gold standard for the IGM diagnosis which demonstrates a lobulocentric granulomas without caseous necrosis. Oral corticosteroid therapy is the initial choice of treatment. Conclusion Now, with several cases of concomitant IGM and EN reported, dermatologists should be aware that erythema nodosum can be one of the presenting signs of IGM, since the two conditions appear to be associated. The particularity of our case lies in the incidental discovery of SARS-CoV-2 infection. Is a chronic granulomatous disease associated with SARS-CoV-2 infection, a coincidence?
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Affiliation(s)
- Mendrika Fifaliana Rakotoarisaona
- Department of Dermatology, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
- Correspondence: Mendrika Fifaliana Rakotoarisaona, Department of Dermatology, University Hospital Joseph Raseta Befelatanana, Rue Dr Davioud Jacques, Antananarivo, 101, Madagascar, Tel/Fax +261 34 61947 34, Email
| | | | | | | | - Anne Ducournau
- Department of Dermatology, Nord Franche-Comté Hospital, Trevenans, France
| | | | - Anne-Sophie Dupond
- Department of Dermatology, Nord Franche-Comté Hospital, Trevenans, France
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Nguyen MH, Molland JG, Kennedy S, Gray TJ, Limaye S. Idiopathic granulomatous mastitis: case series and clinical review. Intern Med J 2021; 51:1791-1797. [PMID: 34713960 DOI: 10.1111/imj.15112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 06/15/2020] [Accepted: 07/12/2020] [Indexed: 01/16/2023]
Abstract
Idiopathic granulomatous mastitis is a chronic inflammatory breast disorder that typically affects young, parous women, often following lactation. Patients present with tender, erythematous breast lesions with histological evidence of non-caseating granulomata and an inflammatory cell infiltrate. An immune-mediated pathophysiology is hypothesised and an association with lipophilic Corynebacterium species is observed. Initial diagnosis is often delayed due to lack of awareness of the condition and management of refractory disease can be challenging. We present an extensive case series of patients collaboratively managed by subspecialty physicians and surgeons at a single centre in Sydney, Australia. The accompanying review expands on features of this condition and supports the utility of a multidisciplinary approach.
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Affiliation(s)
- Matthew H Nguyen
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Janice G Molland
- Department of Breast and Endocrine Surgery, Concord Hospital, Sydney, New South Wales, Australia
| | - Suellyn Kennedy
- Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia
| | - Timothy J Gray
- Department of Microbiology and Infectious Diseases, Concord Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, Concord Hospital Clinical School, Sydney, New South Wales, Australia
| | - Sandhya Limaye
- Faculty of Medicine, Concord Hospital Clinical School, Sydney, New South Wales, Australia.,Department of Immunology, Concord Hospital, Sydney, New South Wales, Australia
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Velidedeoğlu M, Papila Kundaktepe B, Mete B, Uğurlu S. Idiopathic granulomatous mastitis associated with erythema nodosum may indicate a worse prognosis. Int J Rheum Dis 2021; 24:1370-1377. [PMID: 34514701 DOI: 10.1111/1756-185x.14218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory breast disease of unknown etiology, and erythema nodosum (EN) is a rare extramammary manifestation of this entity characterized by reddish, tender nodules of the lower legs. We aimed to investigate whether the association of IGM with EN has a role as a prognostic indicator. There are few case reports, and only 1 original article including 12 IGM patients with EN has been reported. METHODS We present 43 women with IGM coexisting with EN and 43 with a diagnosis of IGM only, who were randomly selected from 610 patients for a control group. To the best of our knowledge, this paper comprises the first comparative study of the coexistence of IGM and EN to be reported in the literature. RESULTS Our findings show that the association of IGM with EN indicates a more aggressive disease course. White blood cells, erythrocyte sedimentation rate, and C-reactive protein were significantly higher in the EN-positive group (P < .05). Arthralgia, breast feeding, fistula distribution and recurrence distributions were significantly higher in the EN-positive group (P < .05). CONCLUSION Since fistula distribution and recurrence rates were higher in EN-positive group, association of IGM with EN may be an indictor of a worse prognosis. The present study highlights the importance of dermatological care. All physicians should not neglect questioning breast complaints in patients with EN since EN may be caused by IGM.
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Affiliation(s)
- Mehmet Velidedeoğlu
- Department of General Surgery, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpasa, Fatih, Turkey
| | - Berrin Papila Kundaktepe
- Department of General Surgery, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpasa, Fatih, Turkey
| | - Bilgul Mete
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpasa, Fatih, Turkey
| | - Serdal Uğurlu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpasa, Fatih, Turkey
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Luo W, Xu B, Wang L, Xiang L, Lai M, Zhang X, Liu X. Clinical characteristics and predictive factors of erythema nodosum in granulomatous lobular mastitis. Australas J Dermatol 2021; 62:342-346. [PMID: 34106462 DOI: 10.1111/ajd.13640] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 05/06/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND/OBJECTIVES In recent years, there is a growing incidence of granulomatous lobular mastitis (GLM), but studies about the coexistence of erythema nodosum (EN) and GLM are rare. In this study, we assess the clinical characteristics and predictive factors of EN in GLM. METHODS A total of 303 patients diagnosed with GLM were enrolled from January 2012 to October 2018 at the second affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, including 78 patients with EN. Follow-up data included: lesion site, lesion size, therapy approaches, course of GLM, course of EN, the recurrence of disease, possible causes. All patients had pathologic confirmation of GLM based on core needle biopsy (CNB) or surgical excision. RESULT Fever in the EN group was significantly more common compared to the non-EN group (44.87% vs 12.89%, P < 0.001). The proportion of lesion range >2 quadrants in the EN group was significantly higher than that in the non-EN group (42.31% vs 16.00%, P < 0.001). The course of the disease was longer in the EN group compared to the non-EN group (10.32 moths vs 8.74 moths, P < 0.001). Patients with EN had a trend towards a higher risk of recurrence (5.13% vs 1.33%, P = 0.055). CONCLUSION EN is more likely to be found in GLM patients with breast lesion range >2 quadrants. The presence of EN in GLM indicates that the condition becomes more severe and the course of GLM also becomes longer.
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Affiliation(s)
- Wei Luo
- Department of Mammary Disease, The Second affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Biao Xu
- Department of Mammary Disease, The Second affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Lei Wang
- Department of Mammary Disease, The Second affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Lifang Xiang
- Department of Mammary Disease, The Second affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Milin Lai
- Department of Mammary Disease, The Second affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xu Zhang
- Department of Mammary Disease, The Second affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xiaoyan Liu
- Department of Mammary Disease, The Second affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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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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Affiliation(s)
- Dua Hashmi
- Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Ahmad Al Samaraee
- Department of General Surgery, Gateshead Health NHS Foundation Trust, Gateshead, UK
| | - Bertram Marks
- Department of General Surgery, Gateshead Health NHS Foundation Trust, Gateshead, UK
| | - Tarannum Fasih
- Department of General Surgery, Gateshead Health NHS Foundation Trust, Gateshead, UK
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Koksal H, Vatansev H, Artac H, Kadoglou N. The clinical value of interleukins-8, -10, and -17 in idiopathic granulomatous mastitis. Clin Rheumatol 2020; 39:1671-1677. [PMID: 31916110 DOI: 10.1007/s10067-020-04925-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 12/20/2019] [Accepted: 01/01/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Idiopathic granulomatous mastitis (IGM) is a rare, chronic inflammatory benign breast disease. Although the etiology of this disease is unknown, it has been suggested that hormonal disorders, autoimmunity, smoking, and α1-antitrypsin deficiency may play a role in the etiopathogenesis. The aim is to investigate the changes in cytokine profiles including interleukin (IL)-4, -8, -10, -17, and tumor necrosis factor (TNF)-alpha in patients with IGM. METHODS Forty-seven patients with pathologically diagnosed IGM and 30 healthy women were included. The cytokines including IL-4, -8, 10, -17, and TNF-alpha were measured by human enzyme-linked immunosorbent assay. RESULTS The IL-8, IL-10, and IL-17 levels were higher in IGM patients than control group (p = .002; p = .008; and p = .018, respectively). The IL-8 levels of patients with active lesions and in remission were statistically higher than the control group (p = .027 and p = .015, respectively). IL-10 levels of patients in remission were higher than the control group (p = .024). There was no difference in IL-4 and TNF-ɑ levels between all groups. CONCLUSION These results showed that proinflammatory cytokines including IL-8 and IL-17 have role in pathogenesis of IGM. However, the increased levels of IL-10 in especially patients in remission suggest that it reduces the release of proinflamatory cytokines as well as suppressing their function and activation for controlling IGM. Although IGM is thought to be a surgical disease, these cytokine changes indicate the presence of serious immune dysregulation. This suggests that in the treatment of IGM, treatment needs to evolve from surgery to medical treatment.Key points• The IL-8, IL-10, and IL-17 levels were higher in IGM patients than in control group.• The IL-8 levels of both patients with active lesions and in remission were high.• There was no difference in IL-4 and TNF-ɑ levels between all groups.
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Affiliation(s)
- Hande Koksal
- Department of General Surgery, Hamidiye Faculty of Medicine, Konya Education and Research Hospital, Saglik Bilimleri University, Konya, Turkey.
| | - Husamettin Vatansev
- Department of Biochemistry, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Hasibe Artac
- Department of Pediatric Immunology and Allergy, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Naim Kadoglou
- Department of General Surgery, London North West Healthcare NHS Trust, Northwick Park Hospital, Middlesex, London, UK
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Koksal H. Human leukocyte antigens class I and II in patients with idiopathic granulomatous mastitis. Am J Surg 2019; 218:605-608. [DOI: 10.1016/j.amjsurg.2019.01.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/04/2019] [Accepted: 01/10/2019] [Indexed: 12/13/2022]
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Abstract
BACKGROUND Erythema nodosum can be associated with a number of systemic diseases. There is, however, a paucity of information in the pediatric literature on this condition. The purpose of this article is to familiarize pediatricians with the evaluation, diagnosis, and treatment of erythema nodosum. DATA SOURCES A PubMed search was completed in Clinical Queries using the key terms "erythema nodosum". RESULTS Clinically, erythema nodosum presents with a sudden onset of painful, erythematous, subcutaneous nodules mainly localized to the pretibial areas. Lesions are usually bilateral and symmetrical, ranging from 1 to 5 cm in diameter. Erythema nodosum may be associated with a variety of conditions such as infection, medications, sarcoidosis, pregnancy, inflammatory bowel disease, vaccination, autoimmune disease, malignancy, and miscellaneous causes. The condition is idiopathic in approximately 50% of cases. The diagnosis is mainly clinical with biopsy reserved for atypical cases. To evaluate for the underlying cause, some basic laboratory screening studies are worthwhile in most cases and include a complete blood cell count, erythrocyte sedimentation rate and/or C-reactive protein, throat swab culture, antistreptococcal O titers, and a chest radiograph. Other tests should be individualized, guided by the history and physical examination results. Most cases of erythema nodosum are self-limited and require no treatment. Bed rest and leg elevation are generally recommended to reduce the discomfort. Nonsteroidal anti-inflammatory drugs are the first-line treatment for pain management. CONCLUSIONS As erythema nodosum is often a cutaneous manifestation of a systemic disease, a thorough search should be performed to reveal the underlying cause.
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